All posts by researchingparents

I am a parenting researcher, focusing on children and families. I earned my PhD in Women's and Children's Health at Uppsala University in Sweden. My research focuses on the intervention and implementation of parenting programs, looking at parent and child outcomes. I have also done research on public policies, especially family policies in Sweden, such as parental leave and the concept of gender equality, especially from a fathers' perspective. My previous research has been on similar topics: parenting, preschool aged children, education, father involvement, teacher retention, child health nurses, and the influence of environments on parental involvement. In my free time, I love to stay active by running, biking, and swimming (competing in triathlons), as well as anything outdoors that's active, like hiking, camping, canoeing, white water rafting, kayaking, and cyclocross. I also do a fair amount of traveling and enjoy meeting new people and learning about other cultures first hand.

Supporting fathers in the Swedish child health field

I recently published a literature review and meta-ethnography entitled Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals in Acta Paediatrica.

This article received a lot of attention when it was first published. For example, Sverige’s vetenskapsradio first interviewed me on the findings. Then TT picked it up, meaning that the story was in every newspaper, from national to local newspapers. Before being interviewed by a national news program, Rapport.

It was further promoted by different organizations, such as Män för Jämställdhet. And other writers/bloggers talked about it.

What was really cool was that Sven Bremberg was asked by Acta Paediatrica to write an editorial which he called Supporting fathers is essential in the child health field

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So I had my 15 minutes of fame.

Now, a year or so later, I have finally had the time to make my first video. I’ve always wanted to promote my research through videos, but haven’t had the time. I’m highly critical of the final product, both of the video and the content, but it was my first attempt and it was a fun learning experience.

In fact, as a researcher, it’s hard to see your work lose it’s nuance. I thought enough nuance was lost when publishing it, as word counts affected how many details I could say. But trying to make a 5 minute video left very little room for nuance.

What I attempted to do was to show four examples–one from each arena within the child health field: prenatal, labor & birth, postnatal, and child health centers. I wanted to show two positive examples of ways midwives and nurses support fathers and two examples where support could be improved. However the two examples of improved support are more on the organizational/managerial level, rather than critiques of midwives’/nurses’ attitudes and support given to fathers.

Perhaps future videos will be made to provide a more nuanced understanding of the support fathers receive in the different child health arenas. Until then, I have my first overview video.

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2016 Research Year in Review: Grants, Publications, Citations, and Media Attention

So it’s September 2017, and I’m just now getting around to my 2016 yearly review 🙂 I guess being off on parental leave all year certainly takes its toll on free-time and how I allocate that time.

Luckily, I made screenshots on January 1st of various markers to better record my early review.

To see what I’ve accomplished this year, I want to go back and see what I did last year for comparison purposes. Luckily I can click on this link to remind myself. Marking my first full year as a postdoc, 2016 was a great year!

My single biggest research accomplishment was that I secured my very first research grant! I applied for a gender-focused research grant through Stockholm’s Läns Landsting (County Council). The grant is for 500,000 SEK for two years (250,000 SEK per year). So while not a huge grant, it was very exciting to receive my first grant. And this grant allows me to continue my father research.

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In 2017, Stockholm county will implement a new father-only visit when the child is three-to-five months old. I received the grant, along with co-applicant, Dr. Malin Bergström, to evaluate the implementation, as well as the familial outcomes of this community-based intervention.

While I had some temporary postdoc positions in 2015 with Child Health and Parenting (CHAP) at Uppsala University and at the Centre for Health Equity Studies (CHESS) at Stockholm University, in 2016, I started a 100% position in Child and Adolescent Public Health Epidemiology Group, Department of Public Health at Karolinska Institute under Dr. Finn Rasmussen. However, wanting to continue my research with Dr. Malin Bergström at CHESS on fathers in the Swedish child health field, I negotiated an 80-20 split.

Finn hired me to run a Job Seeking intervention for young (18-24) high school dropouts who were currently seeking employment, among other register-based research. This project took a dramatic turn before I even started–instead of working with Arbetsförmedlingen, we would now need to run the project ourselves, meaning we would make the program online. Similarly, we needed to device a whole new manual, as some collaborators from Finland, with their School2Work program, fell through.

