Anna-Karin Dykes

Domestic violence is a global health problem as well as a violation against human rights. The aim of this study was to explore prevalence and incidence of domestic violence during pregnancy and 1 to 1.5 years postpartum as well as to explore the history of violence among new mothers in the southwestern region of Sweden. In addition, the aim was to explore the association between domestic violence postpartum and possible risk factors. This is a longitudinal cohort-study including pregnant women ≥ 18 years of age. Total 1939 pregnant women were recruited to the study and requested to answer three questionnaires (QI-III) during pregnancy and postpartum. Statistical analysis were descriptive statistics, logistic regression and multiple regression with Odds ratios (OR) and 95 % confidence intervals (95 % CI). The response rate for those who received the Q-III (n = 755) at a Child Welfare Center was almost 97 % (n = 731). When all three questionnaires were answered the prevalence of domestic violence during pregnancy irrespective of type or severity was reported by 2.5 % (n = 40/1573). At 1 to 1.5 years postpartum the prevalence of domestic violence had increased to 3.3 % (n = 23/697). The incidence was 14 per 1000 women during pregnancy and 17.2 per 1000 women postpartum. The strongest risk factor for domestic violence reported at1-1.5 years postpartum was a history of violence whereby all of the women (n = 23) who had revealed their exposure to domestic violence postpartum also reported a history of violence (p < 0.001). Being single/living apart gave a 12.9 times higher risk for domestic violence postpartum (AOR 12.9; 95 % CI: 4.5–37.1). Having several symptoms of depression and a low score on the SOC-scale gave a 3.5 and 3.0 times higher risk respectively (AOR 3.5; 95 % CI: 1.2–10.4) and (AOR 3.0; 95 % CI 1.1–8.3). Domestic violence increases as the pregnancy develops and postpartum. A history of violence and being single/living apart may be strong indicators for domestic violence during pregnancy as well as postpartum. Also, having symptoms of depression are associated with domestic violence both during pregnancy and postpartum. Collaboration between health care providers at Antenatal and Welfare centres is essential.

Domestic violence during pregnancy is not only a severe public health issue that jeopardizes maternal and foetal health but also violates human rights. The aim was to explore the prevalence and incidence of domestic violence among pregnant women, in the southwestern region of Scania in Sweden, and their experience of a history of violence. In addition, to explore the association between domestic violence during pregnancy and possible risk factors. This is a longitudinal cohort-study including pregnant women ≥18 years of age, registered at antenatal care when pregnant. A cohort of 1939 pregnant women answered Questionnaire I (QI) in gestational week 13 (mean 12.8 week, SD 5.11). Response rate of Questionnaire II (QII) in gestation week 34 (mean 33.9 week, SD 2.2) was 78.8 % (n = 1527). Statistical analysis was descriptive statistics, logistic regression and multiple regression with Odds ratios (OR) and 95 % confidence intervals (95 % CI). Both QI and QII were completed by 77.8 % (n = 1509) of the women and 44.3 % (n = 668) reported a lifetime experience of abuse irrespective of type, severity or perpetrator. Also, 5.1 % (n = 77) reported some experience of abuse past year. Prevalence of domestic violence during pregnancy was 2.0 % (n = 29) and the incidence was 7.3 new cases per 1000 women. The strongest risk factor for domestic violence, during early and late pregnancy, was history of violence whereby all women who disclosed exposure had also reported history of violence (p < 0.001). To be single/living apart gave 8.4 times more risk associated with domestic violence during pregnancy (AOR 8.4; 95 % CI: 2.2–32.6). Having several symptoms of depression and lack of sleep gave 3.8 times more risk respectively (AOR 3.8; 95 % CI: 1.1–13.6) and (AOR 3.8; 95 % CI 1.1–12.9). Pregnant women with a history of violence as well as being single/living apart and/or having several symptoms of depression during pregnancy should be alerts for clinical working midwives and obstetricians. Further, this is important knowledge for health care providers to develop or upgrade guidelines and plans of action for pregnant women exposed to violence.

Most injuries to young children happen in the home. Therefore, this study aimed to investigate if extended individual information to mothers’ related to injury to children in the home and possible preventative actions has any effect on their awareness of the problem and if Sense of Coherence has an influence. This was a quasi-experimental designed intervention study with a comparison group. Extended individual information with empowerment as the approach was used. Ninety-nine mothers of children under the age of 7 months participate. A questionnaire with sociodemographic data and questions regarding awareness towards prevention was used. Mothers who took part in the intervention significantly increased their awareness of the fact that child injuries take place at home when compared with the mothers in the comparison group, [OR 2.3, CI 1.3–4.3]. However, no significant improvement of awareness towards prevention was noted, neither any association to the mothers’ SOC-scores. This study showed that the intervention had a positive effect on mothers’ awareness towards the fact that child injuries are taking place at home, but it did not increase the mothers’ awareness towards prevention of child injury.

Intimate partner violence (IPV) during pregnancy is a serious matter which threatens maternal and fetal health. The aim of this study was to develop a grounded theoretical model of women’s experience of IPV during pregnancy and how they handle their situation. Ten interviews with women who had experience of being exposed to IPV during pregnancy were analyzed using the grounded theory approach. The core category ‘Struggling to survive for the sake of the unborn baby’ emerged as the main concern of women who are exposed to IPV during pregnancy. The core category also demonstrates how the survivors handle their situation. Also, three sub-core categories emerged, ‘Trapped in the situation’ demonstrates how the pregnant women feel when trapped in the relationship and cannot find their way out. ‘Exposed to mastery’ demonstrates the destructive togetherness whereby the perpetrator’s behavior jeopardizes the safety of the woman and the unborn child. ‘Degradation process’ demonstrates the survivor’s experience of gradual degradation as a result of the relationship with the perpetrator. All are properties of the core category and part of the theoretical model. The theoretical model “Struggling to survive for the sake of the unborn baby” highlights survival as the pregnant women’s main concern and explains their strategies for dealing with experiences of violence during pregnancy. The findings may provide a deeper understanding of this complex matter for midwives and other health care providers. Further, the theoretical model can provide a basis for the development and implementation of prevention and intervention programs that meet the individual woman’s needs.

Domestic violence during pregnancy is a serious public health issue which threatens maternal and foetal health outcomes. The aim of the study was to explore prevalence of domestic violence among pregnant women in southern Sweden (Scania) and to explore associations with background factors, as symptoms of depression and sense of coherence.

Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care.

Background: Registered Sick Children’s Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care.Method: A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden.Results: Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent’s lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight.Conclusion: CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse’s conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse’s, as well as the parent’s efforts to influence the children’s weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight.

Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term.

National guidelines recommend that healthy pregnant women take 30 minutes or more of moderate exercise a day. Most women reduce the level of physical activity during pregnancy but only a few studies of women's experiences of physical activity during pregnancy exist. The aim of the present study was to elucidate experiences and views of leisure time physical activity during pregnancy in nulliparous women who were physically active prior to their pregnancy.

An ultrasound examination is an important confirmation of the pregnancy and is accepted without reflection to any prenatal diagnostic aspects. An abnormal finding often comes unexpectedly and is a shock for the parents. The aim was to generate a theoretical understanding of parents' experiences of the situation when their fetus is found to have an abnormality at a routine ultrasound examination.