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Biomedical subjects

B Wijma

Publications and source records attributed to B Wijma.

At least 19 recordsLinked to original sources
PubMed2003

Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study.

BACKGROUND: Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims. METHODS: We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's chi(2) test. FINDINGS: The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit. INTERPRETATION: Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

Adolescent↗
PubMed2002

Development of the Delivery Fear Scale.

This article reviews the development of the Delivery Fear Scale (DFS) to measure fear during labor and delivery. In an initial study, 92 women in labor answered a list of 60 items, expressing fear-related appraisals and their contrasts that were characteristic of women in labor. The items were then selected by means of an item-total analysis. In a second study, the final list of ten items was tested psychometrically, and a semi-structured interview was performed on 45 women in labor, to explore the women's descriptions of the content of each of the ten items. According to the content analysis of the interviews, the dominating connotation of the ten items is fear based on the appraisal of being captured. The studies show that the DFS is a questionnaire that almost effortlessly can be completed within 60-90 seconds during any moment of labor and delivery. The scale has a good reliability: Cronbach's alpha was 0.88 in both studies.

Adult↗
PubMed2002

Traumatic stress after childbirth: the role of obstetric variables.

In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables. A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES). Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia. Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery. It is of clinical importance, however, that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD). This implies that a normal vaginal delivery can be experienced as traumatic, just as an emergency cesarian section is not necessarily traumatic. Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia.

Adult↗
PubMed2001

Fear during labor.

BACKGROUND: The aims of the present study were to compare primiparous and multiparous women's experiences of fear of delivery during an early stage of active labor (cervix dilatation 3-5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm - partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section. METHOD: Thirty-five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief. RESULTS: Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor. CONCLUSION: The clinical implications of the study are that the delivery staff should consider women's fear during labor and pay attention especially to primiparous women's increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women's. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman's need of pain relief.

Adult↗
PubMed2000

Can women's cognitive appraisals be registered throughout childbirth?

The aims of the present study were: (a) to examine whether it was possible to measure women's cognitive appraisals hourly during the whole process of labor and delivery, and (b) to explore how the appraisals varied during labor. Measurements from 12 nulliparous women are presented. The findings indicate that it is possible to study psychological appraisals directly, in detail and continuously during the process of labor and delivery. The women's cognitive appraisals varied throughout labor both per individual woman and between the participating women.

Adult↗
PubMed2000

Vulvar vestibulitis syndrome and vaginismus. A case report.

BACKGROUND: Recent reports have argued for a revision of the criteria used for the establishment of a diagnosis of vulvar vestibulitis syndrome (VVS). On theoretical grounds it might be hypothesized that women with VVS also suffer from vaginismus. CASE: A young woman presented with a history, symptoms and objective findings typical of vaginismus, yet she suffered from continuous, burning pain and itching in the vestibule. Earlier in the course of the problem she had received a diagnosis VVS. The patient was treated with behavioral therapy developed for vaginismus. Notations made during the course of therapy supported the assumption that the pain and itching were conditioned responses to penetration in the same way that a vaginal muscular reflex is. CONCLUSION: Differential diagnostic difficulties exist in the field of VVS and vaginismus. Psychophysiologic theories are needed as the basis for research to clarify the connections between different diagnostic entities associated with coital burning pain and itching in the vestibule.

Adolescent↗
PubMed1999

Variations in sickness absence and use of social benefits among pregnant women in a Swedish community 1978-1997.

