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Bioethical concepts in theory and practice: an exploratory study of prenatal screening in Iceland.

https://arctichealth.org/en/permalink/ahliterature100280
Source
Med Health Care Philos. 2011 Feb;14(1):53-61
Publication Type
Article
Date
Feb-2011
Author
Helga Gottfreðsdóttir
Vilhjálmur Arnason
Author Affiliation
Department of Midwifery, Faculty of Nursing, University of Iceland, Eiríksgata 34, IS-101, Reykjavík, Iceland, helgagot@hi.is.
Source
Med Health Care Philos. 2011 Feb;14(1):53-61
Date
Feb-2011
Language
English
Publication Type
Article
Abstract
A hallmark of good antenatal care is to respect prospective parent's choices and provide information in a way that encourages their autonomy and informed decision making. In this paper, we analyse the meaning of autonomous and informed decision making from the theoretical perspective and attempt to show how those concepts are described among prospective parents in early pregnancy and in the public media in a society where NT screening is almost a norm. We use interviews with Icelandic prospective parents in early pregnancy (N = 40) and material covering the discourse around prenatal screening in the media over 5 years period. Our analysis indicates that both prospective parents and the public media include ethical terms in their rhetoric around prenatal screening although those concepts differ in their expression. We conclude that the context in which these decisions are taken does not encourage moral reflection. Prospective parents describe that there is a lack of dialogue with professionals when decisions are made about screening. With routine offer of screening the conceptualization of bioethical concepts finds its own way through a mainstream discourse which has limited connections to the theoretical notions. This has been neglected in the implementation of screening, as limited effort has been subject to audit with reference to explore how the offer of screening and informed choice is experienced among prospective parents.
PubMed ID
20949321 View in PubMed
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Content of antenatal care: Does it prepare women for birth?

https://arctichealth.org/en/permalink/ahliterature282825
Source
Midwifery. 2016 Aug;39:71-7
Publication Type
Article
Date
Aug-2016
Author
Helga Gottfredsdottir
Þóra Steingrímsdóttir
Amalía Björnsdóttir
Embla Ýr Guðmundsdóttir
Hildur Kristjánsdóttir
Source
Midwifery. 2016 Aug;39:71-7
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cohort Studies
Cross-Sectional Studies
Curriculum - standards
Delivery, Obstetric - methods - psychology - standards
Female
Humans
Iceland
Longitudinal Studies
Nurse Midwives - standards
Pain - nursing - psychology
Patient satisfaction
Pregnancy
Prenatal Care - psychology - standards
Surveys and Questionnaires
Teaching - standards
Time Factors
Abstract
clinical guidelines for antenatal care recommend informing women about birth. The aim of this study was to explore the content of antenatal care from women's perspective and to establish whether they consider information on birth to be sufficient.
the data was gathered in a longitudinal, cross-sectional cohort study known as The Childbirth and Health Study in Iceland. The study group consisted of 765 women attending antenatal care at 26 urban and rural health care centres in Iceland, during the year 2009-2010. They participated by replying to two questionnaires, at 16 gestational weeks and six months after birth. The questions covered objective and subjective aspects of antenatal care, pregnancy, birth, and the postpartum period.
the majority (87%) of the women want to be informed about birth in the antenatal phase of care, and 41% reported 5-6 months post partum that too little time had been spent on this issue, by health care professionals. Post partum, mode of delivery affected women's estimated time spent on information in pregnancy, with women who had planned caesarean section being most satisfied with the time spent on antenatal information about birth. Women who experienced their birth as difficult or very difficult were more likely to report that insufficient time had been spent on information than women who had experienced their birth as easy or very easy.
antenatal care can play an important role in preparing women for birth. This study shows that information about birth provided during pregnancy is insufficient from women's perspective, although some groups of women do report being more satisfied with this information. The way that this segment of antenatal care is provided leaves room for improvement.
PubMed ID
27321723 View in PubMed
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[Fetal loss after amniocentesis and chorionic villus sampling in Iceland].

