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Background: The modern phenomenon of delayed parenthood applies not only to women but also to men, but less is known about what characterises men who are expecting their first child at an advanced age. This study investigates the sociodemographic characteristics, health behaviour, health problems, social relationships and timing of pregnancy in older first-time fathers. Methods: A cross-sectional study was conducted of 14 832 men who were expecting their first child, based on data from the Norwegian Mother and Child Cohort Study (MoBa) carried out by the Norwegian Institute of Public Health. Data were collected in 2005-2008 by means of a questionnaire in gestational week 17-18 of their partner's pregnancy, and from the Norwegian Medical Birth Register. The distribution of background variables was investigated across the age span of 25 years and above. Men of advanced age (35-39 years) and very advanced age (40 years or more) were compared with men aged 25-34 years by means of bivariate and multivariate logistic regression analyses. Results: The following factors were found to be associated with having the first child at an advanced or very advanced age: being unmarried or non-cohabitant, negative health behaviour (overweight, obesity, smoking, frequent alcohol intake), physical and mental health problems (lower back pain, cardiovascular diseases, high blood pressure, sleeping problems, previous depressive symptoms), few social contacts and dissatisfaction with partner relationship. There were mixed associations for socioeconomic status: several proxy measures of high socioeconomic status (e.g. income >65 000 €, self-employment) were associated with having the first child at an advanced or very advanced age, as were several other proxy measures of low socioeconomic status (e.g. unemployment, low level of education, immigrant background).The odds of the child being conceived after in vitro fertilisation were threefold in men aged 34-39 and fourfold from 40 years and above. Conclusions: Men who expect their first baby at an advanced or very advanced age constitute a socioeconomically heterogeneous group with more health problems and more risky health behaviour than younger men. Since older men often have their first child with a woman of advanced age, in whom similar characteristics have been reported, their combined risk of adverse perinatal outcomes needs further attention by clinicians and researchers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to explore how information about being at risk of carrying a fetus with Down's syndrome was understood, and whether the actual risk and the woman's perception of risk was associated with worry or depressive symptoms during and after pregnancy. Design and setting: observational study. The sample was drawn from the intervention group of a Swedish randomised controlled trial of ultrasound screening for Down's syndrome by nuchal translucency measurement. Measurements: data were collected by three questionnaires. Questions were asked about recall of the risk score and perception of risk. The Cambridge Worry Scale and the Edinburgh Postnatal Depression Scale measured worry and depressive symptoms, respectively, on all three occasions. Findings: of the 796 women who provided data for this study, one in five was unaware that the risk score was noted in her case record. In total, 620 women stated that they had received a risk score, but only 64% of them recalled the figure exactly or approximately. The actual risk was associated with the perceived risk, but of the 31 women who perceived the risk to be high, only 14 were actually at high risk. A high-risk score was not associated with worry or depressive symptoms in mid-pregnancy, in contrast to a woman's own perception of being at high risk. Two months postpartum, no associations were found between maternal emotional well-being and actual or perceived risk. Conclusions: information about fetal risk is complicated and women's perception of risk does not always reflect the actual risk, at least not when presented as a numerical risk score. The possibility that the information may cause unnecessary emotional problems cannot be excluded. Implications for practice: caregivers should ascertain that information about fetal risk is interpreted correctly by pregnant women. [Copyright &y& Elsevier]

Abstract: Objectives: to investigate women''s experiences of postnatal hospital care in relation to four different aspects: (1) interpersonal care; (2) time spent on physical check-ups; (3) time spent on information and support; and (4) time spent on assistance with breast feeding. More specifically, we aimed to establish whether typical clusters of women could be identified, and if so, whether these clusters could be related to specific outcomes of care, to the way in which care is organised, and to the individual''s psychological health and socio-demographic background. Design: longitudinal population-based survey, including three questionnaires completed in early pregnancy, at 2 months and 1 year after birth. Setting: all postnatal wards in Sweden. Participants: women (n=2338) recruited at their first booking visit at 593 antenatal clinics, who responded to questions