1
|
Bekkhus M, Oftedal A, Haugen G, Mortensen B, Kaasen A. Acute symptoms of depression and traumatic stress in men and women who terminate pregnancy after the detection of fetal anomaly: A prospective observational study. BJOG 2024. [PMID: 38899436 DOI: 10.1111/1471-0528.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/28/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To assess acute and long-term stress in men and women after the detection of fetal anomalies leading to pregnancy termination. DESIGN Prospective observational study. SETTING Tertiary referral centre for fetal medicine. POPULATION From the initial sample of 180 pregnant women with a fetal anomaly detected by ultrasound examination, a total of 87 women terminated their pregnancy, with 72 partners included in the sample. At the time of detection, the group of women (n = 93) and their partners (n = 81) who did not terminate the pregnancy following a diagnosis were included as a comparison group. METHODS These women and their partners were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale (IES) questionnaires, both at the time of initial detection and at 6 weeks after the termination of the pregnancy. MAIN OUTCOME MEASURES Responses to the EPDS and the IES at the time of initial detection and at 6 weeks after pregnancy termination. RESULTS Women who underwent pregnancy termination reported higher symptom levels of depression, but not traumatic stress, prior to the termination than women who chose not to terminate their pregnancy. Among men, there was a difference across depression and all subscales of traumatic stress (e.g. IES intrusion: mean difference 5.31; 95% CI 2.32-8.31). Women experienced more depressive symptoms over time than men (β = 4.33, P < 0.001) and higher symptom levels on all subscales of traumatic stress (e.g. IES intrusion: β = 5.27; P < 0.001). CONCLUSIONS Overall, our study underscores the heightened levels of depression and traumatic stress experienced by prospective parents, particularly prior to the decision to terminate a pregnancy following the detection of a fetal anomaly. Although women generally report more pronounced symptoms, it is noteworthy that men also experience considerable traumatic stress during this challenging time.
Collapse
Affiliation(s)
- Mona Bekkhus
- Department of Psychology, PROMENTA Research Centre, University of Oslo, Oslo, Norway
| | - Aurora Oftedal
- Division of Mental and Physical Health, Department of Children and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Guttorm Haugen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Berit Mortensen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Kaasen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
2
|
Yeşildere Sağlam H, Gürsoy E. Termination of pregnancy due to fetal anomaly: A qualitative study from Turkey on women's experiences. Midwifery 2024; 132:103957. [PMID: 38428136 DOI: 10.1016/j.midw.2024.103957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Termination of pregnancy due to fetal anomaly is an unexpected traumatic event for women. It can cause serious complications that can negatively affect both the physical and psychological health of women. AIM This study aims to examine the experiences of women who underwent medical termination for fetal anomaly in the second trimester. METHODS The study included 12 women whose pregnancies were terminated due to fetal anomaly. Data were collected through in-depth interviews until data sufficiency was reached. Thematic analysis method was used to analyze the data. This study was conducted using an inductive qualitative design. The women's statements were examined and double-coded. By examining the codes, main themes were created after sub-themes. RESULTS Women's experiences were analyzed in five themes: difficulty in decision-making (1), emotional impact (2), stigmatization (3), dilemma between hope and anxiety (4), and post-termination care and support needs (5). Participants stated that they experienced many emotions such as indecision, sadness, helplessness, guilt, and remorse during the medical termination process. Hope, anxiety, fear, social pressure and support needs were also frequently experienced in this process. CONCLUSION Termination of pregnancy in the second trimester due to fetal anomaly caused significant psychological symptoms. In order to prevent long-term health complications, it will be important for health professionals to provide interventions designed to meet the demands of women diagnosed with fetal anomaly.
Collapse
Affiliation(s)
- Havva Yeşildere Sağlam
- Faculty of Health Sciences, Department of Nursing, Kütahya Health Sciences University, Kütahya, Turkey.
| | - Elif Gürsoy
- Faculty of Health Sciences, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
3
|
O'Donnell AT, Foran AM. The link between anticipated and internalized stigma and depression: A systematic review. Soc Sci Med 2024; 349:116869. [PMID: 38678910 DOI: 10.1016/j.socscimed.2024.116869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.