https://arctichealth.org/en/permalink/ahliterature104712
Source
Laeknabladid. 2014 Mar;100(3):147-51
Publication Type
Article
Date
Mar-2014
Author
Kristin Rut Haraldsdottir
Helga Gottfredsdottir
Reynir Tomas Geirsson
Source
Laeknabladid. 2014 Mar;100(3):147-51
Date
Mar-2014
Language
Icelandic
Geographic Location
Iceland
Publication Type
Article
Keywords
Abortion, Spontaneous - epidemiology - genetics
Adult
Amniocentesis - adverse effects
Chorionic Villi Sampling - adverse effects
Female
Hospitals, University
Humans
Iceland - epidemiology
Incidence
Karyotype
Maternal Age
Pregnancy
Pregnancy, Twin
Retrospective Studies
Risk factors
Time Factors
Abstract
Amniocentesis and chorionic villus sampling (CVS) are methods for fetal chromosomal diagnosis. Pregnant women aged =35 years have been offered amniocentesis in Iceland for over 35 years. The main testing indication was maternal age until 1998, when universal early screening was introduced. We examined outcome and fetal loss following amniocentesis and CVS in singleton and twin pregnancies, age distribution changes, reasons for the procedures and fetal karyotype diagnoses.
Retrospective quantitative study on women who had amniocentesis and CVS (n=2323) in the Prenatal Diagnosis Unit at Landspitali University Hospital during 1998-2007. Unit files and individual case and maternity records were used to retrieve information on the indications and on maternal age, type of procedure, outome of pregnancy, and the fetal karyotype.
The number of procedures was substantially reduced from over 500 to just over 100 per year, with a proportional shift to CVS. Procedure-related fetal loss was 22/2323 (0.9%), with no significant difference between amniocentesis (0.8%) and CVS (1.3%). The difference decreased in the latter half of the study period to 0.7% and 0.8%, respectively. Age-related reasons decreased from 81.2% to 30.8%.
The fetal loss incidence rates indicated that amniocentesis and CVS have the same safety level as elsewhere. Complications were uncommon. With CVS fetal screening was moved to an earlier time in pregnancy. Early screening has changed the maternal age profile and is available to all women on request. The information obtained can be used to improve service information.
PubMed ID
24636902 View in PubMed
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'Have you had the test?' A discourse analysis of media presentation of prenatal screening in Iceland.

https://arctichealth.org/en/permalink/ahliterature97702
Source
Scand J Caring Sci. 2010 Jun;24(2):414-21
Publication Type
Article
Date
Jun-2010
Author
Helga Gottfredsdóttir
Kristín Björnsdóttir
Author Affiliation
Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland. helgagot@hi.is
Source
Scand J Caring Sci. 2010 Jun;24(2):414-21
Date
Jun-2010
Language
English
Publication Type
Article
Abstract
Nuchal translucency (NT) screening has come to be widely used in antenatal care in many countries. In the capital area of Iceland, which is the focus of this study, 84% of pregnant women underwent screening in 2005. At the time no official policy had been formulated regarding the use of this screening, and very limited public discussion had taken place on the ethical issues related to its use. Although screening has been widely welcomed as a scientific and technological improvement, it may also have unintended consequences, both for practitioners and prospective parents, and for particular groups such as the disabled, which have not been fully explored. The purpose of this study was to examine how NT screening was introduced as a new practice and came to be adopted in prenatal care in Iceland. Using a genealogical approach, we explored the way in which the value and potential drawbacks of NT screening were presented to the public. The data used in the analysis comprised material published from the beginning of 2000 until the end of 2005, such as television programmes, newspaper and magazine articles and booklets written for prospective parents. The findings reveal that the screening was mainly promoted by staff at the specialized clinic where the test was offered, and that soon after its initiation screening became widespread. In interviews, both practitioners and parents of children with Down's syndrome questioned the eugenic implications of screening and its impact on the lives of the disabled and their relatives. However, the societal response was fairly muted and a critical debate regarding the routine use of NT screening can hardly be said to have taken place. These findings alert us to the importance of promoting critical discussion of new knowledge and technology in health care, particularly when serious ethical issues are involved.
PubMed ID
20230519 View in PubMed
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Home birth constructed as a safe choice in Iceland: A content analysis on Icelandic media.

