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Johnsen H, Juhl M, Rydahl E, Karentius SM, Rath SM, Friis-Alstrup M, Backhausen MG, Røhder K, Schiøtz ML, Broberg L, de Lichtenberg V. The Feasibility of the Adverse Childhood Experiences Questionnaire among Women in Danish Antenatal Care: A Mixed-Methods Study. Int J Environ Res Public Health 2023; 20:6601. [PMID: 37623184 PMCID: PMC10454047 DOI: 10.3390/ijerph20166601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
A traumatic upbringing increases the risks of antenatal health problems, unfavourable pregnancy outcomes, and mental disorders. Such childhood experiences may affect women's pa-renting skills and the social-emotional functioning of their children. Research on screening for adverse childhood experiences in antenatal care is limited. The objective of this study was to explore pregnant women's attitudes towards and experiences of an adverse childhood experiences questionnaire, and to assess the relevance of the questionnaire among a population of pregnant women referred to antenatal care levels one and two, targeting women who are generally not perceived to be vulnerable. Data were collected at three maternity wards and consisted of quantitative data on 1352 women's adverse childhood experience scores, structured observations of 18 midwifery visits, and in-depth interviews with 15 pregnant women. Quantitative data were analysed by descriptive statistics, and qualitative data were analysed using systematic text condensation. The qualitative analysis revealed two main categories: "Being screened for childhood adversities" and "Having adverse childhood experiences". In the study population, the prevalence of adverse childhood experiences was high. The women assessed the adverse childhood experiences questionnaire to be a relevant and acceptable screening method. Furthermore, women's perceptions of their relationship with their midwife greatly impacted their attitudes towards and experiences of the questionnaire.
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Affiliation(s)
- Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Sara Mbaye Karentius
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Sabine Marie Rath
- Department of Gynaecology and Obstetrics, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark;
| | | | - Mette Grønbæk Backhausen
- Department of Gynaecology and Obstetrics, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark;
| | - Katrine Røhder
- Department of Psychology, Copenhagen University, Øster Farimagsgade 2A, 1350 Copenhagen, Denmark;
- The Family Clinic, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospital, Pavillon 4, Østre Hospitalsvej 5A, 2650 Hvidovre, Denmark
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark (L.B.)
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark (L.B.)
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
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Johnsen H, Lichtenberg VD, Rydahl E, Karentius SM, Dueholm SCH, Friis-Alstrup M, Backhausen MG, Røhder K, Schiøtz ML, Broberg L, Juhl M. The Feasibility and Acceptability of the Adverse Childhood Experiences Questionnaire in Danish Antenatal Care-A Qualitative Study of Midwives' Implementation Experiences. Int J Environ Res Public Health 2023; 20:ijerph20105897. [PMID: 37239623 DOI: 10.3390/ijerph20105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; "Relevance of the adverse childhood experiences questionnaire", "Challenges related to use of the adverse childhood experiences questionnaire" and "Apprehensions, emotional strain, and professional support". The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives' acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women's boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.