SUBJECT: Pregnancy is a well defined condition. Any possible need for sickness absence should remain unchanged over time. STUDY OBJECTIVE: To investigate the relationship between rates of sickness absence during pregnancy in a long term perspective. SUBJECTS STUDIED: Two thousand nine hundred and thirty-five women consecutively delivered at the University Hospital in Linköping in 1978, 1986, 1992 and 1997. RESULTS: In 1986, after a period of expansion of social benefits, the proportion of sick-listed pregnant women was observed to be significantly higher (78 per cent) than in 1978 (51 per cent). Parallel to cuts in compensation, sickness absence 1997 was observed to decrease (53 per cent). The mean number of days of sickness absence per pregnant woman increased from 18.9 in 1978 to 36.5 in 1986. In 1997 the mean number of days was 18.8. The Parental benefit, available to all pregnant women, was significantly ameliorated during the period of the study. In spite of this, the mean number of sickness absence days used before delivery decreased from 11.7 days in 1978 to 6.6 days in 1997. CONCLUSIONS: Sickness absence among pregnant women is to a high degree sensitive to the levels of compensation in the available social benefits. A high level of reimbursement and expanded social benefits seem paradoxically to increase the sickness absence among pregnant women, but cuts in benefits lower the absence, suggesting an adaptation and a coping strategy to what seems most economically favorable for the pregnant woman and her family.

Female↗
PubMed1998

Increase in sick leave rates caused by back pain among pregnant Swedish women after amelioration of social benefits. A paradox.

STUDY DESIGN: A retrospective population study. OBJECTIVES: To explore whether the increase in social benefits for pregnant women introduced in Sweden between 1978 and in 1986 was associated with a decrease in the use of sick leave caused by back pain during the same period. SUMMARY OF BACKGROUND DATA: Back pain is a common condition among Swedish pregnant women. It may be regarded as a normal discomfort of pregnancy, because at least 50% of pregnant women experience back pain to some extent during pregnancy. METHODS: Participants were women consecutively delivered in 1978 (n = 1524) and in 1986 (n = 1688). Between these two time points, the number of offered days of parental benefit increased and a new benefit, the pregnancy benefit, was introduced. Data were collected from the antenatal care and delivery records and from pregnant women's social insurance files. RESULTS: From 1978 to 1986 the use of sick leave because of back pain during pregnancy increased. The number of pregnant women granted sick leave employed pregnant women because of back pain increased from 11% in 1978 to 29% in 1986 (P < 0.001). The sick leave rate increased in most occupations and especially among young women. CONCLUSIONS: The Swedish society has provided ample social benefits to allow the pregnant woman to take leave from work, without having to be labeled as "ill," because of normal conditions such as back pain during pregnancy. Instead of an expected decrease in sick leave because of back pain during pregnancy, an increase was observed.

Absenteeism↗
PubMed1998

[Gynecologic examination, a role-playing for two].

Although pelvic examination (PE) is a common procedure in gynaecological practice, there is little discussion among gynaecologists about the decision-making process and the possible indications and contraindications. Moreover, examiners need to be aware that their approach and body language during PE will inevitably reflect their attitude toward women. At PE, there is tacit agreement between the examiner and the patient involving a cognitive restructuring of the situation. However, if memories of earlier experiences bearing some resemblance to the PE situation are aroused in the patient, and the emotions connected with them reactivated, she may become overwhelmed by the intensive reactions triggered. In such cases, the examiner needs to be able to recognise what is happening and provide the support the patient needs. Other responsibilities of the examiner at PE include recognising symptoms of post-traumatic stress reactions and vaginismus. In performing a young woman's first PE, the examiner's primary aim should be provide the experience; that PE is a benign procedure, unconnected with pain or distress; as the patient's experience at her first PE will inevitably influence all future examinations. Learning to perform a PE in such a way that it is beneficial to the patient in all these respects is an intricate and challenging task. However, experience with students and gynaecological teaching associates suggests that such skills can be taught and learned. The PE situation is charged with latent salubrious potential, which is usually insufficiently exploited.

Attitude of Health Personnel↗
PubMed1998

Experiences of emergency cesarean section: A phenomenological study of 53 women.

