Using the Internet as a source of information during pregnancy — A descriptive cross-sectional study in Sweden
Introduction
A pregnancy is a transformative time in a woman's life. Her body changes, questions are raised about the baby and the new lifestyle that awaits the family. Most women want assurance about their pregnancy being normal and thus seek information in order to be able to feel a sense of security. Antenatal care (ANC) is an important source of information during pregnancy, however, many women have a need for information in between visits that can be weeks apart. The Internet provides an easy access for women to seek knowledge about pregnancy, childbirth and social support, but the broad scope and great amount of information available can be difficult to evaluate and assimilate.
ANC in Sweden is mainly provided within the public healthcare system. One aim of the ANC is to achieve ‘good sexual and reproductive health for the whole population’, which is in agreement with the WHO definition of sexual and reproductive health. Almost all pregnant women in Sweden (99%) attend ANC, which is free of charge (SFOG, 2008). Midwives have the responsibility and the authority to care for women with normal pregnancies and uncomplicated childbirths. They identify risk factors during pregnancy that could result in complications for the mother or fetus. An obstetrician is consulted if needed. National guidelines specify eight to ten visits for uncomplicated pregnancies and one postnatal visit at 6–12 weeks post partum (The National Board of Health and Welfare, SOU, 2008: 131).
The midwives provide psychosocial support to the pregnant woman and her partner, as well as the medical screening and check-ups. This support includes information and advice to facilitate problem solving and empowerment to improve self-care and prepare the couple for childbirth and parenthood. Luyben and Fleming (2005) confirm that pregnant women have physical, emotional and social needs such as wanting reassurance, confirmation and information. It is important to find encouragement and to share their experiences including negative feelings. They turn to the ANC in order to fullfill these needs. All expecting couples should be offered parental education classes. The purpose of these classes is to prepare for the childbirth and strengthen the couple's ability to become parents (The National Board of Health and Welfare, SOU, 2008: 131). Approximately 70% of nulliparous women attended parental education classes in Sweden 2014, and there has been a decrease in attendance in the last five years (The Swedish pregnancy register, 2014).
Previous research has shown that women all over the world use the Internet as a source of information during their pregnancy. A study among Swedish women showed that 84% used the Internet to obtain pregnancy related information (Larsson, 2009). Several studies from different parts of the world confirm this finding, that almost all pregnant women use the Internet (Bert et al., 2013, Gao et al., 2013, Huberty et al., 2013, Kavlak et al., 2012, Lima-Pereira et al., 2011). Scaioli et al. (2015) did not find any differences in socio-demographic characteristics and Internet use, while on the other hand Kavlak et al. (2012) showed that first time pregnant women, women with high education level or between the ages of 25-34 in Turkey more frequently used the Internet to obtain information online. Plantin and Daneback (2010) confirm that primiparous women have an increased need for online information compared to multiparous women. A majority of pregnant women consider the Internet a highly reliable source of information (Larsson, 2009, Lagan et al., 2011, Gao et al., 2013, Bert et al., 2013, Kavlak et al., 2012).
The most commonly read topics on the Internet were fetal development, nutrition, delivery, delivery complications and breastfeeding (Gao et al., 2013, Larsson, 2009, Lima-Pereira et al., 2011, Scaioli et al., 2015). In Larsson's Swedish study (2009) women also read about shopping for mother and baby, pain management, physical exercise during pregnancy and the newborn baby.
In the study by Lagan et al. (2011) the women searched for online information because their healthcare professionals did not provide sufficient information to meet their needs. Reading pregnancy-related information online provided the women with the information they wanted when they wanted it, at all hours, and there were also opportunities to ask questions anonymously. By obtaining information the women had more control over their decisions affecting their pregnancy, which increased their confidence. It prepared them for their antenatal visits and after their visit they went online to find more information on their own (Huberty et al., 2013). Apart from pregnancy-related information the women also sought social support (Bert et al., 2013, Lagan et al., 2011, Plantin and Daneback, 2010; Bert et al., 2013, Lagan et al., 2011). Forum web pages provide the opportunity to get in touch with like-minded, to share experiences, to get emotional support and to ask for advice from other pregnant women (Lagan et al., 2011). In Larsson's study (2009) six per cent of the women used Internet forums. Multiparous women used forum web pages or blogs more than primiparous women (Bert et al., 2013).
Information online was not only seen as a positive resource. It could cause concerns or feelings of fear when reading about pregnancy complications and worst case scenarios (Lagan et al., 2011, Lima-Pereira et al., 2011). The large amount of information provided by the Internet was seen as overwhelming and feelings of frustration could emerge (Widarsson et al., 2012). Over half of the women in the study by Huberty et al. (2013) had read online information that was wrong or misleading.
Internet use is steadily increasing. The availability and range of online information for pregnant women is today grand. Previous research shows that it could be difficult for the women to handle the information. To identify trends there is a need for updated research. Few previous studies have been found that had the aim of investigating how online information affect pregnant women and no studies have examined if information from the Internet could cause worry during pregnancy. No studies investigated if any specific web pages caused more worry than others, and if the women experiencing these feelings differs in socio-demographic characteristics. Obtaining information about these topics could contribute to increased knowledge and understanding and could be a helpful tool for midwives at the ANC. The aim of this study was to identify how women use the Internet as a source of information during their pregnancy and how it affects them.
The questions addressed were; whether, and how often, Swedish women used the Internet as a source of information during pregnancy, what kind of information they looked for, what their reasons for searching information online were, if the women reported having experienced feelings of worry and how those feelings were coped with.
Section snippets
Methods
A cross-sectional descriptive design was used to meet the objectives of this study. It was performed in southern Sweden in February 2015. All Swedish-speaking women, who were between 34-42 weeks pregnant and visited one of the twelve ANC clinics in the county during the period of investigation, were invited to participate in the study.
The midwives at the ANC clinics were responsible for collecting data. Potential respondents received verbal and written information about the purpose and
Demographics
Two of the twelve ANC clinics, which were approached to take part in the study, did not return any questionnaires. Of the 206 questionnaires that were submitted, a total of 193 met the inclusion criteria and thus constituted the data material. The response rate was 94%. The mean and the median age of the women were 30,0 years (range 19-43, SD 5,07) and the mean gestational age was 36.6 weeks (34–42, SD 2,12). Almost all women, 95% (n=183), used the Internet to access pregnancy-related
Discussion
This study confirms the previous findings that most pregnant women use the Internet as a source of information during pregnancy. Larsson found in 2009 that 84% of women in Sweden used the Internet; this study shows a higher rate of Internet use (95%). One reason for this may be that Internet access has been growing steadily. The study by Kavlak et al. (2012) showed differences in socio-demographics and whether the women read or do not read on the Internet and Plantin and Daneback (2010) found a
Strength and limitations
Two ANC clinics did not return any questionnaires, which is a limitation of the study. Although, these were small clinics with few listed pregnant women. The response rate was 94% and thus the study's credibility for this response group could be seen as high. Non-Swedish speaking women were excluded from the study, which is also a limitation. The study was conducted in a medium-sized Swedish city with clinics in both urban and rural areas. A study performed with a larger number of participants
Conclusion
Almost all women in this study searched the Internet to find pregnancy-related information, despite being satisfied with the information they received from the ANC. Using the Internet was seen as complementary to the information from professionals. It also caused feelings of worry, which could lead to the woman contacting healthcare services for support. ANC could help to reduce these feelings for some women by informing about the advantages and disadvantages with online information and
Acknowledgement
The authors would like to thank all of the women and midwives who gave their time and effort to participate in this study. Also to Professor David Brunt for providing language help.
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These authors contributed equally to this work.