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Affiliation(s)
- Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Sara Mbaye Karentius
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | | | | | - Mette Grønbæk Backhausen
- Department of Gynecology and Obstetrics, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Katrine Røhder
- Institute for Psychology, Copenhagen University, Øster Farimagsgade 2A, 1350 Copenhagen K, Denmark
- The Family Clinic, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospital, Pavillon 4, Østre Hospitalsvej 5A, 2650 Hvidovre, Denmark
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
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Severinsen A, Midtgaard J, Backhausen MG, Broberg L, Hegaard HK. Pregnant women’s experiences with sick leave caused by low back pain. A qualitative study. Work 2019; 64:271-281. [DOI: 10.3233/wor-192991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anette Severinsen
- The Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - Julie Midtgaard
- The University Hospitals’ Centre for Health Research (UCSF), Copenhagen University Hospital (Rigshospitalet), Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Lotte Broberg
- The Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Denmark
| | - Hanne Kristine Hegaard
- The Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital (Rigshospitalet), Denmark
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de Wolff MG, Backhausen MG, Iversen ML, Bendix JM, Rom AL, Hegaard HK. Prevalence and predictors of maternal smoking prior to and during pregnancy in a regional Danish population: a cross-sectional study. Reprod Health 2019; 16:82. [PMID: 31200725 PMCID: PMC6567454 DOI: 10.1186/s12978-019-0740-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Maternal smoking is still a major public health problem posing the risk of several negative health outcomes for both the pregnant woman and her offspring. The prevalence of maternal smoking in Denmark and other high-income countries has decreased continuously since the 1980s, and a prevalence below 10% of women who continue to smoke during pregnancy has been reported in studies after 2010. Previous studies have shown that low socioeconomic status is associated with maternal smoking. Information from the Danish Birth Register about maternal smoking shows that the prevalence of women who report to smoke in pregnancy has decreased continuously with 23.3% who reported ever smoking in pregnancy in 2000, 12.9% in 2010 and 9.0% in 2017. The aim of this study was to estimate the prevalence of maternal smoking at the time of conception and at 20 weeks of gestation in a regional Danish population, to describe differences in maternal characteristics among smokers, quitters and never-smokers, and to estimate predictors of smoking at the time of conception. METHODS A cross-sectional study was conducted among pregnant women receiving antenatal care at the Department of Obstetrics, Zealand University Hospital, Denmark from August 2015 to March 2016 (n = 566). The main outcome was smoking at the time of conception and at 20 weeks of gestation. The questionnaire also collected information about maternal, health-related and sociodemographic characteristics. Descriptive analysis was conducted, and multivariate logistic regression analysis was used to assess the potential associated predictors (adjusted odds ratio). RESULTS The prevalence of self-reported smoking at the time of conception was 16% (n = 90) and 6% smoked at 20 weeks of gestation (n = 35), as 61% of smokers quit smoking during early pregnancy. Multiple logistic regression analysis showed that significant predictors for smoking at conception were the socioeconomic factors; ≤12 years of education, shift work and being unemployed. CONCLUSION The prevalence of self-reported maternal smoking in this regional Danish population of pregnant women is lower than seen in previous studies. However, predictors for smoking at the time of conception remain to be factors of low socioeconomic status confirming a social inequality in maternal smoking. Women at risk of smoking during pregnancy must be identified in early pregnancy or even before pregnancy and be offered interventions to help them quit smoking.
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Affiliation(s)
- Mie Gaarskjaer de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mette Grønbæk Backhausen
- Department of Gynecology and Obstetrics, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Mette Langeland Iversen
- Department of Gynecology and Obstetrics, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Jane Marie Bendix
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, Hillerød, University of Copenhagen, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Ane Lilleøre Rom
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Kristine Hegaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, Denmark
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Ekelin M, Langeland Iversen M, Grønbæk Backhausen M, Hegaard HK. Not now but later - a qualitative study of non-exercising pregnant women's views and experiences of exercise. BMC Pregnancy Childbirth 2018; 18:399. [PMID: 30305060 PMCID: PMC6180661 DOI: 10.1186/s12884-018-2035-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence has shown that there are several physical and mental advantages of exercise during pregnancy. Despite this, the recommendations for exercise during pregnancy are poorly fulfilled. The aim of this study was to illuminate non-exercising pregnant women's views and experiences concerning exercise before and during pregnancy. METHOD The study had a qualitative design with an inductive approach and was analysed by content analysis. A total of 16 individual and face-to-face interviews were conducted with healthy pregnant women, mainly in the third trimester and living in Sweden. The participating women had not been exercising 3 months before pregnancy or during pregnancy. RESULTS The main category "Insurmountable now, but possible in the future" was based on the four categories: "Lost and lack of routines", "Feelings of inadequacy", "Having a different focus" and "Need for support". The women experienced that their lack of routines was a major barrier that prevented them from exercising. Other factors that contributed were, for example, pregnancy-related problems, long working days and prioritizing family life. The women described it as difficult to combine exercise with their focus on the pregnancy and they missed continuous support from the antenatal care provider. The women expressed a need for suggestions concerning exercise during pregnancy and follow-up on previous counselling, especially when pregnancy-related issues arose. Information about easily accessible alternatives or simple home exercises was requested. They felt immobile and were not satisfied with their inactivity and tried to partly compensate with everyday activities. The women identified the postpartum period as an important possibility for becoming more active, for their own sake, but also because they wanted to become role models for their children. CONCLUSION Continuous support during pregnancy is needed concerning exercise. Pregnancy is mostly a barrier that prevents exercise for this group of women but, at the same time, may be a motivator and a possibility for better health. As the result showed that these women were highly motivated to a life-style change post-pregnancy, it may be crucial to support previously non-exercising women postpartum.
