Making existential meaning in transition to motherhood—A scoping review

Transition to Motherhood: Adverse Childhood Experiences, and Support from Partner, Family and Friends

BACKGROUND

The complex identity changes women have to go through to become mothers makes it a challenging transitional period. Especially, mothers who have experienced childhood adversity (ACEs) may be vulnerable to poor adjustment to motherhood. However, support from a partner, family and friends can act as a buffer to cope with this challenging transitional period. Therefore, the aim was to study whether ACEs and experienced social support (partners, family, and friends) were related to the adjustment to motherhood or 'motherhood constellation' of women after the birth of their first child.

METHOD

Data were collected via an online questionnaire among first-time mothers from June-September 2020. Motherhood constellation was measured with four items based on the descriptions by (Stern, 1995) about the motherhood constellation, i.e. worries about Life/Growth, Emotional Engagement, Support Systems, Identity Organisation. Multiple regression analyses with pairwise deletion were conducted.

RESULTS

ACEs were related to all four themes of motherhood constellation, indicating that the more frequent these adverse experiences occurred in the past the more concerns, both about the child and herself, the mother had. Moreover, after controlling for ACEs and other forms of support, only support from friends was related to the use of support systems and identity organisation. Finally, statistically significant interactions were found between ACES and support from friends with life/growth and between ACES and support from family with identity organisation. These interactions indicated that contrary to the expectation the positive association between mother's ACEs and worries was stronger for mothers who experienced more support.

CONCLUSION

The consequences of ACEs seemed to show up in the transition to motherhood, indicating that interventions targeting first-time mothers should address the motherhood constellation that may arise from earlier adverse life experiences. Moreover, especially support from friends seemed to be associated with less worries among mothers. Social support has no buffering effect for the negative consequences of ACEs on the themes of motherhood constellation. Further research is clearly needed to get more insight into these themes and to understand the meaning of different types of social support during the transition to motherhood.

A critical need for the concept of matrescence in perinatal psychiatry

The concept of matrescence, akin to adolescence but for mothers, has gained increasing attention in perinatal psychiatry, marking a paradigm shift towards understanding the holistic development of mothers. Matrescence encompasses the myriad psychological, social, cultural, and existential changes which occur as women transition into motherhood. Despite advances in maternal mental health, a bias towards pathologizing maternal experiences persists in research and practice. This commentary advocates for the integration of matrescence into perinatal psychiatry, drawing from the work of Dana Raphael and contemporary scholarship. Matrescence offers a strengths-based framework that acknowledges both the challenges and opportunities of motherhood, emphasizing the normative aspects of a mother's self-development. By adopting matrescence terminology and nosology, clinicians and researchers can enhance traditional psychiatric classifications. Additionally, matrescence underscores the importance of considering ecological systems and historical factors in maternal well-being, highlighting the need for comprehensive and compassionate healthcare services. Embracing matrescence as a fundamental concept in perinatal psychiatry holds promise for improving maternal mental health outcomes and promoting the flourishing of mothers worldwide.

The paradox of awareness of death in parenthood transition-A qualitative study

In the high-income countries of Scandinavia, there is a low statistical risk of death during childbirth. However, awareness of the possibility of death seems to have prevailed. In existential psychology and philosophy, awareness of death is a universal condition in life, and facing the anxiety this awareness might invoke has the potential of being life-invigorating. In a hermeneutic analysis of Qualitative data, generated in a study on new parents' existential meaning-making, this study aimed to explore awareness of death as experienced in parenthood transition. The results found two overarching themes: Awareness of my own Finitude and Fragility of our loved ones. These were interpreted in existential philosophical and psychological theories, and concludes that awareness of death might signify an existential integration of 'self' in the new role of parenthood. Acknowledging these thoughts as healthcare professionals could support the meaning-making of parenthood transition, by normalizing their universal nature.

The midwife's support during transition to motherhood: A modified Delphi study among care providers and childbearing women

OBJECTIVE

To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood.

METHODS

A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1-year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1.

FINDINGS

In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies.

CONCLUSION

The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.

Cradling disparities: A descriptive qualitative study of maternal experiences of mothers from low-socioeconomic status in the first month postpartum

AIM

To explore the experiences, expectations and needs of mothers from low-socioeconomic status at 1 month postpartum.

DESIGN

Descriptive qualitative.

METHODS

Mothers from low-socioeconomic status and irrespective of their parity were invited to participate in one-to-one interviews at 1 month postpartum. Semi-structured interviews were conducted until data saturation. Interviews were audio recorded, transcribed verbatim and analysed thematically. Written informed consent was obtained.

RESULTS

Twenty mothers participated and six themes were identified: (1) No choice but to find meaning; (2) Father as a major pillar of support; (3) 'Kampung' Spirit; (4) Trials and Tribulations of Transition to Motherhood; (5) Shame, guilt and internalized stigma and (6) Reclaiming the power.

CONCLUSION

This study reflected the unique struggles of mothers from low-socioeconomic status with pregnancy, childbirth and early postpartum and the wider health inequities within Singapore's maternal health system. To provide much-needed support and improved care, the stakeholders within government, healthcare providers and social organizations should consider the niche needs of this community.

IMPLICATIONS FOR PATIENT CARE

Nurses need to reflect on their own biases and ensure consistent care delivery regardless of socioeconomic status. When delivering patient education, patient-centred and sincere advice rooted in personal experience can help to establish rapport.

IMPACT

This study is the first to explore the experiences of mothers from low-socioeconomic status in the Singapore context. Low-socioeconomic status mothers experienced less autonomy over their health, the care they received and their childcare options. As mothers adjusted to their new roles, they struggled to cope. However, as they were wary of the stigma surrounding poverty and their guilt of not being a 'good mother', they preferred to seek informal support from their family, friends and self-help through learning from social media, as compared to formal, external help.

REPORTING METHOD

COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A cross-sectional analysis of factors associated with the teachable moment concept and health behaviors during pregnancy

BACKGROUND

Pregnancy is often associated with a change in health behaviors, leading some to suggest that pregnancy could be a teachable moment for lifestyle change. However, the prevalence and underlying mechanism of this phenomenon is not well understood. The aim of this study is to explore the prevalence of a teachable moment during pregnancy, the psychosocial factors that are associated with experiencing such a moment, and its association with actual health behaviors.

METHODS

In this cross-sectional study, 343 pregnant Dutch women completed an online questionnaire. Participants reported on their intentions to change lifestyle due to pregnancy, their current health behaviors, and several psychosocial factors that were assumed to be linked to perceiving a teachable moment during pregnancy: perceived risk, affective impact, changed self-concept, and social support. Multivariable linear and logistic regression were applied to the data analysis.