BACKGROUND: Childbirth by emergency cesarean section can be a traumatic experience, but since the result is often a healthy mother and baby, its seriousness is open to doubt. METHOD: Fifty-three women were interviewed approximately two days after emergency cesarean section to ascertain whether or not the trauma met the stressor criterion of posttraumatic stress disorder. A time-spatial model from disaster psychiatry was used to chart the women's thoughts and feelings during consecutive phases of the delivery process. The women's causal attributions of the event were also assessed. RESULTS: Generally speaking, the feeling of the women after they had arrived at the delivery ward changed from one of confidence and safety to one of fear. The decision to undertake a cesarean section brought a feeling of relief, but this was again replaced by fear as the operation approached. The women's thoughts centered around the impending delivery and operation until after the event, when the newborn baby occupied their attention and happiness predominated. In retrospect, 55 percent of the women experienced intense fear for their own life or that of their baby. Eight percent felt very badly treated by the delivery staff and were angry. Almost all the women had adequate knowledge of the reasons for the emergency cesarean section. One in four blamed themselves to some extent for the event. CONCLUSIONS: The stressor criterion of DSM IV is applicable to the trauma of emergency cesarean section. Even if and when a new mother is happy to meet her baby, negative feelings, such as fear, guilt, or anger, may dominate her memories of the birth.

Adult↗
PubMed1998

Changes in sick leave rates and the use of pregnancy-associated social benefits among pregnant Swedish women: an outcomes study.

We attempted to determine if an amended social security system has lessened the rate of sickness absence during pregnancy in Sweden over the period 1978-1989. We studied the records of 3998 women who gave birth in 1978, 1986, 1988, and 1989 at the University Hospital in Linköping and the Värnamo County Hospital. Retrospective collection of all data concerning the rates and durations of sickness absence during pregnancy, drawing of parental benefit, and use of granted pregnancy benefit was performed from Sweden's standardized social security files. Obstetric variables concerning the course and outcome of pregnancy and delivery, as well as the health status of the newborns, were obtained from standardized and antenatal care and delivery files. Between 1978 and 1989, the rate of sickness absenteeism during pregnancy increased by almost 100% for periods of absence not supported by a doctor's certificate and by about 50% for those with a doctor's certificate. During the same time, the average number of days of sick leave per pregnant woman more than doubled. The changes were most apparent among younger pregnant women. During the decade studied, no significant differences were found with regard to antenatal care, modes of delivery, or the health status of the newborns. In spite of the introduction within the Swedish social security system of more generous rules for pregnant women, the changes in the rates of registered sick leave during pregnancy observed over time were most unfavorable. The present study indicates that the rate of sick leave during pregnancy reflects a complex social phenomenon and cannot be explained solely by an increase in the rate of actual illness or sickness. Such a rate is also likely to depend on general attitudes and expectations among pregnant women, which may vary over time. When amendments in social benefits for pregnant women are considered to improve the health status of the pregnant population, society ought to clearly define the precise aim pursued and the consequences expected to escape unintended socioeconomic results.

Absenteeism↗
PubMed1998

Psychological impact of emergency cesarean section in comparison with elective cesarean section, instrumental and normal vaginal delivery.

The purpose of the study was to compare the psychological reactions of women after emergency Cesarean section (EmCS), elective Cesarean section (ElCS), instrumental vaginal delivery (IVD) and normal vaginal delivery (NVD). The participants (EmCS, n = 71, ElCS, n = 70, IVD, n = 89, and NVD, n = 96) answered questionnaires a few days postpartum and 1 month postpartum. The EmCS group reported the most negative delivery experience at both times, followed by the IVD group. At a few days postpartum the EmCS group experienced more general mental distress than the NVD group, but not when compared with the ElCS or the IVD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ElCS and NVD groups, but not when compared to the IVD group. An unplanned instrumental delivery (EmCS or IVD) should be regarded as a pointer with respect to possible post-traumatic stress.

Adolescent↗
PubMed1998

Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth.