So I started working on this project from scratch throughout the year, in collaboration with Finn and Dr. Ata Ghaderi.

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Publications were still ongoing however. In 2016, I had five publications:

  1. Wells MB. Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals. Acta Paediatrica. 2016;105(9):1014-23.
  2. Wells MB, Sarkadi A, Salari R. Mothers’ and fathers’ attendance in a community-based universally offered parenting program in Sweden. Scandinavian Journal of Public Health. 2015;44:274-80.
  3. Wells MB, Lang SN. Supporting Same-Sex Mothers in the Nordic Child Health Field: A Systematic Literature Review and Meta-synthesis of the Most Gender Equal Countries. Journal of Clinical Nursing. 2016;25(23-24):3469-83.
  4. Bergström M, Wells MB, Söderblom M, Ceder S, Demner E. Projektet Pappa på BVC: Barnhälsovården i Stockholms län 2013-2015. Stockholms län landsting: 2016.
  5. Wellander L, Wells MB, Feldman I. Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems. Journal of Mental Health Policy and Economics. 2016;19(2):91-101.

Technically, #2 came out in December of 2015, and therefore I reported it last year. In addition, #4 is a Swedish report, not a peer-review article. So I had three new peer-review articles published in 2016; two of which were meta-sythenses. While many postdocs may have more publications in a year, I was quite proud for two reasons: 1) it takes a PhD student four years to publish 3 papers and one manuscript, so having recently received my PhD the year before, I liked the idea of doing a “PhD” in one year and 2) I just had my first child in January 2016, and so it was a hectic year with a nice parenting learning curve on top of juggling full time work and commuting from Uppsala to Stockholm daily.

I took a course on how to conduct Systematic Reviews and Meta-analyses, but quickly learned that most studies completed in the child health field are qualitative in nature. Therefore, I independently learned about meta-syntheses and meta-ethnographies, and then completed two articles using these methods. I was very proud of these articles because 1) I learned a method and completed it on my own (for one of the articles) and 2) I was able to contribute a larger voice to how parents are and are not supported in the Nordic and Swedish child health fields, respectively.

It wasn’t only me who was proud–apparently other researchers were also proud. For example, Dr. Hugo Lagercrantz, the editor of Acta Paediatrica, wrote about my findings in his “highlights in this issue”. Having published in Acta Paediatrica a couple of times before this, it was cool to see my research being highlighted.

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But, then they invited Dr. Sven Bremberg to write an editorial on why we should “Support fathers in the child health field“, where he springboarded his editorial based off of my article. That was super cool! To see a well-known researcher highlighting why your research is important and necessary. Boom!

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Sweden also wanted to get in on the conversation!

While I had had a few interviews before, I had my 15 minutes of fame after publishing these back-to-back literature reviews, although much more notoriety and focus was on fathers, rather than same-sex mothers, sadly.

Initially vetenskapsradio (science radio–sort of the Swedish NPR radio station) interviewed me, paying particular attention to my findings on the ways fathers are treated throughout the Swedish child health field. It was a really pleasant experience, even though I desperately struggled to say one or two sentences in Swedish.

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After that news story broke, I not only had friends calling, texting, and Facebooking messages to me saying they heard me on the radio (I didn’t even know people listened to vetenskapsradio), but also TT, a news reporting agency similar to the Associated Press, picked up the story and re-reported it (without talking to me). This meant that the story was in basically every Swedish paper, from national papers to small local ones.

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Newspaper

By the afternoon, I had received a phone call from Rapport; I was going to be on the national evening news. That was exciting!

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And then my day long fame had ended….until I met a father at a park three weeks later, and he recognized me from the news report. That was a cool feeling!

My citations also significantly grew. In 2015, I had 74 citations, while at the start of January 2016, I had 118, according to my ScholarGoogle page. My h-index increased from 5 to a 6, while my i10-index increased from 2-5.