Collapse
Affiliation(s)
- Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife-Marie Foran
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| |
Collapse
|
4
|
Irmscher L, Marx R, Linke M, Zimmermann A, Drössler S, Berth H. Anxiety, depression, somatization and psychological distress before and 2-6 years after a late termination of pregnancy due to fetal anomalies. BMC Womens Health 2024; 24:255. [PMID: 38658921 PMCID: PMC11040822 DOI: 10.1186/s12905-024-03082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND For many women, a late termination of pregnancy (TOP) can be an enormous psychological burden. Few studies have investigated the long-term psychological impact of late TOP. METHODS N = 90 women answered a questionnaire containing questions about anxiety, depression and somatization (Brief-Symptom Inventory, BSI-18) shortly before (T1) and 2-6 years after (T4) their late termination of pregnancy. RESULTS Prior to the late TOP, 57.8% of participants showed above-average levels of overall psychological distress (66.7% anxiety, 51.1% depression, 37.8% somatization). This number decreased significantly over time for all scales of the BSI-18. 2-6 years later, only 10.0% of women still reported above-average levels (17.8% anxiety, 11.1% depression, 10.0% somatization). CONCLUSIONS Our results support those of previous research showing that late TOP has a substantial psychological impact on those experiencing it in the short-term. In the long-term, most women return to normal levels of psychological distress, although some still show elevated levels. Limitations of the study include monocentric data collection, drop-out between T1 and T4, and the relatively wide range of two to six years after TOP. Further research should be conducted in order to identify factors that impact the psychological processing of the experience.
Collapse
Affiliation(s)
- Lisa Irmscher
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany.
| | - Romy Marx
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| | - Maike Linke
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| | - Anja Zimmermann
- Charité Universitätsmedizin Berlin, Referat für Studienangelegenheiten, 10115, Berlin, Germany
| | - Stephanie Drössler
- Freistaat Sachsen, Landesamt für Schule und Bildung, Beratungsstelle zur Begabtenförderung, 01445, Berlin, Germany
| | - Hendrik Berth
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| |
Collapse
|
5
|
Chen C, Wu Q, Zhao J, Zhao G, Li X, Du H, Chi P. Enacted Stigma Influences Bereavement Coping Among Children Orphaned by Parental AIDS: A Longitudinal Study with Network Analysis. Psychol Res Behav Manag 2023; 16:4949-4958. [PMID: 38089527 PMCID: PMC10712676 DOI: 10.2147/prbm.s423707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/27/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose The study aims to understand how enacted stigma influences bereavement coping at the style (scale) level and the specific pathways at the strategy (item) level. Methods The longitudinal data of 755 children orphaned by parental Acquired Immune Deficiency Syndrome (AIDS) in rural China were used. Grief processing and deliberate grief avoidance were measured at wave 1 (baseline) and wave 2 (one-year follow-up) to reflect bereavement coping in the contexts of being with family members, being with friends, being with community members, and being alone. Enacted stigma that measured at wave 1 was used to assess the experienced stigma of these AIDS-orphaned children. Network analyses were run following regressions. Results Controlling for demographics and baseline-level bereavement coping, multivariate regressions revealed that enacted stigma at wave 1 significantly predicted grief processing and deliberate grief avoidance at wave 2. Network analyses showed that, for grief processing, stigma increased searching for meaning alone and with friends and expressing feelings to community members, which then provoked the same strategy across contexts. Meanwhile, stigma triggered the deliberate grief avoidance network by initially suppressing the expression of feelings to community members. Conclusion Enacted stigma contributes to bereavement coping. Stigma stirs up complex feelings but forces AIDS-orphaned children to suppress expressions, and it increases needs to process grief through meaning making but cuts supporting forces by promoting avoidance. Interventions are imperative to reduce stigma, improve emotion regulation, and facilitate meaning making for people bereaved by stigmatized deaths.
Collapse
Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, Southeast University, Nanjing, Jiangsu, People’s Republic of China
| | - Qinglu Wu
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, Guangdong, People’s Republic of China
| | - Junfeng Zhao
- Institute of Psychology and Behavior, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Guoxiang Zhao
- Department of Psychology, Henan Normal University, Xinxiang, Henan, People’s Republic of China
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Hongfei Du
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, Guangdong, People’s Republic of China
| | - Peilian Chi
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, People’s Republic of China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, People’s Republic of China
| |
Collapse
|
6
|
Gebeyehu NA, Tegegne KD, Abebe K, Asefa Y, Assfaw BB, Adella GA, Alemu BW, Sewyew DA. Global prevalence of post-abortion depression: systematic review and Meta-analysis. BMC Psychiatry 2023; 23:786. [PMID: 37884930 PMCID: PMC10605843 DOI: 10.1186/s12888-023-05278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Depression after abortion is a common problem for all women of reproductive age. However, there are not any data on post-abortion depression at a global level. Consequently, the purpose of this study was to find out the global prevalence of post-abortion depression. METHODS The present study involved a comprehensive search of several databases, including Science Direct, Scopus, EMBSE, Google Scholar, and PubMed. The search was conducted between February 1, 2023, and March 10, 2023. The data was extracted using Microsoft Excel (version 14) and analyzed using STATA statistical software. To evaluate publication bias, a forest plot, Begg's test, and Egger's test were employed. Heterogeneity was assessed using I2, and a pooled estimated analysis was conducted. Additionally, subgroup analysis was performed based on the study continent/region, World Bank income group, screening instrument, and study design. RESULTS This analysis included 15 papers with a total of 18,207 research participants out of a total of 657 articles. The overall pooled prevalence of post-abortion depression was found to be 34.5% (95% CI: 23.34, 45.68), with an I2 value of 71.6%. The prevalence of post-abortion depression varied based on geographic location, World Health Organization (WHO) regions, World Bank income category, screening approach, and study design. The highest proportion of post-abortion depression was observed in Asia (37.5%), while the WHO's Eastern Mediterranean region had the greatest rate of post-abortion depression (43.1%). Lower-middle-income countries had the highest frequency of post-abortion depression (42.91%) based on World Bank economic classification. The Center of Epidemiological Studies Depression Scale was found to have the highest incidence of reported depression prevalence (30%) across diagnostic tools. Furthermore, the prevalence of depression was higher in cross-sectional study designs (36.42%) compared to cohort studies (22.7%). CONCLUSION In conclusion, the occurrence of post-abortion depression has been observed to be widespread globally. The prevalence of post-abortion is found to be influenced by several factors, including the methodology employed in the study, the diagnostic tool utilized, the geographical location, and the socioeconomic status of the population. Healthcare providers should prioritize the provision of post-abortion counseling, care, and emotional support to women.