RESULTS

Results demonstrate that 56% of the women experienced a teachable moment based on intentions to change their health behavior. Multivariate regression analyses revealed that changed self-concept (β = 0.21; CI = 0.11-0.31), positive affect (positive β = 0.28; CI = 0.21-0.48), and negative affect (β = 0.12; CI = 0.00-0.15) were associated with higher intentions to change health behavior. Conversely, more perceived risk was associated with lower intentions to change health behavior (β=-0.29; CI = 0.31 - 0.13). Multivariate regression analyses showed a positive association between intentions to change health behavior and diet quality (β = 0.11; CI = 0.82-1.64) and physical activity (OR = 2.88; CI = 1.66-5.00).

CONCLUSIONS

This study suggests that pregnancy may be experienced as a teachable moment, therefore providing an important window of opportunity for healthcare professionals to efficiently improve health behaviors and health in pregnant women and their children. Results suggest that healthcare professionals should link communication about pregnancy-related health behaviors to a pregnant women's change in identity, affective impact (predominantly positive affective impact) and risk perception to stimulate the motivation to change healthy behavior positively.

Experiences of success and failure in childbirth

AIMS

To determine what kinds of birth-related experiences of success and failure are described by the participants, and whether there are differences according to fear of childbirth and parity. Studying these experiences is important for understanding the psychological mechanisms behind different childbirth experiences and their impact on maternal mental well-being.

METHODS

This was a longitudinal mixed methods study. Descriptions of the birth experiences of 113 Finnish participants were gathered in a survey at 4-8 weeks postpartum and analysed with content analysis. Fear of childbirth was determined antenatally with the Wijma Delivery Expectations scale (W-DEQ A).The number of success and failure expressions were compared between people with FOC and others and between primiparous and multiparous people.

RESULTS

The contents of the childbirth-related experiences of success and failure were categorised into 12 subcategories, organised under three higher-order categories that were named personal factors, course of childbirth, and support. The most typical expressions of success were in the categories of mode of birth, staff, and mental factors, and the most typical expressions of failure in the categories of staff and mental factors. Experiences of failure were more often expressed by primiparous than multiparous people, but there were no statistically significant differences by FOC. Expressions of success were equally common regardless of parity or FOC.

CONCLUSION

Postpartum people categorise aspects of their birth experiences in terms of success and failure. Primiparous people are more susceptible to experiencing failure at childbirth, but possible differences between people with FOC and other people warrant further investigation.

Occupations and balance during the transition to motherhood with a lifetime chronic illness: A scoping review examining cystic fibrosis, asthma, and Type-1 diabetes

INTRODUCTION

Throughout the transition to motherhood, changes are experienced across a woman's physical, mental, social, and occupational self. Maternal chronic illness adds the complexity of increased healthcare needs and navigating a high-risk, medicalised pregnancy, birth, and post-natal period. Literature concerning motherhood transitions in chronic illness generally focusses on the mother's medical health and pregnancy outcomes; little is known about the impacts on women's occupations, balance, and quality of life. Understanding these issues may help support women in a more tailored and holistic way.

OBJECTIVE

This scoping review aims to gather, analyse, and synthesise existing empirical research on occupational engagement and occupational balance as they impact on wellbeing and quality of life in women with a lifetime chronic illness before and during pregnancy and in early motherhood.

METHOD

The review follows the nine-stage framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (2020). Five databases were searched: Embase, Medline, PsycINFO, CINAHL, Scopus, and OT Seeker. Data were extracted and examined via content analysis, described in narrative synthesis, summarised into a conceptual framework, and tabulated.

FINDINGS

A total of 8,655 papers were discovered on initial search. Following title and abstract screening, 220 full-text studies were assessed for eligibility, and 46 papers were finally included. Analysis generated four major themes: The Disrupted Transition Journey; Adaptation, Compromise and Choice; Outcomes; and Drawing on What's Available. The themes were conceptualised into a framework to explain how women sought to balance motherhood and illness-related occupations. Adequate access to information, social support, expert care, and financial resources improved both quality of life and healthcare compliance.

CONCLUSION

Findings of this scoping review deepen the understanding of occupational balance during the transition to motherhood in the context of lifetime chronic illness. Healthcare providers and supportive family and friends can use this knowledge to adapt their approach to assisting women with chronic illness on the motherhood journey. These findings may also inform further inquiry into the scope of occupational therapy practice with this population.

"Connection, community and convenience": A case study of a Facebook group for fathers navigating parenthood

ISSUES ADDRESSED

Fathers remain less likely to participate in parenting interventions which can limit their ability to receive support and build their parenting capacity. The advent of social media has engendered novel opportunities for fathers to connect with, and support, one another in the form of online peer support. Growth of these online communities exemplifies the demand from fathers to relate to other fathers who are navigating parenthood. However, the benefits of membership to these communities remain unclear. This study evaluated the perceived benefits of members of an online father-to-father, community-created and moderated Facebook group designed for Australian fathers in both rural and metropolitan regions.

METHODS

One-hundred and forty-five Australian fathers (aged 23-72 years) who were members of the same online fathering community completed an online survey where they qualitatively described their experiences as members of this community.

RESULTS

Content analysis of open-ended survey questions revealed that fathers identified a series of unique and important personal and familial benefits, which were largely attributed to their ability to connect with fellow fathers. Specifically, the opportunity to have convenient access to a safe space for fathers to connect was highly valued, providing fathers with opportunities to support, discuss and normalise parenting experiences.

CONCLUSIONS

Online father-to-father connection is a highly valued resource for fathers who are navigating parenthood. SO WHAT?: Online, community-led groups for fathers contribute to perceptions of genuineness and ownership by its members and provide a unique opportunity to connect and seek support for parenting.

Existential aspects of parenthood transition seen from the health professionals' perspective - an interview and theatre workshop study

OBJECTIVES

A sense of existential vulnerability is embedded in parenthood transition. It is linked to meaning in life, relationship changes, awareness of death, and sometimes a transcendent belief. Nevertheless, in most maternity service guidelines, the existential aspects of life are not an explicit focus. Therefore, this study aimed to explore how health professionals in maternity services experience and understand existential aspects of parenthood transition among new parents.

STUDY DESIGN

Data were generated through a user-involving two-phase process inspired by action research consisting of three focus group interviews with health professionals (n = 10) and, subsequently, a theatre workshop for parents, health professionals, and researchers (n = 40). Between the two phases, case narratives were constructed using information from the interviews and, in collaboration with a dramatist, dramatized and then played out at a workshop by professional actors. We used thematic analysis for all data.

RESULTS

We identified five themes in the data material: 1. Death and fragility in maternity care, 2. Existential aspects in camouflage, 3. Existential and spiritual aspects of being professional in maternity care, 4. Talking about existential aspects of care, 5. Equipped for providing existential care?

CONCLUSIONS

Existential aspects were often recognized during birth, specially in traumatic situations or discerned in the physical and non-verbal relational energy between the birthing woman and midwife or partner. Less often, existential aspects were recognized during pregnancy and the post-partum period.