relating to postnatal hospital care 2 months after birth. Findings: eight cluster profiles defined by the four aspects of postnatal care were identified. About half of the women were found in clusters that were satisfied with most aspects of care, and half in clusters that were dissatisfied with one aspect or more. Only 32% were very satisfied with all four dimensions. Specific groups of women, such as first-time mothers, migrants, young mothers and those with a short length of stay, were dissatisfied with different assessments of postnatal care. Psychological health in early pregnancy was associated with high ratings of all aspects of care, whereas emergency caesarean section and instrumental vaginal delivery was associated with dissatisfaction with breast feeding support and time spent on health check-ups. Key conclusions and implications for practice: women''s individual appraisal of specific aspects of hospital postnatal care could be grouped into response patterns that were shared by smaller or larger groups. These patterns were related to maternal characteristics, labour outcomes and the way in which care was organised. The multi-faceted approach used in this study provided details about who was dissatisfied with what, and showed that women are not necessarily either satisfied or dissatisfied with care in a general sense. In order to provide individualised care, the carer needs to be aware of these differences. [Copyright &y& Elsevier]

Background: Fetal screening for Down syndrome by an ultrasound examination, including measurement of fetal nuchal translucency, at 12 to14 weeks’ gestation is presently being evaluated in a Swedish randomized controlled trial. Women at high risk were offered an amniocentesis to obtain a definite diagnosis. The aim of this study was to explore women's reactions and responses to information about being at high risk after the scan, with a special focus on reactions to a false positive test. Method: Interviews were conducted with 24 women within 1 week after the scan, in midpregnancy, and 2 months after the birth. The interviews were analyzed qualitatively. Down syndrome was confirmed in 4 women, who chose to terminate the pregnancy. The remaining 20 women had a false positive test. Results: For the majority, the risk information caused strong reactions of anxiety and worries about the future. A typical way for women to cope was to “withhold” the pregnancy, to take a “timeout,” and try to live as if they were not pregnant any longer. Some weeks later, when the women received normal results from the chromosome analysis, they resumed being pregnant. Six women ages more than 35 years who had a risk score lower than their age-related risk did not express similarly strong reactions. Two months after the birth of a healthy baby, most stated they would undergo the same procedure in a subsequent pregnancy. One woman still suffered from the experience when interviewed at 2 months after the birth, and another said she regretted participating in the fetal screening program. Conclusions: A false positive test of fetal screening for Down syndrome by ultrasound examination may cause strong reactions of anxiety and even rejection of the pregnancy. The prevalence of such reactions and possible long-term effects need further investigation. (BIRTH 33:1 March 2006) [ABSTRACT FROM AUTHOR]

Background: The modern phenomenon of delayed parenthood applies not only to women but also to men, but less is known about what characterises men who are expecting their first child at an advanced age. This study investigates the sociodemographic characteristics, health behaviour, health problems, social relationships and timing of pregnancy in older first-time fathers.Methods: A cross-sectional study was conducted of 14 832 men who were expecting their first child, based on data from the Norwegian Mother and Child Cohort Study (MoBa) carried out by the Norwegian Institute of Public Health. Data were collected in 2005-2008 by means of a questionnaire in gestational week 17-18 of their partner's pregnancy, and from the Norwegian Medical Birth Register. The distribution of background variables was investigated across the age span of 25 years and above. Men of advanced age (35-39 years) and very advanced age (40 years or more) were compared with men aged 25-34 years by means of bivariate and multivariate logistic regression analyses.Results: The following factors were found to be associated with having the first child at an advanced or very advanced age: being unmarried or non-cohabitant, negative health behaviour (overweight, obesity, smoking, frequent alcohol intake), physical and mental health problems (lower back pain, cardiovascular diseases, high blood pressure, sleeping problems, previous depressive symptoms), few social contacts and dissatisfaction with partner relationship. There were mixed associations for socioeconomic status: several proxy measures of high socioeconomic status (e.g. income >65,000 €, self-employment) were associated with having the first child at an advanced or very advanced age, as were several other proxy measures of low socioeconomic status (e.g. unemployment, low level of education, immigrant background).The odds of the child being conceived after in vitro