Collapse
Affiliation(s)
- Natnael Atnafu Gebeyehu
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia.
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Kelemu Abebe
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Yibeltal Asefa
- Department of Public Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Belete Birhan Assfaw
- Department of Psychiatry, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Biresaw Wassihun Alemu
- Department of Midwifery, College of Medicine and Health Science, Indiana University, Injibara, Ethiopia
| | - Dagne Addisu Sewyew
- Department of Midwifery, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
7
|
Barnes-Davis ME, Cortezzo DE. The patient/physician relationship in a post-Roe world: a neonatologist viewpoint. J Perinatol 2023; 43:968-972. [PMID: 36528653 PMCID: PMC10325948 DOI: 10.1038/s41372-022-01583-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The Supreme Court ruling in Dobbs v. Jackson Women's Health Organization has far-reaching implications that go beyond the practice of obstetrics and gynecology. The ruling and subsequent laws and bills impact many specialties and have implications for healthcare as a whole. The rapidly changing medicolegal landscape has significant bearings on and implications for the fields of neonatology and pediatrics. These rulings have an impact on the patient-physician relationship and a shared decision-making approach to care. Furthermore, there are significant sequelae of forced birth and resuscitation. This review provides a clinically relevant update of the current medicolegal landscape and applications to the practice of neonatology.
Collapse
Affiliation(s)
- Maria E Barnes-Davis
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, USA, OH.
| | - DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
8
|
Bagheri L, Chaman R, Ghiasi A, Motaghi Z. Cognitive behavioral counselling in post abortion grief: A randomized controlled trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:120. [PMID: 37397123 PMCID: PMC10312394 DOI: 10.4103/jehp.jehp_474_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/09/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND Abortion is can led to certain psychological problems that may decreased self-esteem, and concerns about future fertility. Abortions have multiple psychological consequences such as grief, anxiety, depression, and post-traumatic stress. The purpose of this study is to examine the effect of cognitive behavioral counseling intervention on women in post-abortion period. MATERIAL AND METHODS This research was a randomized, controlled trial study that was conducted on 168 women during the post-abortion period at the Khalill Azad Center of Larestan (Iran), where the women were selected randomly from February 2019 to January 2020. Data were collected using post-abortion grief questionnaire. All women in the post-abortion period answered the perinatal grief scale questions at the beginning of the intervention, immediately after the intervention and three months after the end of the intervention. Data were analyzed through descriptive statistics and repeated measures analysis of variance (ANOVA) with time and group were used to evaluate the effect of intervention. RESULTS By using repeated measures ANOVA, the comparison of the mean score of grief in the two groups indicated that the scores decreased over time and it was lower in the intervention group. The mean score of grief between the intervention and control groups at the end of the intervention was 67.59 ± 13.21 and 75.42 ± 12.7, respectively (P < 0.001). Mean post-abortion grief score in the intervention and control groups three months after the intervention were 59.41 ± 13.71 and 69.32 ± 12.45, respectively (P < 0.001). CONCLUSION According to results of this study, it can be concluded that the use of cognitive behavioral counselling can reduce post-abortion grief intensity or prevent the occurrence of complicated grief. Therefore, this method can be used as a preventive or therapeutic approach to control post-abortion grief and other psychological disorders.
