Living with uncertainty: A Swedish qualitative interview study of women at home on sick leave due to premature labour

Being PAL: Uncertainty and Coping in r/PregnancyAfterLoss

Women who become pregnant again following miscarriage or stillbirth are in a particularly vulnerable position as they grapple with uncertainty about the current pregnancy's viability and outcomes. In this study, we examine the types of uncertainty that emerge in pregnancy after loss (PAL) and how women manage that uncertainty. Framed by the theory of communication and uncertainty management, we thematically analyzed threads (N = 636) from the online discussion board Reddit, focusing on the specific subreddit community r/PregnancyAfterLoss. Themes of physiological, emotional, and social uncertainty dominated the PAL experiences of these online community members. Uncertainty management and coping strategies included direct information seeking, bracing, mantras, and accepting uncertainty as part of the PAL experience. Theoretical contributions of this study include an initial conceptualization of emotional uncertainty in health communication. In addition, we draw parallels between uncertainty in PAL and in illness and highlight the unique features of PAL that expand our understanding of uncertainty in health. Practical implications are drawn from members' expressed needs and uncertainty management practices, and provide direction for supporting women through the PAL experience.

Development of the Uncertainty Scale for Women Hospitalized With High-Risk Pregnancies in South Korea

The purpose of the study was to develop the Uncertainty Scale for Women Hospitalized with High-Risk Pregnancies (USWHHP) and to evaluate its validity and reliability. The USWHHP was developed through four steps: generation of the initial items, evaluation of content validity, preliminary survey, and evaluation of validity and reliability in a sample survey. The final USWHHP scale includes 27 items in seven subdomains, which are scored using a 5-point Likert scale. The total possible score ranges from 27 to 135, and a higher score indicates a greater level of uncertainty. The USWHHP had a Cronbach's alpha coefficient of 0.93. The USWHHP is an easy-to-apply questionnaire specifically designed to measure uncertainty levels of women hospitalized with high-risk pregnancies.

Ten women's decision-making experiences in threatened preterm labour: Qualitative findings from the EQUIPTT trial

BACKGROUND

Clinical triage of women in threatened preterm labour (TPTL) could be improved through utilising the QUiPP App, as symptoms alone are poor predictors of early delivery. As most women in TPTL ultimately deliver at term, they must weigh this likelihood with their own personal considerations, and responsibilities. The importance of personal considerations was highlighted by the 2015 Montgomery ruling, and the significance of shared decision-making.

AIMS

Through qualitative interviews, the primary aim was to explore women's decision-making experiences in TPTL through onset of symptoms, triage, clinical assessment, and discharge.

METHODS

Qualitative interviews were undertaken as part of the EQUIPTT study (REC: 17/LO/1802) using a semi-structured interview schedule. Descriptive labels of the coding scheme were applied to the raw transcript data. This coding scheme was then increasingly refined into key themes and allowed parallels to be made within and between cases.

RESULTS

Ten ethnically diverse women who presented at six different London hospitals sites in TPTL were interviewed. Three final themes emerged from the data incorporating 10 sub-themes, 'Seeking help', 'Being "assessed" vs making clinical decisions together', and 'End result.'

CONCLUSION

Women described their busy lives and the need to juggle their commitments. Participants drew comparisons between their TPTL symptoms and 'period pain,' contrasting to typical medical terminology. Shared decision-making and the clinician-patient relationship could be improved through clinicians utilizing terminology women understand and relate to. Women used language that highlighted the clinician-patient power balance. While not fully involved in shared decision-making, women were overall satisfied with their care.

Status and related factors of depression, perceived stress, and distress of women at home rest with threatened preterm labor and women with healthy pregnancy in Taiwan

BACKGROUND

Women with threatened preterm labor (TPTL) resting at home face several life challenges, but their psychological well-being has been ignored. This study aimed to explore the status and related factors of the psychological status of women with TPTL resting at home, and to compare the psychological status differences between TPTL and healthy pregnant women.

METHODS

A cross-sectional, multiple time-point study was conducted to repeatedly assess depression, perceived stress, and distress in 49 TPTL women and 62 healthy pregnant women during pregnancy in Taiwan. Mann-Whitney U tests were used to compare the psychological status differences between these women and the generalized estimating equation was used to identify the factors related to their psychological status.

RESULTS

The TPTL women's perceived stress at 24-27 weeks (p=0.047) and 32-35 weeks (p=0.04) and distress at each time point was significantly greater than that of healthy pregnant women (p<0.001). The common distress experienced by TPTL women was the inability to provide self-care and family care, the baby's health and safety, and to request leave from work for bed rest. Positive personalities, gestational age, preterm birth history, follow-up status and employment have been shown to be related to the psychological status of TPTL women.

LIMITATIONS

The major limitation of this study is the small sample size.