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ResearchGate numbers also grew. In 2015, I had 1066 reads and in 2016 I had 2310. ResearchGate however has far fewer reads than the publications website and the number of citations ResearchGate finds is considerably lower than ScholarGoogle or even PubMed. Moreover, they keep changing their metrics, so it’s hard to compare year to year, but my ResearchGate score went from a 16.87 to 20.02.

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I have also been able to do a bit of teaching, although not nearly enough. For example, I have given lectures in 1) Sexual and Reproductive Health I (a course for midwives in Women’s and Children’s Health), where I talked about the importance of involving fathers in the child health field and 2) How to Conduct a Literature Review and Meta-analysis mainly for PhD students/postdocs in Public Health, where I talked about conducting a meta-synthesis.

I was however also invited to give a talk at “Mödra- och barnhälsovårdens gemensamma studieeftermiddag” where again, I discussed fathers in the Swedish child health field.

Lastly, I helped to write a debate article that was printed in Svenska Dagbladet, a major Swedish newspaper on supporting fathers.

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While I never heard from the public on this issue, I did upset a colleague by participating in this debate article. I guess you just can’t please everyone.

 

Sixth Parental Group Meeting:

This is the last parent group meeting pre-children. It was held in the morning (second meeting at this time point), and every parent showed up for this final meeting.

The meeting opened with a psychologist talking about the post-pregnancy blues. She defined that has the mother having a lot of hormonal changes, often leading to crying, especially for the first three days, as well as having symptoms of depression.

The psychologist further stated that if the depressive symptoms lasted for 10 days or more, then the parent (either the mother or the father may have postpartum depression) should call the psychologist (who seemed to be funded through the antenatal clinics).

Her main message:

  1. Don’t be too hard on yourself
  2. Call a psychologist sooner rather than later
    • So symptoms don’t get worse
    • The parent can start receiving support.

The midwife then took over and advised us to break into groups, while eating fika, to discuss how we currently divide our time as a couple and for personal time (today) and how we plan to divide our time as an individual, a couple, and as a family once the baby arrives.

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The midwife though didn’t offer any sage advice. Rather, she simply listened as each group described their time spent with the family, the relationship, and by themselves.

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Our answers: Notice our alone time didn’t change, but we increased our overall family hours by 14 hours believing we’d receive 2 hours less sleep per night spent on the baby.

She then thanked us and wished everyone a Merry Christmas!

We will meet one more time in March, after everyone has their baby.

Fifth Prenatal Parent Group Meeting: Visiting the Labor & Birth Ward

At the fifth prenatal parent group meeting we were told to not come to our usual meeting place; instead, go to Uppsala’s Academic Hospital.

Everything suddenly became so real. The ultrasound brought the baby to life. Charting the growth of the uterus was exciting!

Going to the hospital where my baby will one day be born = slightly scary and exhilarating.

One couple and one expectant father did not show up to this meeting. The rest of us searched for where we were supposed to go….but luckily we had found each other 🙂

Eventually we worked our way down to a basement, and found the rest of the group. A midwife from Hjärtet met us there, introduced us to another midwife who works in the labor & birth ward, and then left us with her, while we got the grand tour.

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We started by seeing the waiting room, where we were told that while expectant mothers are fed, there is no food for the expectant fathers; therefore, they are encouraged to bring their own food, label and date it, and put it in the fridge. Or they could go upstairs and buy food at the food court (if you happen to give birth during normal business hours).

Then we made our way to the bathing area. There was a large bathtub that expectant mothers are encouraged to go in while they’re in labor. There’s even enough room for the expectant father; although we’re told he should wear a bathing suit (apparently because the medical staff may walk in, and for some unknown reason, seeing a naked man, but not a naked woman, is unacceptable).

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Then we made our way to a potential birthing room. It was dull and drab. The midwife pointed out that there were no curtains. And then pointed out that we should feel free to bring objects and entertainment with, since we could be there for several hours before actually giving birth.

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We all sat around the rim of the room, while the midwife sat in the middle, demonstrating to us different tools that could be used, as well as different ways expectant mothers could use the room.