Collapse
Affiliation(s)
- Leila Bagheri
- Faculty of Nursing and Midwifery, Assistant Professor of Reproductive Health, Islamic Azad University of Larestan, Larestan, Iran
| | - Reza Chaman
- Department of Epidemiology, School of Health Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ashraf Ghiasi
- Department of Midwifery, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Motaghi
- Associate Professor of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| |
Collapse
|
9
|
Li X, Peng H, Hu S, Xie J, Qin C. How does stigma influence depressive symptoms among women who underwent termination of pregnancy for foetal anomaly: A path analysis. J Clin Nurs 2023; 32:1410-1420. [PMID: 35583605 DOI: 10.1111/jocn.16372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES The purpose of this study was to explore the effect and paths of stigma on depressive symptoms in women who underwent termination of pregnancy for foetal anomaly (TOPFA). BACKGROUND Stigma may cause distress and depressive symptoms for women with TOPFA. However, few studies have examined the relationship between stigma and depression in women with TOPFA. DESIGN This study followed the STROBE checklist. A cross-sectional survey was conducted among 469 women with TOPFA. The path analysis used hierarchical multiple regression and structural equation model to examine the mediating role of social support and psychological flexibility on the relationship between stigma and depressive symptoms. RESULTS Hierarchical multiple regression analysis revealed the mediation effect of psychological flexibility between stigma and depressive symptoms. By contrast, social support did not present such effect. The structural equation model confirmed that stigma, directly and indirectly, affected depressive symptoms. DISCUSSION Many women with TOPFA have severe depressive symptoms and that stigma is an important influencing factor. Psychological flexibility plays an essential role in mitigating the effects of stigma on depressive symptoms. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should focus on measuring and intervening on stigma and psychological flexibility for alleviating the depressive symptoms of women with TOPFA. No Patient or Public Contribution.
Collapse
Affiliation(s)
- Xi Li
- Department of Health Management, Third XiangYa Hospital, Central South University, Changsha, China.,Jishou University School of Medical, Jishou, China
| | - Huiting Peng
- Department of Gynaecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Siqing Hu
- XiangYa Nursing School, Central South University, Changsha, China
| | - Jiaying Xie
- XiangYa Nursing School, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, Third XiangYa Hospital, Central South University, Changsha, China
| |
Collapse
|
10
|
Goldblatt Hyatt ED, McCoyd JLM. Counseling pregnant people after previous termination of pregnancy for fetal anomaly (TOPFA): the double RAINBOW approach. ANXIETY, STRESS, AND COPING 2023; 36:259-273. [PMID: 35234560 DOI: 10.1080/10615806.2022.2047179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Pregnancy loss is exceptionally common, yet there exist few interventions for clinical providers to assist parents who are expecting again. Perhaps even less prevalent are practice models for parents who have terminated a pregnancy due to fetal anomaly (TOPFA). In this article, we present the "Double Rainbow" acronym, which provides evidence-supported guidance for counseling people experiencing a subsequent pregnancy after TOPFA. DESIGN AND METHODS Using prompts of: Remember; Rehearse & Anticipate; Attach & Internalize; Interrogate decision; Neutralize; Normalize; Bond; Breathe & Observe; Optimize health; Weave and Whole story, we tie intervention techniques to evidence-based treatments and clinical practice examples. RESULTS Filling a gap for guidance for effective intervention with people during subsequent pregnancies after termination of pregnancy due to fetal anomaly, we aim to improve such treatment while also encouraging evaluation of the approach, encouraging evaluation of its use with broader populations. CONCLUSIONS The double RAINBOW approach weaves together evidence-based therapies while also attending to the work of distinguishing past losses and promoting parental attachment and caregiving systems in clients who have terminated a pregnancy due to fetal anomaly.
Collapse
|
11
|
Mirtabar SM, Pahlavan Z, Aligoltabar S, Barat S, Nasiri-Amiri F, Nikpour M, Behmanesh F, Taheri S, Nasri K, Faramarzi M. Women's worries about prenatal screening tests suspected of fetal anomalies: a qualitative study. BMC Womens Health 2023; 23:66. [PMID: 36782219 PMCID: PMC9926685 DOI: 10.1186/s12905-023-02211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Pregnant women with suspected fetal anomalies experience a great deal of stress following prenatal screening tests. The present study aimed to investigate women's worries about prenatal screening tests suspected of fetal anomalies. METHODS Through the use of qualitative content analysis, the reports of women whose prenatal screening tests were suspected of fetal anomalies were analyzed and the results were interpreted. The participants were selected from four public and private maternity care clinics of Babol, Iran, from December 2021 to January 2022, using targeted convenience sampling. Data were collected from 20 women aged 24 to 41 years old, who underwent prenatal screening tests and were suspected of fetal anomalies, using semi-structured face-to-face interviews. RESULTS The four main themes included the "causes of worries" (with sub-themes of challenge with spouse and relatives, medical diagnosis processes, previous unpleasant experiences, physical and mental problems, financial worries, and misinformation), "anxiety-coping styles" (with cognitive emotion-oriented, behavioral emotion-oriented, and problem-oriented sub-themes), "reactions to a possible diagnosis of anomaly" (with three sub-themes, namely concealment, extreme fear and worry, and denial), and "attribution of the cause of the anomaly" (with sub-themes of consanguine marriage, evil eyes, tendency to have a baby of a particular gender, a history of anomalies in the previous child, the spouse's medical illness, unplanned pregnancy, and high maternal anxiety). CONCLUSION Women with suspected fetal anomalies experience a great deal of stress, the most important reason for which is the "physician's uncertainty". "Sharing worries with relatives" was the most common style of coping with worries. Establishing emotional support and empathetic communication between midwives and physicians with pregnant women suspected of fetal anomalies were important ways to reduce their worries.
