Use of non-medical contraceptive methods: a survey of women in western Sweden

OBJECTIVES

To describe women's self-reported use of non-medical contraceptive methods (including barrier methods, fertility awareness-based methods and withdrawal), explore reasons for and satisfaction with choice of contraceptive methods and examine women's fertility awareness.

METHODS

A cross-sectional survey was conducted among women consulting at primary healthcare clinics not using medical contraceptives.

RESULTS

Most of the 648 participants (67%) reported using a mix of condom use, withdrawal and a calendar method, while 23% used only condoms. Eleven percent reported using the Billings ovulation method, diaphragm/cap or fertility monitor and found these methods highly satisfactory. A majority of the women who primarily used condoms also reported being satisfied. Most women actively chose non-medical contraception because it was perceived as without adverse effects, uncomplicated and effective. Fertility awareness was generally poor.

CONCLUSION

Frequent use of withdrawal and a calendar method, as well as poor fertility awareness, suggests a need for improved counselling at contraceptive clinics on fertility awareness and more effective non-medical contraceptive methods to assist women in making an informed contraceptive choice.

Sense of coherence in first-time parents: a longitudinal study

Background: Antonovsky’s idea of sense of coherence (SOC) is related to wellbeing and is of importance for individuals in public health care. SOC in parents with healthy children has not previously been studied. The objectives of this study were (1) to describe the SOC of first-time parents during the first 8 years of their child’s life, (2) to describe gender differences in regards to SOC, and (3) to describe covariates with SOC in the parents’ life situations. Methods: The study was longitudinal comprising three cross-sectional studies conducted when the first child was 6 months (T1), 4 years (T2), and 8 years (T3) of age. A sample of 258 mothers and fathers answered a questionnaire on the experienced quality of their partner relationship (QDR36) on all three occasions. SOC was measured using the SOC-13, and psychosocial variables were included at T2 and T3. Descriptive, comparative statistics and multiple regression analyses were performed. Results: SOC decreased for both genders at T2 and increased again at T3. At T1 and T2 the fathers’ SOC was statistically higher than that of the mothers, but at T3 this difference could no longer be statistically secured. Covariates at T2 were QDR index, social support, experience of parenthood, strained economy, and health. Covariates at T3 were experience of parenthood and social support, QDR index, and strained economy. Conclusions: SOC in first-time parents decreased at 4 years, especially in mothers, and social support can be of significance for parents of young children to be able to experience health.

Partner relationships and long-term sick leave among female workers: consequences and impact on dimensions of health and return to work

Few efforts have been made to prospectively identify resources and obstacles outside work that may predict regained work ability and return to work when workers are on sick leave. This study investigates the association between partner relationships and sick leave. Our research questions were as follows: (i) What is the influence of sick leave, pain, stress and domestic strain on the quality of the dyadic partner relationship?, and (ii) What is the influence of the partner and social relationship on pain, stress, work ability, self-rated health and return to work? A cohort of female workers (n = 225) on long-term sick leave (>60 days), all in a partner relationship, at 6-month intervals completed a questionnaire based on the Quality of Dyadic Relationship (QDR) instrument, the Interview Schedule of Social Interaction (ISSI), the Work Ability Index (WAI) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Univariate and multivariate analyses of baseline and prospective data were performed. The results showed that decreased partner relationship quality was related to having major responsibility for household work despite being on sick leave, having pain and having decreased social integration. Among younger individuals on sick leave, a reduction in the quality of the partner relationship was shown already at the first (6-month) follow-up, while among middle-aged women, such a reduction was seen only at the 12-month follow-up. No dimensions of partner relationship quality at baseline were related to dimensions of return to work, either as a resource or as an obstacle. Consequently, our results show that a good relationship does not keep the woman from returning to work. Having main responsibility for household work, which implies domestic strain while on sick leave, predicts lower partner relationship quality. The practical implications are that healthcare professionals treating women on sick leave should emphasize the importance of keeping a social network as well as making sufficient adjustments at home for the relationship quality to be safeguarded. Special attention should be given to the young woman on sick leave as being on sick leave seems to influence her partner relationship considerably.