https://arctichealth.org/en/permalink/ahliterature277637
Source
Sex Reprod Healthc. 2015 Oct;6(3):138-44
Publication Type
Article
Date
Oct-2015
Author
Helga Gottfredsdottir
Herdís Magnúsdóttir
Berglind Hálfdánsdóttir
Source
Sex Reprod Healthc. 2015 Oct;6(3):138-44
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Choice Behavior
Female
Home Childbirth - psychology
Humans
Iceland
Medicalization
Midwifery
Newspapers as Topic
Pregnancy
Professional-Patient Relations
Safety
Abstract
The rate of home birth in Iceland increased from 0.1% in the 90's, to 2.2% in 2012. As the media contributes to the development and public perceptions, engagement and use of health care, it is of interest to explore the media representation of planned home birth in Iceland.
The aim of this study was to explore the way in which the constructions of planned home birth are represented in the Icelandic media; the frequency with which planned home birth was discussed and by whom it was discussed; whether the discourse was congruent with practice development in the country; and if so, how such congruency was effected.
Data from the main newspapers in Iceland published from the beginning of 1990 until the end of 2011 were explored using content analysis.
In total, 127 items were summarized and we identified five themes: approach to safety, having a choice, the medicalization of childbirth, the relationship between women and midwives, and the reaction of the pregnant woman's local community. Central in the analysis were the importance of being able to choose a safe place of birth and the need for woman-centred care.
Overall planned home birth was not discussed with much intensity or frequency, but in general the discussion was shaped by a positive attitude. There was a distinction in the public media discourse among midwives and physicians or obstetricians who do not argue against planned home birth but who nevertheless speak with caution. The pregnant women who chose home birth found their own home to be safe and similar views were identified among women and midwives.
PubMed ID
26842636 View in PubMed
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Making sense of the situation: women's reflection of positive fetal screening 11-21 months after giving birth.

https://arctichealth.org/en/permalink/ahliterature272804
Source
Midwifery. 2014 Jun;30(6):643-9
Publication Type
Article
Date
Jun-2014
Author
Hildur Kristjansdottir
Helga Gottfredsdottir
Source
Midwifery. 2014 Jun;30(6):643-9
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Cohort Studies
Congenital Abnormalities - nursing - ultrasonography
Decision Making
False Positive Reactions
Female
Humans
Iceland
Interviews as Topic
Midwifery
Mothers - psychology
Postpartum Period
Pregnancy
Surveys and Questionnaires
Ultrasonography, Prenatal
Young Adult
Abstract
we aimed to gain insights into women's reflection on their experience of receiving a false-positive screening result for fetal anomalies, more than 11 months from birth.
the women constituted a subgroup of participants in a larger cohort study (n=1111) where the purpose was to explore women's experience of maternity services, their health, well-being, attitudes and expectations during pregnancy and after birth. Semi-structured interviews were collected from 14 women 11-21 months after birth who had been screened positive for fetal chromosomal abnormality in early pregnancy. The method of life-world phenomenological approach was used in data collection and analyses.
four themes were identified: first reaction, framing of the news, I am not an island and pregnancy lost and regained. With few exceptions, their experience can be seen as a pathway from shock to balanced feeling where women have made sense of what happened and have dealt adequately with their situation.
this study indicates that few women still experience anxiety and concerns in relation to positive fetal screening result more than 11 months from birth. They however remember vividly their first reaction and how the result was presented. As such, the findings have implications in the clinical context meaning that framing of the news on face-to-face level, extended information about the test results, help to sort out mixed feelings and support from a named midwife are of importance.
PubMed ID
24332751 View in PubMed
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Midwifery education: Challenges for the future in a dynamic environment.