Collapse
Affiliation(s)
- Seyyedeh Mahboubeh Mirtabar
- grid.411495.c0000 0004 0421 4102Research Clinical Psychology, Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Zeynab Pahlavan
- grid.411495.c0000 0004 0421 4102Rouhani Hospital, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Sajedeh Aligoltabar
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Shahnaz Barat
- grid.411495.c0000 0004 0421 4102Infertility and Health Reproductive Research Center, Health Research Institue, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Fatemeh Nasiri-Amiri
- grid.411495.c0000 0004 0421 4102Social Determinants of Health Research Center, Health Research Institue, Department of General Courses, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Maryam Nikpour
- grid.411495.c0000 0004 0421 4102Non-Communicable pediatric Disease Research Center, Health Research Institute, Babol University of Medical Science, Babol, Islamic Republic of Iran
| | - Fereshteh Behmanesh
- grid.411495.c0000 0004 0421 4102Social Determinants of Health Research Center, Health Research Institue, Department of General Courses, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Sina Taheri
- grid.411495.c0000 0004 0421 4102Rouhani Hospital, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Khadijeh Nasri
- grid.468130.80000 0001 1218 604XDepartment of Gynecology and Obstetrics, Arak University of Medical Sciences, Arak, Islamic Republic of Iran
| | - Mahbobeh Faramarzi
- Social Determinants of Health Research Center, Health Research Institue, Department of General Courses, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.
| |
Collapse
|
12
|
Li X, Peng H, Zeng L, Owusua T, Wang Y, Wang Y, Qin C. Stigma and its influencing factors among women with termination of pregnancy for fetal anomaly: A cross-sectional study. Midwifery 2023; 116:103553. [PMID: 36410260 DOI: 10.1016/j.midw.2022.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the level of stigma and identify its influencing factors among women with termination of pregnancy for fetal anomaly(TOPFA) in China. DESIGN This was a cross-sectional study design. SETTING AND PARTICIPANTS A total of 469 women with TOPFA were recruited from a tertiary care hospital in China using a convenience sampling method. MEASUREMENT AND FINDINGS Women with TOPFA participating in the study completed the Demographic Characteristics Questionnaire, Individual Level Abortion Stigma Scale(ILASS), Acceptance and Action Questionnaire- II scale(AQQ- II), Cognitive Fusion Questionnaire scale (CFQ), Multidimensional Perceived Social Support Scale(MPSS), Responses to Stress Questionnaire (RSQ). Women with TOPFA reported moderate levels of stigma(1.49±0.60). Multiple linear regression showed that correlates influencing their stigma included gestational age (β =0.103, P < 0.05), psychological flexibility (β =-0.319, P < 0.01), social support(β =-0.190, P < 0.01), and disengagement coping(β =0.148, P < 0.05). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Gestational age and disengagement coping are positive predictors of stigma, but psychological flexibility and social support are negative predictors of stigma. Further attention should focus on developing targeted intervention strategies to improve protective and reduce harmful factors to confront the stigma-related challenges faced by women with TOPFA.
Collapse
Affiliation(s)
- Xi Li
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; Jishou University School of Medical, Jishou, China.
| | - Huiting Peng
- Xiangya School of Nursing, Central South University, Changsha, China; Department of Gynaecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Lihong Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Ying Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yaohan Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
| |
Collapse
|
13
|
Muacevic A, Adler JR. Perception of the Saudi Population on Abortion Decisions in Congenital Fetal Anomalies. Cureus 2022; 14:e32587. [PMID: 36540314 PMCID: PMC9756103 DOI: 10.7759/cureus.32587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Termination of pregnancy for fetal anomalies is well reported in the literature and accepted by the western and other non-Muslim communities, but Muslim communities' perception is poorly reported and rarely mentioned. This study aims to evaluate the perception of the Saudi community on abortion decisions as a management option in congenital fetal anomalies. Methods This is an observational, descriptive cross-sectional study, where participants of Saudi nationality, living in Jeddah, and consenting to participate in the research filled up a self-administrated, structured, close-ended, validated questionnaire. The level of agreement was measured on a Likert scale. Results A total of 574 participants were included in the study; 43.3% were female. The mean age of the participants was 30.3 years (SD = 10.6). Undergraduate students were 58.9%, single participants were 56.3%, and participants without children were 61.3%. The prevalence of abortion was 17.9%. The overall agreement on accepting abortion as an option was 61%. Gender (p<0.001), knowledge level (p=0.003), and religion (p=0.01) were the most important factors that influenced people's perception of abortion. Other factors like participants' age (p=0.09), level of education (p=0.48), marital status (p=0.16), having children (p=0.48), and gender of the fetus (p=0.2) were not significant factors in their decision to choose abortion. Conclusion Overall, Saudis were more inclined to accept abortion in case of a confirmed congenital anomaly, yet females were more accepting of the idea than males.