Prayer and meditation practices in the early COVID-19 pandemic: A nationwide survey among Danish pregnant women. The COVIDPregDK study

BACKGROUND

The emergence of the COVID-19 pandemic and the derived changes in maternity care have created stress and anxiety among pregnant women in different parts of the world. In times of stress and crisis, spirituality, including spiritual and religious practices, may increase.

OBJECTIVE

To describe if the COVID-19 pandemic influenced pregnant women's considerations and practises of existential meaning-making and to investigate such considerations and practices during the early pandemic in a large nationwide sample.

METHODS

We used survey data from a nationwide cross-sectional study sent to all registered pregnant women in Denmark during April and May 2020. We used questions from four core items on prayer and meditation practices.

RESULTS

A total of 30,995 women were invited, of whom 16,380 participated (53%). Among respondents, we found that 44% considered themselves believers, 29% confirmed a specific form of prayer, and 18% confirmed a specific form of meditation. In addition, most respondents (88%) reported that the COVID-19 pandemic had not influenced their responses.

CONCLUSION

In a nationwide Danish cohort of pregnant women, existential meaning-making considerations and practices were not changed due to the COVID-19 pandemic. Nearly one in two study participants described themselves as believers, and many practised prayer and/or meditation.

On cloud nine? Maternal emotional wellbeing six weeks up to one year postpartum - A cross-sectional study

BACKGROUND

Little is known about the full scope of emotional wellbeing of mothers up to one year postpartum, to adequately support women during transition to motherhood. Reduced emotional wellbeing (REW) affects women's adaption to the changes and challenges in becoming a mother. We aimed to increase the knowledge and understanding of mothers' emotional wellbeing and the influencing factors.

METHODS

This cross-sectional study includes 385 Flemish mothers up to one year postpartum. Online data were collected with the General Health Questionnaire-12, Postpartum Bonding Questionnaire, Personal Well-Being Index-Adult, The Basic Psychological Needs Scale, Sense of Coherence-13 and Coping Operations Preference Enquiry.

RESULTS

A total of 63.9% of the participants reported REW. Mothers with REW more often had (a history of) psychological problems compared to mothers with healthy emotional wellbeing (p = 0.007). Multiple linear regression analysis showed negative associations between emotional wellbeing and satisfaction (p = 0.002; p < 0.001), comprehensibility (p = 0.013) and positive associations between emotional wellbeing and bonding (p < 0.001), manageability (p = 0.033), problem solving (p = 0.030) and avoidance (p = 0,011) - with an explained variance of 55.5%.

LIMITATIONS

Some limitations of our study are the GHQ-12 cut-off value, the nature and implication of (a history of) psychological problems and the self-selected population.

CONCLUSION

It would be of worth for midwives to discuss with mothers (to be) what to expect. This - to support mothers in making sense of their life as a mother and how various factors might influence their emotional wellbeing. The high prevalence of REW is worrying, but needs to be interpreted with caution.

Systematic Review of the Content Validity of Patient Reported Outcome Measures of Transition to Parenthood

This review aims to identify self-report instruments examining aspects of transition to parenthood for use in practice and research. After performing a literature search in Embase, Medline, Web of Science, Cochrane, PsycINFO and Google Scholar, the Patient Reported Outcome Measures (PROMs) measuring (aspects of) transition to parenthood during pregnancy or up to 1-year postpartum were identified. Following COSMIN guidelines for systematic reviews on PROMs, the quality of the PROM development and PROM content validity was evaluated. From the 129 included studies, 39 PROMs assessed aspects of transition to parenthood. A total of 32 PROMs were included in the evaluation. The development quality of 30/32 PROMS was mostly rated as inadequate and the quality of 15 content validity studies was mostly rated as doubtful. All PROMs received inadequate or doubtful ratings on content validity. Most of the PROMs measuring aspects of the transition to parenthood didn't include parents' points of view when developing them. Many PROMs are being used for a long time without reassessing relevance, comprehensiveness, and comprehensibility among parents and/or practitioners. It is recommended that researchers and healthcare professionals assess content validity of the PROM before use with the target population.

'Just snap out of it' - the experience of loneliness in women with perinatal depression: a Meta-synthesis of qualitative studies

BACKGROUND

Pregnancy and the arrival of a new baby is a time of great transition and upheaval. Women often experience social isolation and loneliness at this time and may develop depression, particularly in the postnatal period. Qualitative studies have reported that loneliness is also a feature of perinatal depression. However, until now there has been no attempt to synthesise research exploring the links between loneliness and perinatal depression. This study's aim was to explore existing qualitative evidence to answer two research questions: What are the experiences of loneliness for women with perinatal depression? What helps and what makes loneliness worse for women with perinatal depression?

METHODS

A qualitative meta-synthesis retrieved primary qualitative studies relevant to the research questions. Four electronic databases were systematically searched (Ovid MEDLINE®; PsycINFO; Embase; Web of Science). Papers were screened according to pre-defined inclusion criteria and assigned a quality score. Thematic analysis was used to identify major overarching themes in the literature.

RESULTS

Twenty-seven relevant qualitative studies were included. Themes relating to the interaction between perinatal depression and loneliness included self-isolation and hiding symptoms due to stigma of perinatal depression and fear of judgement as a 'bad mother'; a sudden sense of emotional disconnection after birth; and a mismatch between expected and actual support provided by partner, family and community. There was also a double burden of loneliness for women from disadvantaged communities, due to increased stigma and decreased social support. Validation and understanding from healthcare professionals, peer support from other mothers with experience of perinatal depression, and practical and emotional family support were all important factors that could ameliorate loneliness.

CONCLUSIONS

Loneliness appears to play a central role in the experience of perinatal depression based on the frequency with which it emerged in women's accounts. The findings provide a foundation for the development of further theories about the role of loneliness in perinatal depression and evidence in which future psychological and social intervention design processes can be rooted. Addressing stigma and offering culturally appropriate professional and peer support are potential targets for interventions that could help women with perinatal depression, particularly in disadvantaged communities, feel less lonely.

TRIAL REGISTRATION

Prospero registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID = 251,936.

In the need of a digital cicerone in healthcare? - Guidance for parents

OBJECTIVE

To explore parents' experiences using digital tools in relation to pregnancy, labor and birth, and the child's first 18 months.

BACKGROUND

Parents find relevant information using digital healthcare tools, material obtained from professionals, as well as personal opinions and experiences that vary in quality.

METHOD

Fifteen parents were interviewed and data were analyzed beginning with content analysis and followed by thematic analysis.

RESULTS

The main theme was insecurity and responsibility for own choices and knowledge. Parents use digital tools to take responsibility for their insecurity and need for knowledge when entering parenthood.