https://arctichealth.org/en/permalink/ahliterature295281
Source
Midwifery. 2018 Apr; 59:78-80
Publication Type
Journal Article
Review
Date
Apr-2018
Author
Helga Gottfreðsdóttir
Marianne J Nieuwenhuijze
Author Affiliation
Faculty of Nursing, Department of Midwifery, University of Iceland, Reykjavík, Iceland; Women´s Clinic, Landspitali University Hospital, 101 Reykjavik, Iceland.
Source
Midwifery. 2018 Apr; 59:78-80
Date
Apr-2018
Language
English
Publication Type
Journal Article
Review
Keywords
Adult
Curriculum - standards - trends
Education, Nursing - trends
Female
Forecasting
Humans
Iceland
Maternal Health Services - trends
Midwifery - education
Netherlands
Pregnancy
Abstract
Iceland and the Netherlands both have a long history of midwifery education and midwifery practice. Starting as a midwife requires a direct entry BSc program in midwifery in The Netherlands, where Iceland requires a nurse-midwife model. This paper presents an overview of midwifery education and its dynamic in these countries. Subsequently, we explore two most notable components that were identified as important for the future of midwifery education. In the concluding section, we reflect how these components support the scope of practice as presented in the Lancet framework for quality maternal and newborn care.
PubMed ID
29396384 View in PubMed
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Midwifery in Iceland: From vocational training to university education.

https://arctichealth.org/en/permalink/ahliterature295269
Source
Midwifery. 2018 Jul; 62:104-106
Publication Type
Journal Article
Date
Jul-2018
Author
Olof A Olafsdottir
Hildur Kristjansdottir
Berglind Halfdansdottir
Helga Gottfredsdottir
Author Affiliation
Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, 101 Reykjavik, Iceland. Electronic address: olofol@hi.is.
Source
Midwifery. 2018 Jul; 62:104-106
Date
Jul-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Curriculum - standards - trends
Education, Nursing - methods - trends
Female
Humans
Iceland
Midwifery - education - methods - standards
Pregnancy
Universities - organization & administration - trends
Vocational Education - organization & administration - trends
Abstract
Midwifery education is a foundation for health professionals' competence in providing quality healthcare for the benefit of women, their families and society. This paper describes midwifery and the development of midwifery education in Iceland. It examines policy and extensive reforms, from hospital-based vocational training in midwifery to an academic university education, and the impact on the scope of midwifery practice in Iceland. The university-based programme, with its emphasis on autonomy of the midwife, seems to have affected the context of home birth and strengthened midwives' role in primary healthcare. Education reform with a focus on evidence-based practice and midwife-led continuity of care has had limited influence within the hospital system, where the structure of care is fragmented and childbirth is under threat of increasing interventions. Research is needed on the role of education in supporting evidence-based practice, normal childbirth and reproductive health in the Icelandic context.
PubMed ID
29660573 View in PubMed
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Midwifery students' perspectives on how role models contribute to becoming a midwife: A qualitative study.