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The size the baby will be, along with a demonstration of holding the baby, resting on the mothers’ chest, and cutting the umbilical cord.
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A cord used to measure the infant’s heartbeat.
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A close-up of the bit that actually measures the heart beat.
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A manual vacuum extraction pump.

This was a very informative visit, and let expectant parents know what to expect, see where to go, and feel more comfortable in their soon-to-be surroundings.

Side note: Interestingly, nearly all of the expectant fathers asked various questions about the birthing process, the medical instruments the midwife described, and made joking comments, while only one expectant mother (Lisa) asked a question.

Second (cultural) side note: There was one comfy leather chair to sit on, while nearly all other chairs were hard metal (e.g. not comfortable). In typical Swedish fashion, no one took the comfy chair until the last couple came in. And then the expectant mother sat on the only remaining metal chair, giving the comfy leather chair to the expectant father….a few minutes later he got up and gave it to his partner.

 

Fourth Prenatal Parent Group Meeting: Tragedies of Giving Birth

At the fourth prenatal parent group meeting we discussed some of the complications and tragedies of childbirth.

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Some people did not attend this meeting. While all of the previous meeting had been held in the afternoon, this was the first meeting held in the early morning. One couple came late (traveling from Uplands Väsby), one researcher couple did not attend, and an expectant father (who lives in Örebro).

All expectant parents who attended noted how tired they were.

Quick side note: The midwife always uses the term “pappa/partner” despite the fact that everyone is an expectant father, and one person will be an expectant grandma.

The meeting kicked off by having a child health nurse from the child health centers (barnvårdcentral [BVC]) come in and introduce herself, as well as discuss what the BVC is good for:

  • A place to visit while the child is 0 – 6 years old
  • Do child health check-ups (preventive work)
    • Growth and development
    • Weight and height
  • Offers parenting advice
  • Parent education classes during the infant’s first year

Then the midwife re-entered the room to start discussing the complications of pregnancy.

Pre-Birth

A rehash from the third meeting was stated–where expectant parents should stay comfortable prior to coming to the hospital via massages, baths, and doing other soothing activities (e.g. petting your pets).

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When to go to the Labor & Birth Ward

We were instructed to go to the labor and birth ward not when the expectant mothers’ water breaks, but when she has had three contractions in the span of ten minutes. Each contraction, we’re told, should last for about a minute and will be intense and mildly painful (I say mildly only in comparison for what’s to come).

Prior to this, she may have a contraction every hour (or even more often), but if they are that far apart, there is no reason to rush to the hospital.

We’re told that the water breaking can be quite different for different people. Some actually have a gush of fluid come out of their vagina, letting everyone around them know they’re going into labor soon, while others have little to no liquids leaving their body.

Ways to Give Birth

There are a variety of ways to give birth–laying on your back, kneeling, standing up, in water, etc. In Sweden, we’re told by the midwife, that they encourage expectant mothers to walk around, to use their hospital room, to use a pilates ball prior to giving birth.

If expectant mothers are having pain, they can use epidurals, laughing gas, sterile hot water, acupuncture, and a few other things. Little information is given about the consequences of using any of these methods; although each method is described (e.g. how it works, how you feel if you take it).

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Different methods of pain relief.

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A Normal Birth

We were told by the midwife that in most cases, parents have a normal birth, meaning that they do not need to have a cesarean section, that the father will cut the umbilical cord, and that the baby will immediately start to breastfeed, while the mother is topless (skin-to-skin contact).

Immediately following birth, the baby will be placed on the mothers’ chest, and be encouraged to start breastfeeding. After one to three minutes, the umbilical cord will be cut. We’re told that this will allow all of leftover nutrients still in the umbilical cord to reach the baby.

The placenta, we’re told, should come out within the first 30 minutes. If not, a procedure will need to be done in order to remove it.

Breastfeeding
The importance of breastfeeding immediately following birth and the baby’s first meal is stressed. Apparently there are extra vitamins/nutrients in the first eating that are stored in the mothers’ breast; therefore, expectant mothers shouldn’t try to pump breast milk prior to giving birth. This process could take a while, and complications do arise with baby’s potentially not having a good sucking reflex. Of course, mothers may also experience tender nipples.