Collapse
|
14
|
Heaney S, Tomlinson M, Aventin Á. Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents. BMC Pregnancy Childbirth 2022; 22:441. [PMID: 35619067 PMCID: PMC9137204 DOI: 10.1186/s12884-022-04770-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/16/2022] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly. REVIEW QUESTION What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly? METHODS A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis. RESULTS A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience. CONCLUSION Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service. TRIAL REGISTRATION PROSPERO registration number: CRD42020175970 .
Collapse
Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland.
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland
| |
Collapse
|
15
|
Berengere BM, Jessica S, Diane DW, Marie-Emmanuelle M, Marie-José S, Lisa O, Grosmaitre C, Laurent J S, Bernard G, Ville Y, Sylvain M. Prenatal attachment, anxiety and grief during subsequent pregnancy after medical termination of pregnancy. Attachment to which child? J Gynecol Obstet Hum Reprod 2022; 51:102353. [PMID: 35247609 DOI: 10.1016/j.jogoh.2022.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS Observational study, in a French Tertiary Maternity. POPULATION 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p=0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.
Collapse
Affiliation(s)
- Beauquier-Maccotta Berengere
- Child Psychiatry Department, Perinatal unit, Necker Enfant Malades Hospital, Paris France; Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University.
| | - Shulz Jessica
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University; EPS Ville-Evrard, Infant psychiatry 93i05, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne
| | - De Wailly Diane
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University; Maternity and foetal medicine department Necker Enfant Malades Hospital France
| | | | | | - Ouss Lisa
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Catherine Grosmaitre
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Salomon Laurent J
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Golse Bernard
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University
| | - Yves Ville
- Maternity and foetal medicine department, Necker Enfant Malades Hospital, Paris France. EA 7328, Université de Paris
| | - Missonnier Sylvain
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University
| |
Collapse
|
16
|
Kerns J, Cheeks M, Cassidy A, Pearlson G, Mengesha B. Abortion Stigma and Its Relationship with Grief, Post-traumatic Stress, and Mental Health-Related Quality of Life After Abortion for Fetal Anomalies. WOMEN'S HEALTH REPORTS 2022; 3:385-394. [PMID: 35415714 PMCID: PMC8994429 DOI: 10.1089/whr.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
Background: Materials and Methods: Results: Discussion: Implications for Practice and/or Policy:
Collapse
Affiliation(s)
- Jennifer Kerns
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Morgan Cheeks
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Arianna Cassidy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Geffan Pearlson
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Biftu Mengesha
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
17
|
Dadkhah A, Kazemi A, Torabi F. Psychological health associated with prenatal screening in low‐risk pregnancy for chromosomal aneuploidy. J Obstet Gynaecol Res 2022; 48:593-598. [DOI: 10.1111/jog.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/01/2022] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ashraf Kazemi
- Reproductive Health Department Isfahan University of Medical Sciences Isfahan Iran
| | - Fatemeh Torabi
- Midwifery Department Isfahan University of Medical Sciences Isfahan Iran
| |
Collapse
|
18
|
Mergl R, Quaatz SM, Edeler LM, Allgaier AK. Grief in women with previous miscarriage or stillbirth: a systematic review of cross-sectional and longitudinal prospective studies. Eur J Psychotraumatol 2022; 13:2108578. [PMID: 36016845 PMCID: PMC9397458 DOI: 10.1080/20008066.2022.2108578] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Women who have had miscarriages or stillbirths are known to have a high risk for enduring grief. However, the course and frequency of enduring grief in this subgroup are not fully understood. Objective: Our aims were to assess the intensity of grief and its course in women with miscarriages or stillbirths and to estimate the frequency of severe grief reactions in this population. Additionally, we compared subgroups with miscarriages versus stillbirths and with single versus recurrent pregnancy loss. Method: A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 31 March 2022 in English or German on the prevalence and intensity of grief in women who had miscarriages or stillbirths. Studies that used validated assessment methods were included in this systematic review. The PRISMA guidelines were followed. Results: Study characteristics and grief data were extracted independently by two investigators from 13 cross-sectional and eight longitudinal studies from 11 countries (N = 2597). All studies used self-reporting instruments. According to 17 of 21 studies (81%), grief is markedly elevated in women after miscarriages or stillbirths. The studies are very heterogeneous regarding the samples, the length of pregnancies and the time of assessment regarding grief after miscarriages. Most studies document intense grief and frequent severe grief reactions - with a decrease over time - in women who have had miscarriages or stillbirths. Clear conclusions regarding corresponding differences between women with miscarriages and stillbirths or single and recurrent pregnancy losses cannot be drawn. Conclusions: Pronounced grief is frequent in women who had miscarriages or stillbirths. More longitudinal studies are needed to examine the course of grief in this group and to identify those women who develop prolonged grief disorder, depression or other mental-health problems.
