Ulla Waldenström

• Professor
• Professor (Full) at Karolinska Institutet

Background Obstetric anal sphincter injury (OASI) is a rare but serious outcome of vaginal birth. Based on concerns about the increasing number of women who commence childbearing later than previous generation, this study aimed at investigating age-related risk of OASI in women of different parity. Methods A population-based register study includi...

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 from1999 to 2011, except electi...

Objective: To investigate whether advanced maternal age is associated with preterm birth, irrespective of parity. Design: Population-based registry study. Setting: Swedish Medical Birth Register. Population: First, second, and third live singleton births to women aged 20 years or older in Sweden, from 1990 to 2011 (n = 2 009 068). Methods:...

The aim of the Postponing Parenthood project was to investigate several aspects of the delaying of childbearing phenomenon in Sweden and Norway, such as medical risks and parental experiences. Data were retrieved from the Swedish and Norwegian Medical Birth Registers and three different cohorts: the Swedish Young Adult Panel Study, the Norwegian Mo...

Background Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women’s satisfaction with care across the maternity continuum....

Objective: To determine the effect of primary midwife-led care ('caseload midwifery') on women's experiences of childbirth. Design: Randomised controlled trial. Setting: Tertiary care women's hospital in Melbourne, Australia. Population: A total of 2314 low-risk pregnant women. Methods: Women randomised to caseload care received antenatal,...

To investigate the association between advanced maternal age and stillbirth risks in first, second, third, and fourth births or more. A population-based registry study including all women aged 25 years and older with singleton pregnancies at 28 weeks of gestation and later gave birth in Sweden from 1990 to 2011; 1,804,442 pregnancies were analyzed....

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. This was a cohort study including 100...

Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both...

The trend to delay motherhood to the age of 30 and beyond is established in most high-income countries but relatively little is known about potential effects on maternal emotional well-being. This study investigates satisfaction with life during pregnancy and the first three years of motherhood in women expecting their first baby at an advanced and...

To investigate the association between advanced maternal age and adverse pregnancy outcomes and to compare the risks related to advanced maternal age with those related to smoking and being overweight or obese. A population-based register study including all nulliparous women aged 25 years and older with singleton pregnancies at 22 weeks of gestati...

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. Data from a randomized controlled multicenter trial on antenatal education. 15 antenatal clinics in Sweden between January 2006 and May 2007. 762 men, of whom 83 (10.9%) suffered fro...

Background Delaying the first childbirth to an advanced age has increased significantly during the last decades, but little is known about older first time mothers’ experience of childbirth. This study investigates the associations between advanced maternal age in primiparous women and the postnatal assessment of childbirth. Methods The study was...

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 olde...

Objective: To investigate rates of caesarean delivery in Sweden and Norway from 1973 to 2008 in relation to advanced and very advanced maternal age. Design: Register study. Setting: Sweden and Norway. Sample: All nulliparous women aged over 30 years with a singleton pregnancy, with the fetus in a cephalic presentation, and delivering at term...

Objective: To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care. Design: Randomised controlled trial. Setting: Tertiary-care women's hospital in Melbourne, Australia. Population: A total of 2314 low-risk pregnant women. Methods: Women randomised to caseloa...

To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth. National cohort study. Norway. A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units. Questionnaire data were obtain...

For safety reasons an in-hospital birth center was replaced by a modified form of birth center care with the same medical guidelines and equipment as in standard care. The aim of this study was to investigate women's and men's satisfaction with modified care compared with standard care. Women in both groups gave birth from July 2007 to July 2008. T...

To describe the background characteristics of women who gave birth to their first child at an advanced and very advanced maternal age, including their sociodemographic background, social relationships, health behavior, physical and mental health, and reproductive history. Cross-sectional data from the Norwegian Mother and Child Cohort Study (MoBa)...

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. Randomised controlled multicentre trial. 15 Antenatal clinics in Sweden between January 2006 and May 200...