The Fathers’ Turn

Due mainly to breastfeeding, after the mother has had the infant for about an hour, the father can than start to hold the baby, with skin-to-skin contact being the preferred method.

Vacuum Extraction

Some infants require birth via vacuum extraction. This can happen in one of two ways-either they put a suction-cup on the baby’s head via the vaginal canal and then pull the baby out using the strength from their hand (and only pulling when there are contractions) or to use an electrical machine that does basically the same job as the manual vacuum extraction.

Doing this, we’re told, will not damage the infant, but will leave a red mark (bruise-like feature) on the top of the baby’s head (where the suction-cup was placed).

Acute and Super Acute Cesarean Sections

While some expectant mothers will have a planned cesarean section, others, she warned, will have either an acute cesarean section or a “super acute” cesarean section.

The main difference refers to the amount of prep time doctors, midwives, nurses, and other staff have to prepare for the cesarean section. In a typical acute situation, the midwife said that they normally have about thirty minutes to prepare pre-cesarean. Life is less chaotic for the expectant parents and for the medical staff. However, if a “super acute” cesarean needs to happen, then it means that either the infant or expectant mothers’ life is in danger and the infant needs to be removed (for lack of a better word) immediately. In this scenario, medical staff have maybe up to 15 minutes to prepare, and the expectant parents’ hospital room is typically swarmed with multiple medical personnel, which can cause not only chaos between the two expectant parents, but also added stress, frustration, and alarment. Therefore, it’s important to be aware that this scenario could happen.

After the C-section

We were then warned by the midwife that after a cesarean section, the new father would be handed the baby, and they would be left to their own devices for probably 2-4 hours, while the mother is taken to an operating room to be sown up and recover from surgery.

Only after she’s alert again, will the father, infant, and mother finally unite as one family, and breastfeeding can then commence.

Conclusions:

Since many expectant parents can have great amounts of fear regarding giving birth, it’s great to know what your options are and what to expect. This meeting provided a lot of useful advice.

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Lisa took copious notes.

 

Third Prenatal Parent Group Meeting: Preparations for Birth

At the third parent group meeting we discussed what would happen right before you go to the hospital to give birth.

No one was missing, except my partner.

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We first went over topics we had discussed at the previous meeting (e.g. relationships), and then started jumping into preparations for giving birth.

We were all handed a book on breastfeeding (slightly weird, since we talked at length about breastfeeding during the first meeting).

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The midwife checked in with all people present about their current pregnancy situation–one by one. In other words, expectant mothers were not given any extra time or questioning compared to expectant fathers.

Most expectant mothers complained about losing sleep, changing their walking habits, and looking forward to not being pregnant. While most of the guys either agreed with their partner or restated similar sentiments.

Two women complained about a pain in her side. The midwife, later in the evening brought up this ligament in her talk, and suggested that due to the baby growing, the pain from the ligament could affect every expectant mother.

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Since Lisa wasn’t present, I spoke for her, saying that she was losing sleep, but that she was waking up a couple of times a night due to her acid (no solutions or suggestions were provided).

I then said that I was losing sleep and needed to support Lisa during the night with her acid. This was met with laughter from the parents, with one expectant mother exclaiming “oh, poor you.”

“No seriously,” I replied. “And I can see the lack of sleep starting to affect both of us. Now not just one person is irritable, but two people are, which can add to various relationship problems.”

People still laughed, although not as much as the first time. The midwife waited a second before moving on to the next person. Actually, in thinking about it, not only did the midwife not validate my concerns, but she failed to provide any insight to any individual or couple–she let everyone talk about their problem(s), but offered no sage advice or even thoughts.

Sage Advice

After we were all done sharing our problems and concerns (and joys) related to the pregnancy, the midwife then went over several “useful” tips for preparing for birth.