Fetal movement counting--effects on maternal-fetal attachment: a multicenter randomized controlled trial

BACKGROUND

  Women presenting with decreased fetal movement have an increased risk of adverse pregnancy outcomes. Fetal movement counting may be associated with improvement in maternal-fetal attachment, which in turn, improves pregnancy outcome and postnatal mother-infant attachment. The study aim was to test whether maternal-fetal attachment differed between groups of mothers who systematically performed fetal movement counting and mothers who followed standard antenatal care where routine fetal movement counting was discouraged.

METHODS

  In a multicenter, randomized trial, 1,123 women were assigned to either systematic fetal movement counting from pregnancy week 28 or to standard antenatal care. This study sample included primarily white, cohabiting, nonsmoking, and relatively well-educated women. The outcome measure was maternal-fetal attachment, measured by using the Prenatal Attachment Inventory. Analysis was by intention-to-treat.

RESULTS

  No difference was found between the groups in the scores on prenatal attachment; the means and standard deviations were 59.54 (9.39) and 59.34 (9.75) [corrected] for the intervention and the control groups, respectively (p = 0.747). The mean difference between the groups was 0.20 (95% CI: -1.02-1.42) [corrected].

CONCLUSIONS

  Fetal movement counting in the third trimester does not stimulate antenatal maternal-fetal attachment. This result differs from a previous study where fetal movement counting improved maternal-fetal attachment. Further research with a focus on possible mediating factors such as levels of stress, concern, and other psychological factors is required.

Perception of marital quality by parents with small children: a follow-up study when the firstborn is 4 years old

Swedish couples' perceptions of their marital quality when their firstborn was 6 months old and then 4 years later were studied in 2002 and 2006, respectively. The results show that almost half of the 368 responding parents were satisfied with their marital relationship both in 2002 and 2006 as assessed by a modified Dyadic Adjustment Scale. However, a study of the various dimensions showed a significant decrease in marital quality. Housework and child care were perceived as having a greater strain on the relationship between couples who had had additional children during this period. Dyadic Sexuality and Dyadic Cohesion were the most significant predictors of marital quality. Covariates of marital quality in the group with additional children were "partner relation and parenthood perceived as a strain" and "perceived social support." The results emphasize the need for supportive interventions for parents with children aged 0 to 4 years.

Low maternal awareness of fetal movement is associated with small for gestational age infants

Our aim was to identify associations between information given to pregnant women about fetal activity, level of maternal awareness of fetal activity, maternal concern about decreased fetal movement, and pregnancy outcomes. This was a population-based cross-sectional study. Mothers with a singleton delivery were invited to answer an anonymous structured questionnaire before discharge from the delivery unit. Six hundred and ninety-one mothers participated (60.4% of eligible women). Women were highly aware of fetal activity. Yet, 25% did not receive any information from care providers about expected normal fetal activity. Receiving information about fetal activity was associated with increased maternal awareness (odds ratio, 2.0; 95% confidence interval [CI], 1.2-3.4). Low maternal awareness of fetal activity was associated with an increased risk of having a small for gestational age infant (odds ratio, 6.5; 95% CI, 3.5-12.3). Expectations about the normal frequency of fetal movements, as reported by the mothers, varied from 25 kicks/hour to 3 kicks/24 hours. Receiving information about expected fetal activity was associated with maternal concerns about decreased fetal movement, but not with improved outcomes. We conclude that receiving information about expected fetal activity was associated with maternal concerns, but not with improved outcomes.