Objective. To evaluate the effect of acupressure administered during the active phase of labor on nulliparous women's ratings of labor pain. Design. Randomized controlled trial. Setting. Public hospital in India. Sample. Seventy-one women randomized to receive acupressure at acupuncture point spleen 6 (SP6) on both legs during contractions over a 3...

A challenge of obstetric care is to optimize maternal and infant health outcomes and the mother's experience of childbirth with the least possible intervention in the normal process. The aim of this study was to investigate the effects of modified birth center care on obstetric procedures during delivery and on maternal and neonatal outcomes. In a...

To evaluate the effect of acupressure administered during the active phase of labor on nulliparous women's ratings of labor pain. Randomized controlled trial. Public hospital in India. Seventy-one women randomized to receive acupressure at acupuncture point spleen 6 (SP6) on both legs during contractions over a 30-minute period (acupressure group),...

The objective was to investigate how ultrasound screening for Down syndrome (DS) in the first trimester, compared with a routine ultrasound examination in the second trimester, affected Maternal-Fetal Attachment (MFA) in mid-pregnancy. This study of 2026 pregnant women was a sub-study of a larger RCT aiming at evaluating the effect of fetal screeni...

To study whether use of psychoprophylaxis during labor affects course of labor and experience of childbirth in nulliparous women. Cohort study. Women were recruited from 15 antenatal clinics in Sweden between October 2005 and January 2007. A total of 857 nulliparous women with a planned vaginal delivery. Using data from a randomized controlled tria...

Parental involvement in the care of preterm infants in NICUs is becoming increasingly common, but little is known about its effect on infants' length of hospital stay and infant morbidity. Our goal was to evaluate the effect of a new model of family care (FC) in a level 2 NICU, where parents could stay 24 hours/day from admission to discharge. A ra...

Objective To investigate the memory of labour pain at 2 months, 1 year and 5 years after childbirth and its association with the use of epidural analgesia and overall evaluation of childbirth. Design Longitudinal observational. Setting All hospitals in Sweden. Population One thousand three hundred eighty-three women, who were recruited at their fir...

This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth. Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. Howeve...

To test the hypothesis that the decision to use epidural analgesia during labor is influenced not only by the woman and her background but also by the local cultural practice in the delivery unit. Population-based cohort study. All delivery units in Sweden. A nationwide sample of 2,529 women. Data were collected by questionnaires in early pregnancy...

Fatigue and emotional reactions in the postpartum period were studied among parents interested in participating in an early discharge study. Fifty parents were randomly allocated to a group offered hospital discharge 2448 h after the birth, combined with domiciliary visits (experimental group = EG), and 54 parents to a group offered the traditional...

To examine the effects of antenatal education focussing on natural childbirth preparation with psychoprophylactic training versus standard antenatal education on the use of epidural analgesia, experience of childbirth and parental stress in first-time mothers and fathers. Randomised controlled multicentre trial. Fifteen antenatal clinics in Sweden...

To investigate the memory of labour pain at 2 months, 1 year and 5 years after childbirth and its association with the use of epidural analgesia and overall evaluation of childbirth. Longitudinal observational. All hospitals in Sweden. One thousand three hundred eighty-three women, who were recruited at their first antenatal visit and who provided...

Data were examined from two independent questionnaire‐based longitudinal studies, ‘KUB’ in Sweden (N = 3113) and ‘Greater Expectations?’(N = 1439) in England, which had similar aims and methodology. Our joint data sets offered us the opportunity to look for similarities and differences between the samples that might contribute to women's experience...

Orientation and training program outline for intervention midwives.

Terms of Reference for Reference group; Safety Committee and Data Monitoring Committee.

Position descriptions.

Information brochure.

Protocol for responding to women who may be depressed.

To study uptake of care at the antenatal and child health clinic (CHC), and maternal and child health up to 5 years after the birth, as reported by mothers with a non-Swedish speaking background (NSB). A sample of 300 women with a NSB, 175 originated from a poor country and 125 originated from a rich country, were compared with a reference group of...

Environmental risk during fetal development for non-right-handedness, an index of brain asymmetry, and its relevance for child mental health is not fully understood. A Swedish population-based prospective pregnancy-offspring cohort was followed-up when children were five years old (N = 1714). Prenatal environmental risk exposures were the number of...