CONCLUSION

The parents' experiences highlighted that (1) insecurity can be both eased and enhanced using digital tools, (2) they took responsibility for feelings of insecurity and the search for knowledge, and (3) they needed knowledge to make the right choices and feel secure that these choices are made in the best interest of their new family.

Does Childbirth Preparation Education Affect Prenatal Adaptation?

OBJECTIVE

To determine the effect of childbirth preparation education on the prenatal adaptation of pregnant women.

METHODS

This study design was a quasi-experimental; one-group pretest-posttest. This study was conducted with the participation of 42 pregnant women and their spouses. The educations were given in four sessions in a special area designed for childbirth preparation educations in a private hospital where the study was conducted. The data of the study were collected using the Pregnant Women Information Form and the Prenatal Self-Evaluation Questionnaire. Prenatal Self-Evaluation Questionnaire consists of seven subscales which are the well-being of pregnant women and their infants, acceptance of pregnancy, acceptance of motherhood, fear of childbirth, relationship with her mother and relationship with her spouse. The Wilcoxon signed rank test statistics were used to analyze the difference between the pretest and posttest PSEQ scores.

RESULTS

The concerns about the well-being of pregnant women and their infants (p < .05), acceptance of pregnancy (p < .05), acceptance of motherhood (p < .05), fear of childbirth (p < .05), relationship with her mother (p < .05), relationship with her spouse (p < .05) subscale and total adaptation score (p < .05) were significantly higher before the education compared with the after the education. However, there was no significant difference between pre and post-education scores regarding readiness for birth subscale (p > .05).

CONCLUSION

This study showed that childbirth preparation education improves prenatal adaptation, acceptance of pregnancy and motherhood, relationship with her mother and relationship with her partner of pregnant women. In addition, it decreased fear of childbirth of pregnant women.

The information behaviours of disadvantaged young first-time mothers

Purpose

The purpose of this study is to explore the information behaviours of socioeconomically disadvantaged young first-time mothers, an understudied and at-risk group (health and well-being).

Design/methodology/approach

Questionnaire and semi-structured interviews with 39 young mothers (aged up to 25 years of age) from UK areas of multiple deprivations.

Findings

Our participants' preferred sources of information are interpersonal sources with which they have formed close supportive relationships. Support groups are important sources of interpersonal connection, but young mothers are reluctant to attend groups involving older mothers. With the exception of support group staff and health visitors, institutional and professional information sources are used very little. Societal stigma is a significant issue influencing behaviours, but issues of institutional bureaucracy, information overload, conflicting information and practical access are also reported. A further key factor influencing behaviour is self-identity.

Research limitations/implications

Findings should not be considered representative of young mothers as a whole as not all young mothers are disadvantaged. As our participants identified as ethnically white, findings also cannot speak to the additional barriers experienced by women of colour. Further studies with further population groups are recommended. More broadly, further studies exploring the influence of self-identity on people's information behaviours are also recommended.

Practical implications

Findings provide practical direction for health and welfare services, and public libraries, to better support young mothers.

Originality/value

Findings contribute to conceptual and practical understanding of information poverty in the socio-ecological context. Findings also evidence the role of self-identity in shaping people's information behaviours.

"I feel reassured, but there is no guarantee." How do women with a future childbearing desire respond to active surveillance of cervical intraepithelial neoplasia grade 2? A qualitative study

INTRODUCTION

In Denmark, women with a future childbearing desire diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) are recommended active surveillance instead of excisional treatment. However, we have limited and contradictory knowledge about how active surveillance of CIN2 may affect women emotionally. The aim of this study was to explore thoughts and emotional responses in women undergoing active surveillance of CIN2 and to explore how active surveillance may affect women's future childbearing desire.

MATERIAL AND METHODS

This qualitative study was conducted in the gynecological outpatient clinic, the Department of Obstetrics and Gynecology, Gødstrup Hospital, Denmark. Women of childbearing age undergoing active surveillance with colposcopy, biopsy and smear every 6 months due to CIN2 were eligible for enrollment. In-depth semi-structured interviews were conducted. The interviews were audiotaped and transcribed verbatim. A thematic analysis was performed using a phenomenological approach.

RESULTS

A total of 20 women were included. All women experienced nervousness and anxiety when they were diagnosed with CIN2 initially. Their main concern was whether they had cancer. Most women carried on with their everyday lives with only minor occasional worries about CIN2, often prompted just before check-up. However, some women were particularly nervous and found the period between check-ups frustrating and challenging. Women did not want to postpone their plans for pregnancy because of CIN2, but experienced the worries and check-ups associated with active surveillance as disruptive elements in their family planning. Women preparing for fertility treatment had their startup unnecessarily delayed due to active surveillance of CIN2, as clinical guidelines were inconsistent across subspecialties. Various factors influenced women's emotional well-being: life circumstances, information needs, and mental and physical discomfort during colposcopic examination.

CONCLUSIONS

Women felt that worries and check-ups due to active surveillance of CIN2 were disrupting elements in their family planning, although they did not affect their every-day life. Some women, however, were particularly anxious, demonstrating the importance of including women's experiences and preferences in clinical counseling. The fact that fertility treatment was delayed due inconsistent guidelines across subspecialties, suggests a need for a revision of current guidelines.

Motherhood Experiences of Visually Impaired and Normally Sighted Women

The present study explores the characteristics of visually impaired mothers’ personal identities as reflected in their individual representations of motherhood taking account of the impact of the specific social context on these representations. The sample included 20 visually impaired (VI) and 21 normally sighted (NS) mothers. In line with the narrative psychological approach to motherhood, each participant gave a narrative account of her related experiences in a semi-structured interview. The transcribed responses were subjected to a thematic analysis aimed at comparing the narratives of visually impaired and normally sighted mothers’ for thematic composition in order to identify shared and impairment specific themes of motherhood experiences. The motherhood experiences were sorted into eight thematic categories: Emotions; Continuity; Personal Development; Connectedness; Challenges; Partner; Roles and Principles; and Calling/Career. While in some categories VI and NS mothers showed similar patterns of experience, such as finding a new purpose in life and developing a new role in the family with the advent of pregnancy (Personal Development), in other categories motherhood experiences were thematized differently, such as VI mothers focused on challenges posed by day-to-day situations, NS mothers were rather concerned with their children’s future (Challenges). The study presents the shared and non-shared aspects of disabled and non-disabled women’s motherhood experiences with the primary aim of demonstrating the potential impact of the prevailing sociocultural norms, and attitudes considering visually impaired mothers on their motherhood experiences.