  • Take baths to relax your body
  • Have your partner give you a massage
  • Do relaxing things in your house
  • Play with your pets
  • Take a shower/bath before going to the hospital
  • Eat food before going to the hospital

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We then did a basic profylax course. Profylax is a type of massage that you can give to your partner to make them feel better. There are whole courses that you can take (for a fee) that teach you how to do profylax massages so that when you give birth, your partner can massage the expectant mother to 1) make her feel more comfortable and 2) give the expectant father a role in the birthing process.

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A couple practicing profylax

Side note: I heard from people who took the profylax course that the course had good information, brought the couple closer together (in that they were now both focused on the pregnancy and the importance of giving birth), but that it wasn’t necessarily worth the money. (Sadly I can’t remember how much it costs, maybe 2000 SEK? or thereabouts).

Partners’ Role

The partners’ role was quite basic–be there for the expectant mother. There was little discussed in the way that expectant fathers are important and that they have a right to be at the birth; let alone, what the experience of being there means for the father, for the couple, and for the family. Father’s (partners) were discussed, but mainly in terms of taking care of the expectant mother, and mainly via making her feel comfortable (destressing her in various ways, especially via massages).

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At the end of the meeting, I approached the midwife to go over the highlights from the night (just to make sure I understood everything–after all, I knew Lisa would be asking). After going through the key material, she also handed me an extra book on having a baby (in English)…just to make sure I understood everything that was in the seminar.

Second Prenatal Parent Group Meeting: Relationships

Unli2000px-Svenska_kyrkan_vapen.svgke the first prenatal parent group meeting, not everyone showed up. Two couples did not come: expectant mom/dad who live in Uppsala and an expectant mom/grandma who live in Upplands Väsby.

This second meeting was not led by the midwife, but rather by two people from the Swedish church.

Their topic of the day: Relationships.

They talked a bit about the importance of maintaining a healthy relationship (surface level information): life is tough, having a baby complicates the relationship, make time for each other, support each other, etc.

They then kept the meeting quite interactive, either in small groups, as a large group, or with your partner.

We then broke up into groups, purposefully separated from our partners. In these groups we were to discuss what we need to have a strong loving relationship.

Expectant parents discussed typical things like supporting each other, listening to each other, discussing financial issues, and help each other feel good (see complete list [in Swedish] below).

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After this, we broke for fika. During fika, several expectant parents joked and commented that we were receiving relationship advice from two members of the Swedish church. Apparently, being connected to the Swedish church, at least as far as relationships is concerned, isn’t so highly respected.

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When class started back up, we played a game: To what extent do you agree with the following financial statement:

  • I charge all of my items on a credit card.
  • I just want to have new products for the baby.
  • I like to save as much money as possible.
  • I want to buy used baby products.

If you completely agreed, we were to walk to a woman and if we disagreed, we were to walk to a man (or end up somewhere in between). This would then inform us where we stood, especially relative to our partners. After talking with a few couples (and my own relationship)–no one seemed surprised about where they and their partner ended up. In other words, we all seemed to at least know the spending habits of our partners.

We then met one-on-one with our partners to discuss three things that we think will make our partner a great parent.

The night finished up with some communication tips:

  • “I statements” were emphasized
    • I feel; I need
  • Remember to take a step back before having a big discussion
  • Talk with each other when you start having feelings about something

Then just to be cheeky, I wrote”make-up sex”.

Turns out the leaders actually liked this (or it was coincidence), because then they went into a 10 minute diatribe about the importance of maintaining a healthy sex life and to talk with each other about your sexual feelings.

We then wrote down on a piece of paper things that turn us on–and we were to discuss that with our partners once we went home.

Lacking Couple Relationships within the Context of Parenting
The information covered was fine and fun, but had little to do with becoming a parent. I felt like the leaders could have tailored the meeting better to talk about relationships pre- and post-children: what to expect, and how to deal with problems while raising a child.

For example, how not to fight in front of the child, how the baby alters relationship roles, how conflicts can intensify when new parents are stressed and lacking sleep, how conversations become duller because of exhaustion from parenting, etc.

Oh well–you get what you pay for (#free).