CONCLUSION

This study contributed to a better understanding of the emotional burdens of women with TPTL resting at home. Such findings highlight the need for constructing effective interventions to alleviate the psychological burden of these women.

Development and validation of the prenatal activity restriction stress questionnaire: a Rasch rating scale analysis

Background

Antepartum activity restriction (AAR) is a common recommendation given to women at risk for preterm delivery. However, such treatment has been shown to cause heavy emotional burdens on the women receiving it since it requires them to face many challenges derived from the intervention. Nevertheless, current existing scales lack effective items that can reflect the distress of these women. The aim of this study was to develop a reliable instrument to assess the distress of women experiencing AAR.

Method

The Prenatal Activity Restriction Stress Questionnaire (PARSQ) was developed according to comprehensive literature review, women’s interviews, and existing pregnancy-special stress scales from August 2016 to July 2017 in southern Taiwan. Six experts evaluated its content validity; the Rasch rating scale model (RSM) was used to examine its item-fit, dimensionality, and reliability with 200 women with AAR experience. Furthermore, the concurrent validity was assessed through computing the correlation of AAR women’s scores on the PARSQ and Perceived Stress Scale (PSS), and discriminant validity of the PARSQ was assessed to compare the scores’ differences between the AAR women and the healthy pregnant women.

Results

The PARSQ was constructed with 23 items in the 4-dimensional scale: Role function changes (8 items), Fetal safety and health (5 items), Physical and psychological care issues (5 items), and Socioeconomic and medical issues (5 items). It was confirmed to have satisfactory content vitality (CVI = 0.78 to 1.0), reasonable item-fit (0.77 to 1.51), and good reliability in RSM model, as well as adequate concurrent validity (p = 0.005) and discriminant validity (p < 0.001).

Conclusions

Understanding the distress of women undergoing AAR is necessary for developing appropriate prenatal care to assist women in coping with their situation to alleviate their emotional burdens. The developed PARSQ with satisfied psychometric properties can be an informative instrument for clinicians/researchers to assess the specific stress of pregnant women with AAR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03347-3.

Factors Affecting Uncertainty in Women with High-Risk Pregnancies

OBJECTIVE

To evaluate the state of the science on uncertainty in high-risk pregnancy and identify factors that influence uncertainty in women diagnosed with a high-risk pregnancy.

DATA SOURCES

Primary research articles from CINAHL, Ovid, MEDLINE, Scopus, and PsycINFO written in English, without date restrictions.

STUDY SELECTION

Nineteen articles were identified, including 14 qualitative studies and 5 quantitative studies.

DATA EXTRACTION

This integrative review was guided by Whittemore and Knafl's methodology. Studies were graded on level and quality of evidence as per Dearholt, Dang, and Sigma Theta Tau International.

DATA SYNTHESIS

Studies were synthesized by using constant comparative methods according to factors influencing, outcomes of, and management of uncertainty.

CONCLUSION

Uncertainty is a prominent theme in women experiencing a high-risk pregnancy. Uncertainty is influenced by various personal, pregnancy-related, demographic, and healthcare-related factors. Findings may offer insight and empathy for healthcare professionals. Nurses who understand significance of uncertainty in adjusting to two conflicting life events have the opportunity to help women in their understanding of a high-risk diagnosis during pregnancy through anticipatory guidance. Future research is needed to explore factors affecting uncertainty and to understand the experience of high-risk pregnancy to develop interventions aimed at mitigating uncertainty in high-risk pregnant women.

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

BACKGROUND

Preterm birth is a major cause of neonatal death and severe morbidity, so pregnant women experiencing symptoms of threatened preterm labour may be very anxious. The risk assessment and management that follows recognition of threatened preterm labour has the potential to either increase or decrease this anxiety. The aim of this study was to explore women's experience of threatened preterm labour, risk assessment and management in order to identify potential improvements in practice.

DESIGN

One-to-one semi-structured interviews with 19 women who experienced assessment for threatened preterm labour took place between March 2015 and January 2017. A purposive sample approach was employed to ensure participants from different risk and demographic backgrounds were recruited at an inner city UK NHS hospital. Interviews were recorded and transcribed. Data was managed with NVivo software and analysed using the Framework Approach. A public and patient involvement panel contributed to the design, analysis and interpretation of the findings.

FINDINGS

Data saturation was achieved after 19 interviews. 11 women were low risk and 8 were high risk for preterm birth. All high risk women had experience of being supported by a specialist preterm team. Four main themes emerged: (i) coping with uncertainty; (ii) dealing with conflicts; (iii) aspects of care and (iv) interactions with professionals. Both low and high risk women experiencing TPTL struggle to cope with the uncertainty of this unpredictable state. The healthcare management they receive can both help and hinder their ability to cope with this extremely stressful experience. High risk women were less likely to receive conflicting advice.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.