To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focu...

The aim of this study was to add additional information on intervention rates and maternal and infant outcomes of team midwife care to previous reports which have suggested this model of care can be associated with a reduction in medical interventions during labour and birth with no statistically significant influence on maternal and infant outcome...

Background In Australia and internationally, there is concern about the growing proportion of women giving birth by caesarean section. There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility; and significant resource implications. Randomised controlled trials (RCTs) of continuity...

This paper was presented at a Health Conference in March 2007, celebrating the 150th birthday of the Royal Women's Hospital in Melbourne. It discusses the definition of "normal childbirth", and the pros and cons of three medical technologies: caesarean section, epidural analgesia during labour and routine ultrasound screening during pregnancy, and...

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. observational study. The sample was drawn from the intervention group of a Swedish randomised controlled t...

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 co...

This paper is a report of a study to investigate women's satisfaction with intrapartum care along three distinct dimensions simultaneously (interpersonal care, information and involvement in decision-making and physical birth environment) and to describe the characteristics of women with different patterns of satisfaction. Patient satisfaction is a...

To investigate risk factors for poor self-rated health (SRH) in primiparous and multiparous women 2 months and 1 year after childbirth in a nationwide Swedish sample. Women were recruited at their first booking visit at 593 (97%) antenatal clinics in Sweden during 3 weeks evenly spread over 1 year (1999-2000). Data were collected by questionnaires...

Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of...

The aim of this study was to provide a comprehensive picture of the young to the old first time mother as she presents to the clinician in terms of background, expectations, experiences and outcome of labour. A longitudinal cohort study was conducted, including 1,302 primiparous women recruited at their first booking visit, at 593 antenatal clinics...

Parental education classes are part of the national child health promotion programme of the Swedish Child Health Clinics (CHC). To investigate attendance at parental education classes during the infant's first year, and to identify factors associated with non-attendance in primiparous women. Swedish-speaking women were recruited from 97% of all ant...

The association between obstetric pain relief and long-term memory of pain is poorly researched in spite of the fact that a woman's memory of childbirth may affect her emotional wellbeing and future reproduction. The aim of this study was to investigate the association between epidural analgesia and other forms of pain relief, and memory of pain at...

To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. A prospective study using between-group comparisons. About 600 antenatal clinics in Sweden. A total of 2,662 women recruited at their first visit to an antenatal clinic durin...

The aim of this study was to investigate satisfaction with intrapartum and postpartum care, and the risk of not being satisfied in relation to 1) a woman's sociodemographic background, 2) physical and emotional well-being in early pregnancy, 3) labor outcomes, 4) care organization, and 5) a woman's subjective assessment of aspects of care. All Swed...

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...

Migrant women constitute a growing proportion of the childbearing population in many high-income countries. The aim of this study was to investigate experiences of childbirth, including recollection of pain and use of pain relief, in women born in Vietnam, Turkey, and Australia who gave birth in Victoria, Australia. One hundred Vietnamese-born and...

To study morbidity during the first month of life affecting infants of mothers booked for birth centre care during pregnancy. 3238 live single-born infants whose mothers were admitted to an in-hospital birth centre, located at South Hospital in Stockholm, between 1989 and 2000 were compared with 179,502 infants whose mothers received standard mater...

To investigate women's experiences of child health clinic (CHC) care and risk factors for being dissatisfied. Experiences of specific aspects of care were further explored in subgroups of women who were not generally satisfied. All Swedish-speaking women admitted to any of the approximately 600 antenatal clinics in Sweden during 3 wk evenly spread...

Aim: To investigate women's experiences of child health clinic (CHC) care and risk factors for being dissatisfied. Experiences of specific aspects of care were further explored in subgroups of women who were not generally satisfied. Methods : All Swedish‐speaking women admitted to any of the approximately 600 antenatal clinics in Sweden during 3 wk...