Natality and Relational Transcendence in Humanist Chaplaincy

Every life has a beginning and an end. Natality and mortality are both profound existential fundaments of life that may lead us to question meaning in life as well as to find meaning. In spiritual care, the focus is often on mortality as a source of existential suffering, and on ways to deal with such suffering according to worldview traditions. In humanist traditions, mortality is not only seen as an existential threat but also as an existential given that people need to embrace to find meaning in life. Natality has received much less attention, both in spiritual care and in humanist thought. In this article, we build on philosophical ideas of Arendt and Butler to explore the significance of natality for a humanist perspective on meaning in life and spiritual care. We argue that taking natality into account results in a relational understanding of humanist spiritual care in which the notion of “relational transcendence” is a central element. Natality also means that we can initiate, create, and act in the world, which highlights the political dimension of humanist spiritual care. We reflect on the implications of natality and relational transcendence for humanist spirituality and chaplaincy and formulate some concrete building blocks for working from this perspective.

Expecting parents’ use of digital sources in preparation for parenthood in a digitalised society – a systematic review

Background

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

Question

The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

Methods

A systematic review covered the thematic analysis of 39 articles.

Findings

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Conclusion

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

The concept, importance and values of support during childbearing and breastfeeding - A discourse paper

BACKGROUND

Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing.

AIM

The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites.

DESIGN

Discourse paper.

METHODS

This discourse paper is based on our own experiences and is supported by literature and theory.

RESULTS

Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

Flemish midwives' perspectives on supporting women during the transition to motherhood - A Q-methodology study

OBJECTIVE

In this study we aimed to reveal midwives' distinct perspectives about midwifery support of women in their transition process during the continuum from pregnancy to one-year postpartum.

DESIGN

A Q-methodology study, a mixed quantitative-qualitative approach, was conducted. Participants (P-set) rank-ordered 36 statements (Q-set) about how midwives provide support during the woman's transition to motherhood, followed by interviews to motivate their ranking. To extract the perspectives/factors on support during this transition process, centroid by-person factor analysis and varimax rotation was used. The transcripts of the interviews were interpreted per factor.

SETTING

Independent (self-employed) and employed, community and hospital-based practising midwives in Flanders, Belgium.

PARTICIPANTS

83 practicing midwives participated, selected on: variation in practice setting, years of experience, views on the woman's domestic role in family life, and motherhood status.

FINDINGS

Two distinct perspectives (factors) on supporting women in transition to motherhood emerged. The job-focused midwife acts according to evidence, knowledge and guidelines and adheres to the scope and tasks within the professional profile (Factor 1). The woman-focused midwife acts within a relationship of trust emphasizing the one-on-one connection while supporting transition to motherhood and the woman's needs (Factor 2). Both factors showed an explained total variance of 59% of the Q-set.

KEY CONCLUSIONS

Both the job-focused midwife and the woman-focused midwife represent distinct perspectives about the midwife's execution of supporting transition to motherhood, including salotugenic elements. This provides an understanding of midwives' thoughts and experiences about why and how support is given.

IMPLICATIONS FOR PRACTICE

More awareness about the subjective distinct ways of thinking about supporting transition to motherhood should be integrated in practice, midwifery education and professional development.

An Integrated Mechanistic Model of Mindfulness-Oriented Recovery Enhancement for Opioid-Exposed Mother-Infant Dyads

A growing body of neurobiological and psychological research sheds light on the mechanisms underlying the development and maintenance of opioid use disorder and its relation to parenting behavior. Perinatal opioid use is associated with risks for women and children, including increased risk of child maltreatment. Drawing from extant data, here we provide an integrated mechanistic model of perinatal opioid use, parenting behavior, infant attachment, and child well-being to inform the development and adaptation of behavioral interventions for opioid-exposed mother-infant dyads. The model posits that recurrent perinatal opioid use may lead to increased stress sensitivity and reward dysregulation for some mothers, resulting in decreased perceived salience of infant cues, disengaged parenting behavior, disrupted infant attachment, and decreased child well-being. We conclude with a discussion of Mindfulness-Oriented Recovery Enhancement as a means of addressing mechanisms undergirding perinatal opioid use, parenting, and attachment, presenting evidence on the efficacy and therapeutic mechanisms of mindfulness. As perinatal opioid use increases in the United States, empirically informed models can be used to guide treatment development research and address this growing concern.

Parental-couple separation during the transition to parenthood

AIM

To evaluate factors associated with parental separation during the parenthood transition.

DESIGN

Prospective, longitudinal and explorative.

METHODS

This is a quantitative longitudinal study of N784 subjects throughout the pregnancy journey with multivariate regression analysis of survey data derived from three validated measurement scales; the Sense of Coherence scale, the Multidimensional Scale of Perceived Social Support and the Perceived Quality of the Dyadic Relationship scale conducted 2014-2016.

RESULTS

N17 participants separated at 2 years. Parental separation was significantly greater for those women and partners with low or changing sense of coherence, perceived social support and perceived quality of the parental-couple relationship indexes. Partners with a change in sense of coherence (p: .003) and perceived quality of the parental-couple relationship (p: .020) between 1 week and 2 years were at greater risk for separation. Attending professional preparatory support with a partner for women (p: .013) and attending the "Inspirational Lecture" for partners (p: .046) were, to a lesser extent, associated with a risk of parental separation.

Women's Depressive Symptoms during the COVID-19 Pandemic: The Role of Pregnancy

The Coronavirus Disease 2019 (COVID-19) pandemic has multiple ramifications for pregnant women. Untreated depression during pregnancy may have long-term effects on the mother and offspring. Therefore, delineating the effects of pregnancy on the mental health of reproductive-age women is crucial. This study aims to determine the risk for depressive symptoms in pregnant and non-pregnant women during COVID-19, and to identify its bio-psycho-social contributors. A total of 1114 pregnant and 256 non-pregnant women were recruited via social media in May 2020 to complete an online survey that included depression and anxiety questionnaires, as well as demographic, obstetric and COVID-19-related questionnaires. Pregnant women also completed the Pandemic-Related Pregnancy Stress Scale (PREPS). Pregnant women reported fewer depressive symptoms and were less concerned that they had COVID-19 than non-pregnant women. Among pregnant women, risk factors for depression included lower income, fewer children, unemployment, thinking that one has COVID-19, high-risk pregnancy, earlier gestational age, and increased pregnancy-related stress. Protective factors included increased partner support, healthy behaviors, and positive appraisal of the pregnancy. Thus, being pregnant is associated with reduced risk for depressive symptoms during the pandemic. Increased social support, engaging in health behaviors and positive appraisal may enhance resilience. Future studies of pregnant versus non-pregnant women could clarify the role of pregnancy during stressful events, and clarify aspects of susceptibility and resilience during pregnancy.

Existential aspects in the transition to parenthood based on interviews and a theatre workshop

OBJECTIVES

There are multitudes of existential feelings and considerations around childbirth, with both positive and negative sources of existential meaning; often they are mixed up, but they impact parents' ideas of meaning and purpose in life. The aim of this study was to explore existential aspects of parenthood transition among new fathers and mothers in view of a potential training programme for professionals in maternity services.