https://arctichealth.org/en/permalink/ahliterature308651
Source
Women Birth. 2020 Sep; 33(5):433-439
Publication Type
Journal Article
Date
Sep-2020
Author
Marianne J Nieuwenhuijze
Suzanne M Thompson
Embla Yr Gudmundsdottir
Helga Gottfreðsdóttir
Author Affiliation
Research Centre of Midwifery Science Maastricht, Zuyd University, The Netherlands. Electronic address: m.nieuwenhuijze@av-m.nl.
Source
Women Birth. 2020 Sep; 33(5):433-439
Date
Sep-2020
Language
English
Publication Type
Journal Article
Keywords
Adult
Education, Nursing, Baccalaureate - methods
Female
Focus Groups
Health Knowledge, Attitudes, Practice
Humans
Iceland
Interprofessional Relations
Interviews as Topic
Midwifery - education
Netherlands
Nurse Midwives - education - psychology
Preceptorship - methods
Pregnancy
Qualitative Research
Students, Nursing - psychology
Abstract
The dynamics of maternal and newborn care challenge midwifery education programs to keep up-to-date. To prepare for their professional role in a changing world, role models are important agents for student learning.
To explore the ways in which Dutch and Icelandic midwifery students identify role models in contemporary midwifery education.
We conducted a descriptive, qualitative study between August 2017 and October 2018. In the Netherlands, 27 students participated in four focus groups and a further eight in individual interviews. In Iceland, five students participated in one focus group and a further four in individual interviews. All students had clinical experience in primary care and hospital. Data were analyzed using inductive content analysis.
During their education, midwifery students identify people with attitudes and behaviors they appreciate. Students assimilate these attitudes and behaviors into a role model that represents their 'ideal midwife', who they can aspire to during their education. Positive role models portrayed woman-centered care, while students identified that negative role models displayed behaviors not fitting with good care. Students emphasized that they learnt not only by doing, they found storytelling and observing important aspects of role modelling. Students acknowledged the impact of positive midwifery role models on their trust in physiological childbirth and future style of practice.
Role models contribute to the development of students' skills, attitudes, behaviors, identity as midwife and trust in physiological childbirth. More explicit and critical attention to how and what students learn from role models can enrich the education program.
PubMed ID
31611186 View in PubMed
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Obstetric interventions, trends, and drivers of change: A 20-year population-based study from Iceland.

https://arctichealth.org/en/permalink/ahliterature301167
Source
Birth. 2018 12; 45(4):368-376
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-2018
Author
Emma M Swift
Gunnar Tomasson
Helga Gottfreðsdóttir
Kristjana Einarsdóttir
Helga Zoega
Author Affiliation
Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland.
Source
Birth. 2018 12; 45(4):368-376
Date
12-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Analgesia, Epidural - statistics & numerical data - trends
Cesarean Section - statistics & numerical data - trends
Diabetes Mellitus - epidemiology
Extraction, Obstetrical - statistics & numerical data - trends
Female
Humans
Hypertension - epidemiology
Iceland - epidemiology
Labor, Induced - statistics & numerical data - trends
Labor, Obstetric - physiology
Parity
Poisson Distribution
Population
Pregnancy
Pregnancy Complications - epidemiology
Regression Analysis
Young Adult
Abstract
Population data on obstetric interventions is often limited to cesarean delivery. We aimed to provide a more comprehensive overview of trends in use of several common obstetric interventions over the past 2 decades.
The study was based on nationwide data from the Icelandic Medical Birth Register. Incidence of labor induction, epidural analgesia, cesarean, and instrumental delivery was calculated for all births in 1995-2014. Change over time was expressed as relative risk (RR), using Poisson regression with 95% confidence intervals (CI) adjusted for several maternal and pregnancy-related characteristics. Analyses were stratified by women's parity and diagnosis of diabetes or hypertensive disorder.
During the study period, there were 81 389 intended vaginal births and 5544 elective cesarean deliveries. Among both primiparous and multiparous women, we observed a marked increase across time for labor induction (RR 1.78 [CI 1.67-1.91] and RR 1.83 [CI 1.73-1.93], respectively) and epidural analgesia (RR 1.40 [CI 1.36-1.45] and RR 1.74 [CI 1.66-1.83], respectively). A similar trend of smaller magnitude was observed among women with hypertensive disorders but no time trend was observed among women with diabetes. Incidence of cesarean and instrumental delivery remained stable across time.
The use of labor induction and epidural analgesia increased considerably over time, while the cesarean delivery rate remained low and stable. Increases in labor induction and epidural analgesia were most pronounced for women without a diagnosis of diabetes or hypertensive disorder and were not explained by maternal characteristics such as advanced age.
PubMed ID
29687477 View in PubMed
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15 records – page 1 of 2.