Collapse
Affiliation(s)
- Roland Mergl
- Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Sarah Miriam Quaatz
- Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | | | | |
Collapse
|
19
|
Abstract
Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.
Collapse
|
20
|
Obst KL, Due C, Oxlad M, Middleton P. Men's experiences and need for targeted support after termination of pregnancy for foetal anomaly: A qualitative study. J Clin Nurs 2021; 30:2718-2731. [PMID: 33899276 DOI: 10.1111/jocn.15786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore men's experiences of termination of pregnancy for life-limiting foetal anomaly, including how healthcare providers, systems and policies can best support men and their families. BACKGROUND While there is a sizable body of research and recommendations relating to women's experiences of grief and support needs following a termination of pregnancy for foetal anomaly, very few studies specifically examine men's experiences. METHODS Semi-structured interviews were completed with ten Australian men who had experienced termination of pregnancy for life-limiting foetal anomalies with a female partner between six months and 11 years ago. Interviews were completed over the telephone, and data were analysed using thematic analysis. COREQ guidelines were followed. RESULTS Thematic analysis resulted in the identification of three over-arching themes, each with two sub-themes. First, participants described the decision to terminate their pregnancy as The most difficult choice, with two sub-themes detailing 'Challenges of decision-making' and 'Stigma surrounding TOPFA'. Second, participants described that they were Neither patient, nor visitor in the hospital setting, with sub-themes 'Where do men fit?' and 'Dual need to support and be supported'. Finally, Meet me where I am described men's need for specific supports, including the sub-themes 'Contact men directly' and 'Tailor support and services'. CONCLUSIONS Findings indicated that termination of pregnancy for life-limiting foetal anomaly (TOPFA) is an extremely difficult experience for men, characterised by challenges in decision-making and perceived stigma. Men felt overlooked by current services and indicated that they need specific support to assist with their grief. Expansion of existing infrastructure and future research should acknowledge the central role of fathers and support them in addressing their grief following TOPFA. RELEVANCE TO CLINICAL PRACTICE Nursing/midwifery professionals are well situated to provide men with tailored information and to promote genuine inclusion, acknowledgement of their grief, and facilitate referrals to community supports.
Collapse
Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| |
Collapse
|
21
|
Testoni I, Finco N, Keisari S, Orkibi H, Azoulay B. Conflicts Between Women's Religiosity and Sense of Free Will in the Context of Elective Abortion: A Qualitative Study in the Worst Period of Italy's COVID-19 Crisis. Front Psychiatry 2021; 12:619684. [PMID: 34408671 PMCID: PMC8365241 DOI: 10.3389/fpsyt.2021.619684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
This qualitative study considers the relationship between abortion, bereavement, and the effects of the COVID-19 lockdown nine women who had undergone an elective abortion, which is voluntarily termination of a pregnancy at the woman's request. These women were interviewed in three time points (1 month, 6 months, and 1 year after the event) to consider the possible evolution of their experience. The third phase was concurrent with the COVID-19 pandemic and particularly with Pope Francis's Easter declaration against abortion. All the interviews were conducted and analysed through qualitative research in psychology. Results showed that the abortion experience led to physical, relational, and psychological suffering, similar to perinatal grief. Participants were non-practising Catholics and religiosity did not help them to overcome their sorrow. Though religiosity is a possible resilience factor in other stressful conditions, in this case it is a factor that aggravated suffering. Finally, we discuss the difficulties experienced by Catholic women who choose to have an abortion and assert the necessity of psychological and spiritual interventions to support these women.