STUDY DESIGN

Data were generated through a user-involving two-phase process inspired by action research consisting of first, four focus group-interviews (n = 10); and second, a theatre workshop for parents, health professionals, and researchers (n = 40). Between the two phases, case-narratives were constructed based on the interviews and, in collaboration with a dramatist, dramatized and then played at the workshop by professional actors. Data from interviews and the workshop were thematised for further analysis.

RESULTS

We identified five themes: 1. A turning point of what to hold sacred; 2. Changed relationships - guilt and overwhelming love; 3. Awareness of death; 4. Religiousness embodied; 5. What we talk about.

CONCLUSIONS

Existential aspects of parenthood transition were closely related to meaning in life, changes in relationships, awareness of death and relation to a transcendent belief. Existential aspects were explicated and discussed in nuanced ways expressing existential vulnerability. It is therefore important to both acknowledge and address existential aspects in maternity care, for the simple reason (among others) that they matter to parents. Moreover, this might enhance a coherent and authentic parenthood transition embedding the paradoxicalities.

Characteristics of existing healthcare workforce education in spiritual care related to childbirth: A systematic review identifying only two studies

BACKGROUND

It has been argued that the beginning of life is one of the most significant, universally-shared life events, impacting parental health biologically, sociologically, psychologically and spiritually. In maternity care settings, only a few educational initiatives exist focusing on increasing competencies in spiritual care.

OBJECTIVE

To explore the characteristics of content in existing under- and post-graduate education of healthcare professionals in spiritual care in the field of maternity care.

METHODS

We conducted an integrative review, searching seven databases for studies describing the content of existing education in spiritual care in maternity care settings.

RESULTS

From 235 studies assessed eligible and full text screened, only two were included, originating from the same project. The majority of existing studies about spiritual care focus on the perspective of women related to loss, sickness or bereavement, whereas research related to the field of maternity care is sparser. Furthermore, the perspective of the professional seems overlooked.

CONCLUSION

There is a lack of research exploring the content and structure of educational initiatives related to spiritual care in maternity care. In order to strengthen spiritual care competencies in maternity care, for both women/partners and professionals, future research should investigate how education is planned and evaluated.

Parents' Experiences of Receiving Professional Support Through Extended Home Visits During Pregnancy and Early Childhood-A Phenomenographic Study

Background: While becoming a parent can be challenging for all, it can particularly be challenging for those parents and children who are in a vulnerable situation—e.g., in families whose members have problems related to health, relationships, or socioeconomic status. It is essential for health care professionals to identify the more vulnerable families at an early stage. Home visits are one cost-effective way of identifying and supporting such families. This study describes the parental experiences of an intervention that involves professional support in the form of extended home visits. The aim of the study is to describe the parents' understanding of their experiences of receiving professional support through extended home visits both during pregnancy and the first 15 months of their child's life.

Methods/Design: A phenomenographic approach was used. Semi-structured interviews were conducted with 12 parents who had received the intervention. The interviews were analyzed using the seven-step phenomenography model described by Sjöström and Dahlgren.

Results: The following three descriptive categories emerged from the analysis: (1) conceptions concerning the meaning of the physical environment, (2) conceptions concerning extended home visits promoting feelings of self-confidence in the parental role, and (3) conceptions concerning extended home visits promoting parental participation and relations.

Conclusion and Clinical Implications: Extended home visits as a form of professional support appear to promote parental self-confidence in parenting ability, giving parents a feeling of security that facilitates conversation with professionals. Children and their entire families had natural roles during home visits, which allowed the children to behave more characteristically. Furthermore, the home visits were understood to facilitate social support through social activities at the child health center as well as integration into Swedish society for migrant parents. Professional support should be adjusted to the unique individual needs of parents, which demands a variety of supportive interventions—for example, reorganizing one or two of the regular clinical visits currently being scheduled as home visits instead.

How Giving Birth Makes Sense: A Questionnaire Study on Existential Meaning-Making Among Mothers Giving Birth Preterm or at Term

BACKGROUND

Women's reflections on existential meaning-making in relation to giving birth may seem indistinct in maternity services and have not been thoroughly explored in secular contexts. However, research suggests that childbirth accentuates spiritual and existential considerations and needs even in secular contexts highlighting the importance of care for such needs in maternity care practices. The objectives of this study were two-fold: Firstly, to explore how first-time mothers, living in a secular context, experience their first birth in relation to existential meaning-making. Secondly, to describe the relationship between existential meaning-making reflections and gestational week at birth.

METHODS

A nationwide cross-sectional study in Denmark based on the questionnaire "Faith, existence and motherhood" was conducted in 2011. Eight core items related to birth experience informed this study. The cohort was sampled from the Danish Medical Birth Registry and consisted of 913 mothers having given birth 6-18 months previously. Twenty-eight per cent had given birth preterm (PT) and 72% had given birth at full-term (FT). A total of 517 mothers responded.

RESULTS

In relation to the birth of their first child, both FT and PT mothers answered, that they had existential meaning-making reflections. The consent to the 8 items ranged from 17 to 73% among FT mothers and from 19 to 58% among PT mothers. Mothers who gave birth preterm mainly identified the negative aspects of birth, whereas mothers, who gave birth at full-term, to a higher degree identified positive aspects.

CONCLUSIONS

Findings suggest that not only traumatic birth events accentuate existential reflections, but that even normal childbirth to most mothers is an existential event. However, the quality of existential reflections differs when comparing normal and traumatic birth. The study points towards change in education and organization of maternity care to better care for existential needs and reflections specific to every new mother and birthing woman.

Validating a framework of women's experience of the perinatal period; a scoping review

OBJECTIVE

The aim of this paper is to identify and explain the factors that make up a woman's experience of the perinatal period. We accomplish this by validating a framework, described in an earlier study, that identifies the distinct dimensions of the perinatal experience.

DESIGN

We conducted a scoping review, using five online databases, to identify and categorize studies that investigate women's experience of the perinatal period.

FINDINGS

We found 251 publications that focused on the experience of the perinatal period. Our review confirmed the seven dimensions of our framework describing women's experiences of the perinatal period - the woman as unique individual, the woman as active participant in care, the responsiveness of maternity care and health services, the lived experience of being pregnant, giving birth and the postpartum period, communication and relationships with care providers, information and childbirth education, and support from social environment. One new dimension emerged from the studies we identified: societal influence. The resulting eight dimensions provide a comprehensive overview of the important aspects of women's experience of the perinatal period. While each dimension is distinct, there are significant overlaps and close relationships between them.

CONCLUSION

The framework is a useful guide for healthcare providers, researchers, and policy makers who wish to improve the experience of the perinatal period. It is important to remember, however, that the current framework is dynamic, open to new insights and further development and refinement.