fertilisation were threefold in men aged 34-39 and fourfold from 40 years and above.Conclusions: Men who expect their first baby at an advanced or very advanced age constitute a socioeconomically heterogeneous group with more health problems and more risky health behaviour than younger men. Since older men often have their first child with a woman of advanced age, in whom similar characteristics have been reported, their combined risk of adverse perinatal outcomes needs further attention by clinicians and researchers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to study women’s and men’s satisfaction with two models of antenatal education: natural childbirth preparation with psychoprophylaxis, and standard antenatal education including preparation for childbirth and parenthood but no psychoprophylaxis. Design: randomised controlled multicentre trial. Setting: 15 antenatal clinics in Sweden between January 2006 and May 2007. Participants: 1087 nulliparous women and 1064 of their partners. Interventions: both models had four two-hour sessions during pregnancy and one session post partum. The natural model was manual-based and focused on childbirth preparation, including psychoprophylaxis. In the standard care model, the group leader was free to choose her teaching approach, with an equal amount of time allocated to preparation for childbirth and for parenthood. Measures: women’s and men’s evaluation of antenatal education at three months post partum. The proportion of women and men in each model that expressed satisfaction with the education were compared using χ 2 test. Findings: more women and men in the natural groups were satisfied with the education compared with the standard care groups: women 76% versus 68% (p=0.03) and men 73% versus 65% (p=0.03). The figures were similar for satisfaction with the childbirth preparation component: 78% and 62% in women (p<0.001), and 79% and 67% in men (p<0.001) in the natural and standard care groups, respectively. Fewer participants were satisfied with the parenthood preparation component, but the proportions were higher in the standard care groups: women 37% versus 32% (p<0.001) and men 23% versus 20% (p<0.001). Conclusion and implications for practice: a structured manual-based model of antenatal education which focuses on childbirth preparation with psychoprophylaxis may better meet expectant parents’ expectations than standard antenatal education in Sweden. [ABSTRACT FROM AUTHOR]

Objective To explore if antenatal fear of childbirth in men affects their experience of the birth event and if this experience is associated with type of childbirth preparation. Design Data from a randomized controlled multicenter trial on antenatal education. Setting 15 antenatal clinics in Sweden between January 2006 and May 2007. Sample 762 men, of whom 83 (10.9%) suffered from fear of childbirth. Of these 83 men, 39 were randomized to psychoprophylaxis childbirth preparation where men were trained to coach their partners during labor and 44 to standard care antenatal preparation for childbirth and parenthood without such training. Methods Experience of childbirth was compared between men with and without fear of childbirth regardless of randomization, and between fearful men in the randomized groups. Analyses by logistic regression adjusted for sociodemographic variables. Main outcome measures Self-reported data on experience of childbirth including an adapted version of the Wijma Delivery Experience Questionnaire (W- DEQ B). Results Men with antenatal fear of childbirth more often experienced childbirth as frightening than men without fear: adjusted odds ratio 4.68, 95% confidence interval 2.67-8.20. Men with antenatal fear in the psychoprophylaxis group rated childbirth as frightening less often than those in standard care: adjusted odds ratio 0.30, 95% confidence interval 0.10-0.95. Conclusions Men who suffer from antenatal fear of childbirth are at higher risk of experiencing childbirth as frightening. Childbirth preparation including training as a coach may help fearful men to a more positive childbirth experience. Additional studies are needed to support this conclusion. [ABSTRACT FROM AUTHOR]

Introduction: Advanced maternal age is associated with labor dystocia (LD) in nulliparous women. This study investigates the age-related risk of LD in first, second and third births., Material and Methods: All live singleton cephalic births at term (≥ 37 gestational weeks) recorded in the Swedish Medical Birth Register from 1999 to 2011, except elective cesarean sections and fourth births and more, in total 998 675 pregnancies, were included in the study. LD was defined by International Classification of Diseases, version 10 codes (O620, O621, O622, O629, O630, O631 and O639). In each parity group risks of LD at age 25-29 years, 30-34 years, 35-39 years and ≥ 40 years compared with age < 25 years were investigated by logistic regression analyses. Analyses were adjusted for year of delivery, education, country/region of birth, smoking in early pregnancy, maternal height, body mass index, week of gestation, fetal presentation and infant birthweight., Results: Rates of LD were 22.5%, 6.1% and 4% in first, second and third births, respectively. Adjusted odd ratios (OR) for