To investigate first-time mothers' views about antenatal childbirth and parenthood education and their contact with other class participants after birth, and to compare participants and non-participants with respect to the use of pain relief, experience of pain, mode of delivery, childbirth overall, duration of breastfeeding, and assessment of pare...

This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the cont...

The national recommendation in Sweden regarding number of antenatal care visits was reduced in 1996. The aim of this study was to explore the factors associated with number of visits made and with women's own opinions about these visits. Another aim was to study associations between the number of visits and satisfaction with antenatal care overall....

The aims of the present study were to describe the prevalence of a number of physical symptoms, as described by women themselves, two months and one year after childbirth in a national Swedish sample and to investigate the association between specific symptoms and women's self-rated health. Cohort study. Swedish antenatal clinics. A total of 2413 w...

The aims of the present study were to describe the prevalence of stress incontinence, as described by women themselves, 1 year after childbirth in a national sample of Swedish-speaking women, and to identify possible predictors. A cohort study, including 2390 women recruited from 593 antenatal clinics in Sweden during three 1-week periods evenly sp...

to investigate the attendance rate at childbirth and parenthood education classes during pregnancy in a national Swedish sample and describe the characteristics of women who did not attend. a cohort study utilising a postal questionnaire in early pregnancy and at 2 months after birth. women were recruited from 97% of all antenatal clinics in Sweden...

Despite high levels of breastfeeding initiation in Australia, only 46 percent of women are still breastfeeding (exclusively or partially) 6 months later, with marked differences between social groups. This study aimed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge,...

Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. Two thousand and twenty-six women were randomly...

The current investigation is a follow-up of a study on women's memory of childbirth, which showed that 60 percent made the same assessment of their overall birth experience at 1 year after delivery as they did at 2 months postpartum, and 24 percent had became more negative and 16 percent more positive. The study purpose was to gain some understandi...

Aim: To investigate the association between length of postpartum stay and duration of breastfeeding and breastfeeding problems, with special focus on early hospital discharge. Methods: Swedish-speaking women were recruited from all antenatal clinics in Sweden during 3 wk evenly spread over 1 y in 1999 to 2000. In total, 3293 women (71% of those...

A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the prevalence and risk factors of a negative birth experience in a national sample. A longitudinal cohort study of 2541 women recruited from all antenatal clinics in Swe...

To study perinatal mortality in women booked for birth centre care during pregnancy. Retrospective cohort study. In-hospital birth centre and standard maternity care in Stockholm. Two thousand and five hundred and thirty-four women (3256 pregnancies) admitted to an in-hospital birth centre over 10 years (1989-2000) and 126818 women (180380 pregnanc...

Studies of women's memory of labor and birth have generally concluded that women's recall is fairly accurate, but the findings are not unanimous. The aim of this study was to compare women's experiences of labor pain and overall experience of the birth at 2 months and 1 year after the delivery. A longitudinal cohort study of 2,428 women recruited i...

Background It has proven difficult to reach World Health Organization (WHO) recommendations that infants be exclusively breastfed from birth to six months of age [1,2], yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration. Particularly lacking is evidence about how to maintain bre...

Appendix I: Recruitment dialogue; Appendix II: Consent form Appendix III: "Attach" class protocol; Appendix IV: "Family" class 1 and 2 protocol; Appendix V: Telephone protocol; Appendix VI: Position descriptions; Appendix VII: Research midwife orientation program; Appendix VIII: Information brochure; Appendix IX: Facilitator evaluation forms; Appen...

The Cambridge Worry Scale (CWS) is an instrument including 16 items measuring women's major worries during pregnancy. The aim of the study was to test the scale, translated into Swedish, on pregnant women in Stockholm. We also wanted to explore whether these women were worried about any item not included in the scale. An additional aim was to study...

This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the cont...

Background: In Sweden, few alternatives to a hospital birth are available, and little is known about consumer interest in alternative birth care. The aim of this study was to determine women's interest in home birth and in-hospital birth center care in Sweden, and to describe the characteristics of these women. Methods: All Swedish-speaking women b...

Background: In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. This study's purpose was to assess the impact of this model on women's views and ex...

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 3283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during...