Ritualizing Pregnancy and Childbirth in Secular Societies: Exploring Embodied Spirituality at the Start of Life

Birth is the beginning of a new life and therefore a unique life event. In this paper, I want to study birth as a fundamental human transition in relation to existential and spiritual questions. Birth takes place within a social and cultural context. A new member of society is entering the community, which also leads to feelings of ambiguity and uncertainty. Rituals are traditionally ways of giving structure to important life events, but in contemporary Western, secular contexts, traditional birth rituals have been decreasing. In this article, I will theoretically explore the meaning of birth from the perspectives of philosophy, religious and ritual studies. New ritual fields will serve as concrete examples. What kind of meanings and notions of spirituality can be discovered in emerging rituals, such as mother’s blessings or humanist naming ceremonies? Ritualizing pregnancy and birth in contemporary, secular society shows that the coming of a new life is related to embodied, social and cultural negotiations of meaning making. More attention is needed in the study of ritualizing pregnancy and birth as they reveal pluralistic spiritualities within secular contexts, as well as deeper cultural issues surrounding these strategies of meaning making.

Counselling for prenatal anomaly screening-A plea for integration of existential life questions

The availability in many countries of new prenatal anomaly screening methods, such as the non-invasive prenatal test (NIPT), and the potential broadening of testing for genetic conditions, creates an ongoing debate about the accompanying existential dilemmas at both societal level and for individual new parents. In many countries, the main goal of counselling for prenatal anomaly screening is to facilitate the reproductive decision-making process of future parents. Therefore, counsellors share information to enable a woman and her partner to think about the pros and cons of participating in screening, try to clarify possible moral dilemmas, and dwell on existential life questions. In line with the CanMEDS framework, healthcare professionals must combine the role of communicator (providing health education) with that of professional (by recognising and responding to existential life questions while facilitating decision-making). This is not easy but it is essential for providing balanced counselling. At present, counselling tends to be sufficient regarding health education, whereas guidance in decision-making, including attention for existential life questions and philosophy of life, offers room for improvement. In this paper, we suggest slowing down and turning the traditional prenatal counselling encounter upside down by starting as a counselling professional instead of a healthcare information sharing communicator and thus making the story of the woman and her partner, within their societal context, the starting point and the basis of the counselling encounter.

Cross-Cultural Adaptation of the Communication Assessment Tool for Use in a Simulated Clinical Setting

Construct: The Communication Assessment Tool (CAT) is a 14-item instrument developed in English to assess medical trainees' interpersonal communication skills from the patient's perspective in clinical settings. Background: Using validated instruments and simulated patients constitutes good practice in assessing doctor-patient communication. The CAT was designed for use in real practice, but has not yet been applied to assessing OB-GYN residents' delivery of bad news in Objective Structured Clinical Examination (OSCE) stations. This study aims to provide validity evidence for using the CAT to assess residents' interpersonal communication skills under difficult circumstances in a simulated clinical setting in Brazil. Approach: Cross-cultural adaptation comprised translation into Portuguese, synthesis of translations, and back-translation. Next, a committee of 10 external and independent experts rated the items for linguistic equivalence and relevance to the overall scale. Researchers used the expert ratings to produce a preliminary Brazilian-Portuguese version. This version was applied by four simulated patients to assess 28 OB-GYN residents completing two, 10-minute OSCE stations focused on delivering bad news. Item and scale content validity indices and internal-consistency reliability were calculated. Simulated patients were interviewed to clarify any doubt regarding the content and usability of the tool and their response process. Findings: Thirteen of the 14 items in the Brazilian-Portuguese version were considered "equivalent" by at least 70% of the experts. All items were considered relevant by 100% of the experts. The Item Content Validity Index ranged from .9 to 1, and the Scale Content Validity Index was .99. The instrument showed good reliability for both scenarios (Cronbach's alpha > .90). Simulated patients considered the CAT easy to understand and complete. Conclusions: This study provides validity evidence for using the Brazilian-Portuguese CAT in a simulated clinical environment to assess OB-GYN residents' delivery of bad news. Based on this study's findings, the OB-GYN Department organized an annual formative assessment for residents to improve their interpersonal communication skills. This version of the CAT may also be applicable to other specialties.

The complex information needs of disadvantaged young first-time mothers: insights into multiplicity of needs

Purpose

The purpose of this paper is to holistically explore the information needs of socioeconomically disadvantaged young first-time mothers and associated issues of complexity.

Design/methodology/approach

This paper used survey and semi-structured field interviews with 39 young mothers (aged 15–23) from UK areas of multiple deprivations.

Findings

Participants reported multiple and complex needs spanning interrelated topics of parenting, poverty and personal development. In the majority of instances, participants were either unsure of their ability to meet their needs or needed help with needs, and several described situations of considerable anxiety and stress. Multiplicity is identified and conceptualised as an important factor contributing to complexity, including three component elements: simultaneous occurrence of needs (concurrency), relationships between needs (interconnectivity) and evolving needs (fluidity). In various combinations, these elements influenced a mother's actions and/or ability to selectively attend to needs, with multiple needs often competing for attention, and compounding issues of cognitive load and affect.

Research limitations/implications

This study draws attention to multiplicity of needs as an understudied topic within human information behaviour and calls for further research into how people recognise and attend to complex needs and influencing factors.

Practical implications

This study raises important questions regarding how we approach complexity of information needs in our design and delivery of information systems and services.

Originality/value

Evidences disadvantaged young mothers to have more extensive and complex information needs than previously understood, and identifies and conceptualised multiplicity as an important factor contributing to the complexity of information needs during major life transitions such as motherhood.

[Experiences of parents of children born with microcephaly during the Zika epidemic following disclosure of the diagnosis]

This article aims to understand how parents of children with microcephaly received the diagnosis. This qualitative study was conducted at State Referral Center for Children's Neurodevelopment, Care, and Rehabilitation (NINAR) in São Luís, Maranhão State, Brazil, from April 2017 to February 2018. Participants in the study included parents or guardians of children with microcephaly. Data collection included structured and semi-structured interviews with 3 couples, 16 mothers, and 1 great-grandmother, totaling 20 interviews. The sample was defined by the saturation criterion, and content analysis was performed according to the thematic modality. Eighteen interviewees reported that the diagnosis had been disclosed to them inappropriately and traumatically, sometimes linked to a sense of "end of life" and dissociated from orientation on ways to cope with the situation and care for the child. The diagnosis of microcephaly was disclosed by physicians in 15 of the 20 cases. Three other cases were disclosed as follows: one by a nurse, one by the mother-in-law (who had learned of the diagnosis from the physician), and one by a health department employee. The other two did not receive the diagnosis: one couple learned of the microcephaly from the infant's Certificate of Life Birth and the other associated the child's problem with information broadcast on the media. Three thematic lines were analyzed: omission of the diagnosis; process of disclosure of the diagnosis; and anticipation of the prognosis. The ways diagnosis of microcephaly was disclosed to families influenced how they accepted and coped with the situation.

