Discussion
vaginal bleeding
LATE PREGNANCY, VAGINAL BLEEDING, LEAKAGE OF AMNIOTIC FLUID, SECONDARY, SAID
The aim of this study was to evaluate a model of gANC for Somali-speaking women in Sweden. No differences regarding overall ratings of ANC were detected; however, the reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline. In late pregnancy, women in gANC were happier with received pregnancy and birth information compared with women in standard care.Participants in gANC rated their ANC experience at least on par with women who received sANC. The decrease in EPDS mean scores was larger in women in gANC than in sANC, adjusted for differences at baseline. The gANC group had relatively high EPDS median scores,The most interesting differences detected between the gANC and sANC groups were related to secondary outcomes. Women attending gANC were more likely to say that they had received sufficient information than women in sANC on most aspects of childbirth studied. Findings on the women’s knowledge of danger signs were also promising. A higher proportion of women in gANC gained a better understanding of which healthcare facility to turn to for danger signs like vaginal bleeding and leakage of amniotic fluid. Information and education have been identified as essential in midwifery-led ANC, for adequate knowledge and for women to better understand the healthcare system, and women prefer health professionals who combine clinical knowledge and skills with interpersonal and cultural competence.Additionally, gANC may have played a role in strengthening social networks as intended. Nearly all women in gANC said they had someone who could help with a temporary place to live should they need it, compared with 25.0% of women in standard care 2 months post partum. Additionally, nearly all women in gANC reported that they had made new friends through the ANC clinic during pregnancy, compared with only half of women in standard care.The women in gANC had more appointments with the midwife compared with women in standard care, possibly because individual appointments were shorter in gANC. As a result, additional appointments were booked, rather than extending the time for each appointment when more time was needed. gANC is a complex interventionThe inconsistent evidence about the impact of gANC on improved ratings of care and obstetric outcomes may also be due to substantial differences between settings in the quality of sANC, as suggested in a Canadian study that found that gANC was comparable with individual care on most outcomes measured.