Up to now it has been difficult to study fear of childbirth because of a shortage of adequate psychological measurements. Therefore the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) was developed. This paper presents the theoretical background of the W-DEQ together with a documentation of the first psychometric studies. Examination of construct validity indicates that it seems to be possible to penetrate a psychological construct related to fear of childbirth by means of the W-DEQ, both before and after delivery, in nulliparous as well as in parous women. The questionnaire measures the construct more clearly in parous than in nulliparous women. Internal consistency reliability and split-half reliability of the W-DEQ of > or = 0.87 are good for a new research instrument. More research is on its way to make the W-DEQ suitable even for measurements in applied settings.

Adolescent↗
PubMed1998

Attitudes towards pelvic examination in a random sample of Swedish women.

BACKGROUND: A pelvic examination is the most common procedure in gynecological practice. A majority of women have negative experiences of such examinations. The aim of the present study was to explore attitudes to and experiences of pelvic examinations, as well as possible background factors to such attitudes and experiences. METHODS: A postal inquiry was sent to 788 randomly selected Swedish women, of fertile age. Sixty-seven per cent answered the questionnaire, which had 56 items and covered, inter alia, attitudes to and experiences of pelvic examinations, as well as possible background factors. RESULTS: The women had positive, uniform attitudes to pelvic examinations in general, but negative experiences of the specific parts of the procedure. Women's attitudes to and experiences of pelvic examinations correlated. The experience of the first pelvic examination was more negative than the experience of the last. A negative experience in general and the experience of pain during the first pelvic examination correlated. The first pelvic examination emerged as a statistically powerful background factor for subsequent attitudes to pelvic examinations. CONCLUSIONS: Swedish women have positive attitudes to pelvic examination in spite of negative previous experiences. A powerful background factor for subsequent attitudes to pelvic examination was the experience of the first one. A woman's first pelvic examination should therefore be used as an opportunity to condition positive emotions and behaviors to the examination situation, as a basis for future positive experiences.

Adult↗
PubMed1998

Fear of childbirth during pregnancy may increase the risk of emergency cesarean section.

BACKGROUND: The purpose of our study was to elucidate the association between fear of childbirth, general anxiety, and stress coping during the third trimester of pregnancy, and a subsequent delivery by emergency cesarean section. METHODS: In a case-control study, 1,981 Swedish-speaking women completed three self-assessment questionnaires at 32 weeks' gestation. Ninety-seven of these women were delivered by emergency cesarean section. Fear of childbirth, general anxiety and the stress coping ability of these 97 cases were compared with the same features in 194 controls, matched for age and parity. RESULTS: Women, subsequently delivered by emergency cesarean section, reported a greater anxiety and a poorer stress coping ability, and, most obviously, a greater fear of childbirth at 32 weeks' gestation. After elimination of possible confounders, the odds ratio for emergency cesarean section was examined for women whose scores were above various cut-off points according to the fear of childbirth measuring instrument. For women with a serious fear of childbirth the odds ratio was 3.0 (95% confidence interval 1.4 to 6.6), and the population attributable risk 0.167. CONCLUSION: Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

Adaptation, Psychological↗
PubMed1997

Posttraumatic stress reactions after emergency cesarean section.

BACKGROUND: The study aimed at answering the following questions: Do women experience emergency cesarean section as traumatic? Do women experience any posttraumatic stress reactions or even posttraumatic stress disorder (PTSD) one to two months after emergency cesarean section? METHODS: Twenty-five consecutive women were interviewed a few days and one to two months after emergency cesarean section. RESULTS: Nineteen (76%) of the 25 women had experienced their delivery by emergency cesarean section as a traumatic event. One to two months postpartum none of these women met all the diagnostic criteria of PTSD. However, 13 women had various forms of posttraumatic stress reactions and in eight cases (33%) symptoms of serious posttraumatic intrusive stress reactions. CONCLUSIONS: The emergency cesarean section was in the majority of the cases experienced as a mental trauma. Although none of the women suffered from PTSD one to two months postpartum, one third had serious posttraumatic intrusive stress reactions. The concept of traumatic stress thus seems to be relevant for investigations of psychological aspects of emergency cesarean section.

Adult↗