Women’s expectations and experience of care during pregnancy and childbirth

This thesis focuses on a national sample of Swedish-speaking women’s expectations and experience of antenatal care and women’s opinions of Caesarean section, homebirth and birth centre care. Paper (I): The aim was to describe women’s expectations on antenatal care. The majority of the 3,061 women, who completed the first questionnaire, wanted to follow the standard visiting schedule, while 23 per cent preferred more visits and seven per cent preferred fewer visits. The continuity of caregiver was highly valued. “Checking the baby’s health” was the most important aspect of the content of antenatal care, followed by “checking the mother’s health” and “making the partner feel involved”. The lowest ranking was given to the importance of information about breast-feeding and infant care and the ability to participate in parent education classes. Paper (II): The aim was to follow up the number of antenatal visits and women’s opinions of the number of visits and satisfaction with antenatal care. In all, 2,421 women with full-term pregnancies completed two questionnaires, in early pregnancy and two months after birth. Only 25 per cent of the women followed the standard visiting schedule recommended for an uncomplicated pregnancy, while 57 per cent had more visits and 17 per cent fewer visits. The majority of the women were satisfied with antenatal care in overall terms. No association was found between the number of visits made and satisfaction, but the women’s own opinion that the number of visits was too low was associated with dissatisfaction with the medical and emotional aspects of care, while their feeling that the number of visits was too high was associated with dissatisfaction with the emotional aspects of care. Paper (III) The aim of this study was to investigate how many women, when asked in early pregnancy, wish to have a Caesarean section at the time of birth, and to identify background variables associated with such a wish. The result showed that 8.2 per cent of the 3,061 women wanted to be delivered by Caesarean section. A previous Caesarean section, fear of giving birth and a previous negative birth experience were the strongest factors in predicting a wish for an operative birth. Paper (IV): The aim of this study was to establish women’s interest in homebirth and birth centre care and to describe the characteristics of these women. One per cent of the 2,563 women consistently expressed an interest in home birth, while the figure for birth center care was eight per cent , when these women were asked in early pregnancy, two months and one year after birth. Five factors were associated with an interest in home birth; having the baby’s sibling and a female friend present at birth, not wanting pharmacological pain relief, a low level of education and dissatisfaction with the medical aspects of birth. An interest in birth centre care was associated with the experience of being in control during labour and birth, not wanting pharmacological pain relief and a wish to have a known midwife present at birth.

List of scientific papers

I. Hildingsson I, Waldenstrom U, Radestad I (2002). Womens expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content. Acta Obstet Gynecol Scand. 81(2):118-25.
https://pubmed.ncbi.nlm.nih.gov/11942901

II. Hildingsson I, Radestad I, Waldenstrom U (2003). Numbers of antenatal visits and womens opinions. A national survey. [Submitted]

III. Hildingsson I, Radestad I, Rubertsson C, Waldenstrom U (2002). Few women wish to be delivered by caesarean section. BJOG. 109(6):618-23.
https://pubmed.ncbi.nlm.nih.gov/12118637

IV. Hildingsson I, Waldenstrom U, Radestad I (2003). Swedish womens interest in home birth and in-hospital birth center care. Birth. 30(1):11-22.
https://pubmed.ncbi.nlm.nih.gov/12581035