Sensual and sexual marital contentment in parents of small children--a follow-up study when the first child is four years old

This follow-up study explored parents' (N=452) intimate relationships when their firstborn child was 6 months old and then 4 years later. The measurement used was a modified version of the Dyadic Adjustment Scale, DAS. The present results show that most parents responding were content sensually at 6 months postpartum in 2002 and 4 years later, in 2006. More parents had changed from being sensually content in 2002 to discontent in 2006, than the contrary, however, and the sexual contentment remained low. The average sexual frequency was low both at 6 months and at 4 years for both parents with and without additional children. Experiencing tiredness as a hindrance to having sex was perceived as a greater problem among those parents without additional children. Prospective regression analyses indicated that sexuality was significantly related to both sensual and sexual contentment 4 years later. Sexuality was also one of the most significant covariates in the cross-sectional regression analysis for sensual contentment. Since sexuality plays a central role in partner well-being, it may be an important target for helping parents with small children.

Factors influencing the quality of intimate relationships six months after delivery--first-time parents' own views and coping strategies

The aim of this study was to describe and analyze first-time parents' experiences of factors that affect the quality of their intimate relationship and the way they cope with their situation six months after delivery. The method used was inductive qualitative content analysis of two open questions in a larger questionnaire. The data is based on 535 respondents' statements. The factors affecting the quality of the intimate relationship were available or missing and could be classified into four categories. 1. 'Coping by adjustment to parental role', e.g., mutual support as new parents, 2. 'The couple's 'intimacy', i.e., togetherness and love, 3. 'Coping by communication', i.e., verbal and non-verbal mutual confirmation, and 4. 'Coping with external conditions', e.g., by seeking social support. The results are described in a model, which could constitute a basis for the promotion of health in family health care, with the aim, if possible, of preventing unnecessary separations/divorces after couples become parents.

Quality of intimate and sexual relationship in first-time parents six months after delivery

This study aimed to describe the quality of the intimate relationship among parents six months after the birth of their first child. The Dyadic Adjustment Scale (DAS) has been modified and used on 820 responding first-time parents, of which 768 were couples. The results reveal that most parents were happy in their relationship, but both mothers and fathers were discontented with the dyadic sexuality. "Being too tired for sexual activity" was a problem, especially for the mothers, and the most common frequency of intercourse was once or twice per month. The result does not support the assumption that the couples compensate the lacking sexuality with sensuality. Good communication within the couple was associated with higher levels of several dimensions of the intimate relationship, especially dyadic consensus and satisfaction. Thus, one way to stabilize and strengthen a relationship when dyadic sexual activity is low would be to emphasize dyadic communication and sexual activity.

Assessing the quality of the dyadic relationship in first-time parents: development of a new instrument

The purpose of this research was to psychometrically evaluate the Dyadic Adjustment Scale (DAS), modified for use with new, first-time parents by extending the items of communication, sensuality, and sexuality. A total of 820 Swedish respondents, 6 months after the birth of their first child, participated in the study. Psychometric evaluation was conducted with factor analysis. The obtained factor structure was tested with multitrait analysis program. Thirty-three items were found to fit into a five-factor solution, explaining 50% of the total variance. Descriptive data revealed that most new parents were satisfied with their intimate relationship in general, but dissatisfied with their sexual lives. The modified DAS, now called the Quality of Dyadic Relationship Instrument includes 33 items and seems to be a useful, updated measurement for assessing quality of the intimate relationship in new first-time parents.

The baby was the focus of attention - first-time parents' experiences of their intimate relationship

The baby was the focus of attention - first-time parents' experience of their intimate relationship. The purpose of this study was to describe the phenomenon of 'first-time parents' intimate relationship', to focus on their mental health, and the ability to support them professionally. Ten Swedish parents (five couples) were interviewed on two occasions, when the first baby was 6 and 18 months old, respectively. A descriptive phenomenological method was used. The findings show that the essence of the phenomenon is 'The baby was the focus of attention'. This had different meanings for the couples, putting them in two categories. For the first category, the essence was that the baby was the focus of mutual concern, which implied a fostered relationship. The strain of parenthood in this category was mild. In the second category, the baby was focused on at the expense of the father, who felt rejected emotionally. This impaired the relationship and parenthood involved a severe strain. The way the spouses communicated differed between the two categories. This study shows that mental health can be affected, especially among first-time fathers, and this could jeopardize the relationship and family health. An awareness of this fact is needed among the health professionals giving care to first-time parents.