Public defence in health science: Sofia Tallhage

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Abstract

Aim: This study aimed to explore midwives’ experiences and views of amniotomy and its prevalence and complications in Sweden.

Methods: Study I was a qualitative study in which 16 midwives participated in individual interviews. Data were analysed using content analysis. Studies II, III, and IV were quantitative, for which register data from the Swedish Pregnancy Register were used, covering 95% of all births in Sweden in 2014-2020. Analyses were performed using descriptive and comparative statistics, as well as simple and multiple logistic regression.

Results: The midwives’ experienced and viewed amniotomy as both a simple everyday task and as an intervention demanding respect and wanted a clear indication of when to perform it. The overall prevalence of amniotomy in Sweden was 40%, however, variations between hospitals were observed. A decrease in the prevalence was seen for women belonging to Robson groups 1 and 3. The severe complication of umbilical cord prolapse is rare in Sweden, affecting 0.13% of labours with amniotomy. Higher parity, a baby in non-cephalic presentation, induction of labour, previous caesarean section and polyhydramnios were identified as risk factors for umbilical cord prolapse. Severe perineal trauma is more common for women who undergo amniotomy, thus amniotomy was not identified as a significant risk factor when adjusting for other risk factors in regression analysis.

Conclusion: This thesis provides evidence about amniotomy from different perspectives, including midwives and register data. Decisions on amniotomy were customized to each woman, based on the midwife’s knowledge and experience, but also regulated, and affected by the working environment. Almost half of the women who give birth in Sweden undergo amniotomy, however, variations in the prevalence between hospitals were observed. A decrease in the prevalence was seen for women with spontaneous onset of labour. Umbilical cord prolapse is a rare complication to amniotomy. Beyond previously confirmed risk factors, women with previous caesarean section and induced labour should be carefully evaluated in the decision-making of amniotomy. Amniotomy is frequently used in labours where other, confirmed risk factors for severe perineal trauma are present. Amniotomy is thus not a significant risk factor for severe perineal trauma when adjusting for the risk factors.

Keywords: Amniotomy; Complication; Labour intervention; Nulliparity; Midwifery; Multiparity; Prevalence.