Care in Labor: A Swedish Survey Using the Bologna Score

Abstract

The findings suggest that in Sweden, birth is managed according to scientific evidence to a limited degree. Large differences among units also suggest that care in childbirth is based on attitudes rather than on scientific evidence. The Bologna Score was easy to use and gave a good picture of how care was given at the participating maternity units. We suggest that the instrument is useful as a quality indicator for intrapartum care.

Measuring the quality of documented care given by Swedish midwives during birth

“…The study took place at only one unit and the findings cannot be generalised to all other units in Sweden or in other countries. However, in this study documentation was scrutinized using a validated instrument (Sandin-Bojö et al, 2004) and the results are largely similar to results from other studies carried out in Sweden Sandin-Bojö & Kvist, 2008) and may therefore be indicative of how midwifery care is conducted in Sweden. The sample size was based on convenience rather than on a calculation of power and therefore results of the comparisons between low risk and high risk groups should be viewed with this in mind.…”

“…In this study only 27.8% of the women gave birth in a non-supine position which can be compared to 34.7% in a national Swedish study (Sandin-Bojö & Kvist, 2008). It is unclear whether this was the women's choice.…”

“…A national study in Sweden (Sandin-Bojö & Kvist, 2008) showed that some midwives considered births as normal even though epidural analgesia and oxytocin infusion were used, which endorses the Canadian statement and may be an indication that intervening in the birth process is becoming more and more accepted by the professions. A doctoral thesis from Sweden (Hellmark-Lindgren, 2006) discusses how on the one hand professionals emphasize pregnancy as a healthy condition and on the other they contradict themselves by the way in which they survey pregnancy by looking for deviations.…”

“…A recent national survey of midwifery care in Sweden posed a question to midwives regarding the risk status of the women in the study (Sandin-Bojö & Kvist, 2008) but the survey did not ask about the use of risk assessment at individual units and it remains uncertain to what extent this practice is routinely used in Sweden. At the hospital where this study took place, it was not routine to carry out risk assessment either on the woman's arrival at the maternity unit or during the birth process.…”

“…Earlier studies of documented care from Sweden have suggested that midwifery care given to 4 women whose pregnancy and labour are considered low risk, differs little from the care given to those considered at high risk Sandin-Bojö & Kvist, 2008). Since risk status can change for many reasons, suggestions have been made that it would be interesting to measure the process of intrapartum care (Wiegers et al, 1996;Murphy & Fullerton, 2001;Sandin-Bojö et al, 2004).…”