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Affiliation(s)
- Maria Ekelin
- Department of Health Sciences, Lund University, PO Box 157, S-22100, Lund, Sweden.
| | - Mette Langeland Iversen
- The Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mette Grønbæk Backhausen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,The Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Gynecology and Obstetrics, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Hanne Kristine Hegaard
- Department of Health Sciences, Lund University, PO Box 157, S-22100, Lund, Sweden.,Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,The Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, Denmark
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Sørensen NO, Marcussen S, Backhausen MG, Juhl M, Schmidt L, Tydén T, Hegaard HK. Fertility awareness and attitudes towards parenthood among Danish university college students. Reprod Health 2016; 13:146. [PMID: 27964723 PMCID: PMC5154162 DOI: 10.1186/s12978-016-0258-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postponing parenthood has steadily increased during the past decades in Western countries. This trend has affected the size of families in the direction of fewer children born per couple. In addition, higher maternal age is associated with an increased risk of pregnancy-related complications such as prematurity and foetal death, while higher paternal age increases the risk of miscarriage and affects time-to-pregnancy. Hence, understanding the circumstances and reflections that influence the decision is greatly needed and little is known about potential gender difference influencing the choice. The aim was to investigate attitudes towards parenthood, intentions for childbirth and knowledge about fertility issues among men and women. METHODS We conducted a cross-sectional study based on a validated 49-item questionnaire among students, who attended selected mandatory lectures at a Danish university college in February to April 2016. The participation rate was 99%, and 517 completed the questionnaire. RESULTS Though the majority of all participants wished to have children in the future (>86%), there was significant difference between the genders (p = 0.002). Women rated having children to be more important than men did (p < 0.001), while men rated higher the likelihood of abstaining from having children if faced with infertility (p = 0.003). Knowledge about fertility issues was similar between genders including poor knowledge about the age-related decline in female fertility. While women found it more important to have children before being 'too old' (p = 0.04), still more than 40% of all respondents intended to have their last child after the age of 35 years. For both genders the most important prerequisite for parenthood was having a partner to share responsibility with. Perceived or experienced life changes related to parenthood were generally positive such as personal development. CONCLUSION The majority of respondents wished to have children, but many desired to have these after the biological decline in female fertility. The moderate knowledge level among both genders uncovered in this study is of concern. Future research should address the potential link between fertility knowledge and planning of parenthood. We may benefit from intervention studies examining the effect of routine preconception care.
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Affiliation(s)
- Nina Olsén Sørensen
- The Research Unit Women’s and Children’s Health, section 7821, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Signe Marcussen
- Midwifery Program, Metropolitan University College, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Mette Grønbæk Backhausen
- The Research Unit Women’s and Children’s Health, section 7821, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Gynecology and Obstetrics, Zealand University Hospital, Syghusvej 10, 4000 Roskilde, Denmark
| | - Mette Juhl
- Midwifery Program, Metropolitan University College, Sigurdsgade 26, 2200 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University, Akademiske Sjukhuset, SE-751 85 Uppsala, Sweden
| | - Hanne Kristine Hegaard
- The Research Unit Women’s and Children’s Health, section 7821, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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