Collapse
Affiliation(s)
- Ines Testoni
- FISPPA Department, University of Padova, Padova, Italy.,Faculty of Social Welfare and Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | | | | | - Hod Orkibi
- Faculty of Social Welfare and Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | - Bracha Azoulay
- Faculty of Social Welfare and Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| |
Collapse
|
22
|
Richardson MG, Raymond BL. Sugammadex Administration in Pregnant Women and in Women of Reproductive Potential. Anesth Analg 2020; 130:1628-1637. [DOI: 10.1213/ane.0000000000004305] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
23
|
Psychosocial Profile and Reproductive Decisions of Women Undergoing Pregnancy Termination for Medical Reasons-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183413. [PMID: 31540023 PMCID: PMC6765807 DOI: 10.3390/ijerph16183413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The study aims to define the profile of women who decide to exercise their right to terminate a pregnancy and their future reproductive plans. METHODS Patients found eligible for termination for medical reasons between 2014 and 2016 were asked to complete an anonymous survey consisting of sixty questions examining the determinants of the decision to terminate a pregnancy. In total, 150 completed surveys were returned (62.5%). RESULTS Environmental factors, such as age, education, place of residence, marital status and financial status did not affect the decision-making process. The majority of the respondents were females under 35 years of age (71.3%). In most cases, the pregnancies had been planned and long-awaited (62.7%). The study also indicated that 22.6% of the patients who had been against abortion changed their mind when they encountered problems themselves. In addition, 20% of them changed their views on the acceptability of abortion. Termination had an impact on the participants future reproductive plans. Eighteen percent of the patients said they were definitely not planning more pregnancies. The majority (84.09%) of these women said that the reason was the traumatic experiences related to their pregnancy. CONCLUSIONS The personal experience of a pregnancy termination procedure changed women's opinions about pregnancy termination and modified further reproductive plans.
Collapse
|
24
|
Lafarge C, Rosman S, Ville I. Pregnancy termination for fetal abnormality: Ambivalence at the heart of women's experience. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Guy B. I Poems on Abortion: Women’s Experiences With Terminating Their Pregnancies for Medical Reasons. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/23293691.2018.1523115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
26
|
Zaręba K, Makara-Studzińska M, Ciebiera M, Gierus J, Jakiel G. Role of Social and Informational Support while Deciding on Pregnancy Termination for Medical Reasons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122854. [PMID: 30558123 PMCID: PMC6313640 DOI: 10.3390/ijerph15122854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/23/2018] [Accepted: 12/10/2018] [Indexed: 12/31/2022]
Abstract
Background: Poland is a country with restrictive laws concerning abortion, which is only allowed if the mother’s life and health are in danger, in case of rape, and severe defects in the fetus. This paper specifies the forms of support expected by women considering termination from their family, people in their surroundings and professional medical personnel. Methods: Between June 2014 and May 2016 patients eligible to terminate a pregnancy for medical reasons were asked to complete an anonymous survey consisting of sixty questions to determine patient profile and forms of support expected from the society, family and professional medical personnel as well as to assess informational support provided. Results: Women do not take into consideration society’s opinion on pregnancy termination (95%). The majority of the respondents think that financial support from the state is not sufficient to provide for sick children (81%). Despite claiming to have a medium standard of life (75%), nearly half of the respondents (45%) say that they do not have the financial resources to take care of a sick child. The women have informed their partner (97%) and closest family members (82%) and a low percentage have informed friends (32%). Nearly one third (31%) have not talked to the attending gynecologist about their decision. Conclusions: The decision to terminate a pregnancy is made by mature women with a stable life situation—supported by their partner and close family. They do not expect systemic support, as they believe it is marginal, and only seek emotional support from their closest family. They appreciate support provided by professional medical personnel if it is personal.
Collapse
Affiliation(s)
- Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Marta Makara-Studzińska
- Faculty of Clinical Health Psychology, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 01-809 Warsaw, Poland.
| | - Jacek Gierus
- Department of Psychiatry, Department of Health Sciences, Medical University of Warsaw, 05-802 Warsaw, Poland.
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| |
Collapse
|
27
|
Abortion after diagnosis of fetal anomaly: Psychometric properties of a German version of the individual level abortion stigma scale. PLoS One 2018; 13:e0197986. [PMID: 29894474 PMCID: PMC5997354 DOI: 10.1371/journal.pone.0197986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting. METHODS The Individual Level Abortion Stigma (ILAS) scale was translated into German. Psychometric properties of the ILAS scale were examined among 130 women with a history of an abortion after diagnosis of fetal anomaly. Individual and situational factors associated with stigma in the context of an abortion after diagnosis of fetal anomaly were explored. RESULTS Factor analysis suggested a four-dimensional structure of the German version of the Individual Level Abortion Stigma scale (Cronbach's α, .83-.91), corresponding to the subscales of the original scale. Test-retest reliability was acceptable for the worries about judgment subscale, the self-judgment subscale, and the community condemnation subscale, but less convincing for the isolation subscale. Associations between the subscales and measures of depression, self-esteem and secrecy were found in directions consistent with theory. Women who did not perceive their fetus to have a low survival chance and women whose fetus was at higher gestational age reported higher levels of stigma, whereas higher perceived partner support was associated with lower levels of stigma. LIMITATION Generalizability of study results was limited, as participants were recruited from one clinic in Germany and the study had a response rate of 46.5%. CONCLUSIONS The ILAS subscales are largely reliable and valid measures to assess stigma among women who have had an abortion after diagnosis of fetal anomaly. Suggestions for improving the assessment of stigma experienced in this population are outlined. The scales can be useful in research aiming at investigating psychological outcomes of abortion after diagnosis of fetal anomaly and improving care structures.
Collapse
|