LD increased progressively from the youngest to the oldest age group, irrespective of parity. At age 35-39 years the adjusted OR (95% CI) was approximately doubled compared with age 25 and younger: 2.13 (2.06-2.20) in first birth; 2.05 (1.91-2.19) in second births; and 1.81 (1.49-2.21) in third births., Conclusions: Maternal age is an independent risk factor for LD in first, second and third births. Although age-related risks by parity are relatively similar, more nulliparous than parous women will be exposed to LD due to the higher rate., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Aim: The aim of this study was to investigate if family background and attitudes in early adulthood contribute to postponement of parenthood. Postponement of parenthood is associated with increased need for artificial reproductive techniques, increased risk for adverse pregnancy outcomes and reduced fertility rates., Methods: This was a cohort study including 1000 women and men aged 22 years from the Swedish Young Adult Panel Study. Questionnaire data were linked to information from the Swedish Total Population Register 10 years later. Logistic regression analyses were conducted., Results: Background factors associated with being childless were: being second-generation Polish or Turkish (odds ratio [OR] 1.5; 95% confidence intervals [CI] 1.2-2.0), growing up in a large city (OR 1.5; 95% CI 1.1-2.0), well-educated mother (OR 1.5; 95% CI 1.1-1.9) or father (OR 1.4; 95% CI 1.1-1.9), no siblings (OR 1.9; 95% CI 1.1-3.2), living in parental home (OR 2.2; 95% CI 1.6-3.1), less than good assessment of own mother (OR 1.8; 95% CI 1.2-2.7) or father (OR 1.4; 95% CI 1.0-1.9) as a parent, and less than satisfactory relationship with own mother (OR 1.5; 95% CI 1.1-2.1). Attitudes associated with being childless were: not enjoying children (OR 2.7; 95% CI 2.0-3.6), finding that one could be satisfied in life without being a good parent (OR 2.3; 95% CI 1.7-3.0) and not assuming that one will have children in the future (OR 2.9; 95% CI 2.1-3.9)., Conclusions: The findings suggest that postponement of parenthood to the age of 32 could partly be explained by family background and negative or ambivalent attitudes to children and parenthood in early adulthood., (© 2015 the Nordic Societies of Public Health.)

Background: midwifery education in many countries has been adapted to the academic system by a stronger focus on research methodology and scientific evidence. This development has often taken place without extending the programs. We were interested in exploring views about current content of midwifery education in Sweden with a focus on clinical competencies and the new research components., Objective: to investigate views about Swedish midwifery education held by students prior to graduation and after 1 year of practice, and by experienced midwives and obstetricians, with special focus on clinical competency., Design: nationwide surveys conducted between June 2007 and January 2008, and 1 year later (follow-up of students)., Methods: self-administered questionnaires completed by 171 (83%) students and 121 (59%) of these participants after 1 year of midwifery practice, and by 162 (54%) midwives and 108 (40%) obstetricians with at least 5 years of clinical experience. The responders were asked to assess predefined intrapartum competencies, which components of the education were allocated too little and too much time, and how well the education prepared for clinical practise overall. Content analysis of open-ended questions and descriptive analyses was used., Findings: most students, midwives and obstetricians were 'very' or 'fairly' satisfied with how the education prepared midwives for clinical practice and 1.8%, 4.7% and 17.6%, respectively, were dissatisfied. About half of the obstetricians and one-third of the experienced midwives rated new midwives' ability to identify deviations from normal progress as low or lacking, compared with 10% of the students. A majority found that too little time, of the 60 weeks programme, was allocated to intrapartum care and medical complications and too much time to research and writing a minor thesis., Key Conclusions: although few were dissatisfied with how midwifery education prepared for clinical practice in general, the majority of participants would have liked more time for medical complications, intrapartum care, and emergency situations, and less for research. These findings suggest that the balance between clinical competency and research, and how the research component is integrated into clinical knowledge, should be further discussed and evaluated. Also the discrepancy between the views of newly educated midwives and those of more experienced midwives and obstetricians need further investigation., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish., Design: National survey., Setting: Swedish antenatal clinics., Population: 3,283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999-2000)., Methods: A questionnaire was mailed shortly after the first antenatal visit., Main Outcome Measures: Women's preferences for mode of delivery., Results: 3,061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience., Conclusions: Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.