Previous breastfeeding difficulties: an existential breastfeeding trauma with two intertwined pathways for future breastfeeding-fear and longing

PURPOSE

Experiencing breastfeeding difficulties poses a risk for early cessation of breastfeeding and decreases the likelihood of breastfeeding a future child. To further understand breastfeeding outcomes, the aim of this study is to explain the phenomenon of breastfeeding difficulties in order to understand how women's previous experiences of breastfeeding difficulties relate to their decisions about future breastfeeding.

METHODS

A reflective lifeworld hermeneutical approach was adopted. The study consisted of 15 lifeworld interviews with eight women who had previously experienced difficulties with initial breastfeeding.

RESULTS

Previously experienced breastfeeding difficulties represent an existential breastfeeding trauma in an individual woman's life, from which there are two intertwined pathways for future breastfeeding: a fear of breastfeeding, which renders the idea of future breastfeeding unthinkable, and a longing for breastfeeding, which increases the likelihood of future breastfeeding. Fear and longing are intertwined in ambiguous ways in an individual woman's life.

CONCLUSION

Women with previous breastfeeding difficulties may bring negative breastfeeding experiences with them, which are etched into the woman's being as a mother as an embodied memory. A lifeworld-led caring science perspective as a foundation for care can contribute to the development of caring practices, which grasp the existential nature of the breastfeeding trauma.

Developing a spiritual care competency framework for pre-registration nurses and midwives

This paper identifies competencies in spiritual care from an in-depth literature review and develops a theoretical framework for competencies in spiritual care. It forms part of a larger modified Delphi study which recruited international nursing/midwifery experts. Using Braun and Clark (2006) adapted six-phase content thematic analysis, 7 domains and 116 competency items were generated from an in-depth literature review in three areas; spirituality and spiritual care, spiritual care education, and spiritual care curricular contents.

Late-term pregnancy: Navigating in unknown waters - A hermeneutic study

BACKGROUND

Late-term pregnancy is related to increased risk of serious complications for babies and women, as pregnancies proceed. Pregnancy is an individual, complex and existential situation for women, who may experience late-term pregnancy as a mentally strenuous period, characterised by worries and anxiety. However, there is a lack of studies in this area.

AIM

To describe women's experiences of late-term pregnancy ≥41 gestational weeks.

METHODS

A lifeworld hermeneutic approach was used. Qualitative interviews were performed with ten women, two to seven months after the birth.

FINDINGS

Six themes emerged from the analysis Doubting the body's ability to cope with the transition from pregnancy to giving birth, The importance of their partner's support during the sea voyage, Lacking clear guidelines for the voyage, Worrying about the cargo at the end of the voyage, How the voyage turned out and Thoughts related to a future voyage.

CONCLUSION

The women did not feel sufficiently empowered to trust their body's ability to make the transition from late pregnancy to birth. It is vital that midwives provide clear guidance and empower women to trust the ability of their body to give birth. This transition is important in relation to positive thoughts about future pregnancies and births.

Addressing transition to motherhood, guideline adherence by midwives in prenatal booking visits: Findings from video recordings

OBJECTIVE

To assess if and how primary care midwives adhere to the guideline by addressing transition to motherhood at the first prenatal booking visit and to what extent there was a difference in addressing transition to motherhood between nulliparous and multiparous women.

DESIGN

Cross-sectional observational study of video-recorded prenatal booking visits.

SETTING AND PARTICIPANTS

126 video recordings of prenatal booking visits with 18 primary care midwives in the Netherlands taking place between August 2010 and April 2011.

MEASUREMENTS

Five observers assessed dichotomously if midwives addressed seven topics of transition to motherhood according to the Dutch guideline prenatal midwifery care from the Royal Dutch Organization of Midwives and used six communication techniques. Frequencies and percentages of addressing each topic and communication technique were calculated. Differences between nulliparous and multiparous women were examined with Chi-Square tests or Fischer Exact tests, were appropriate. The agreement between the five observers was quantified using Fleiss' Kappa.

FINDINGS

During all visits at least one of the seven topics of transition to motherhood was addressed. The topics mother-to-infant bonding and support were addressed respectively in 2% and 16% of the visits. In almost all visits the topics desirability of the pregnancy, experience with the ultrasound examination or abdominal palpation or hearing the foetal heartbeat and practical preparation were addressed. Open questions for addressing transition to motherhood were used in 6% of the prenatal booking visits. Dutch midwives addressed transition to motherhood mostly by giving information (100%) and by using closed-ended questions (94%) and following woman's initiative (90%). Nulliparous women brought up transition to motherhood on their own initiative more often than multiparous women (97% versus 84%). For the topics 'desirability of the pregnancy 'and' practical preparations' and for conversation techniques 'giving information' and 'closed-ended questions', 100% agreement was achieved. However, the topic 'Support' had poor agreement (kappa = 0.19).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Although during every visit the transition of motherhood was addressed, the topics mother-to-infant bonding and support should get more attention. Midwives should improve adherence to the guideline by addressing transition to motherhood and by using more open questions. Furthermore, they should focus on taking the initiative to address the transition to motherhood in multiparous women themselves.

The Human Responses and Nursing Diagnoses of Those Living With Infertility: A Qualitative Systematic Review

OBJECTIVE

To systematically retrieve, critique, and synthesize patients' human responses about living with infertility and identify possible related nursing diagnoses according to NANDA-I.

METHODS

Systematic review of qualitative nursing studies.

FINDINGS

A total of 39 papers were included, 49 human responses, and 77 potential infertility-related nursing diagnoses were identified across three themes. Main foci matching nursing diagnosis were related to spiritual well-being, spiritual distress, and resilience.

CONCLUSIONS

Patients respond to infertility in a variety of ways and this raises the need for a more effective, holistic, and accurate nursing diagnosis.

IMPLICATIONS FOR PRACTICE

The accuracy of the nursing diagnosis is critical in raising the quality of the nursing process and in meeting infertile patients' circumstances and care expectations.

The meaning of a poor childbirth experience - A qualitative phenomenological study with women in Rwanda

OBJECTIVE

Being pregnant and giving birth is a pivotal life event and one that a woman ordinarily remembers for most of her life. A negative childbirth experience can affect a woman's health well beyond the episode of the labour and birth itself. This study explored the meaning of a poor childbirth experience, as expressed by women who had given birth in Rwanda.

METHODS

In a cross-sectional household study conducted in Northern Province and in Kigali City, the capital of Rwanda, a structured questionnaire was answered by women who had given birth one to 13 months earlier. One question, answered by 898 women, asked them to rate their overall experience of childbirth from 0 (very bad) to 10 (very good). Of these, 28 women (3.1%) who had rated their childbirth experience as bad (≤ 4) were contacted for individual interviews. Seventeen of these women agreed to participate in individual in-depth interviews. The texts were analysed with a reflective lifeworld approach.

RESULTS

The essential meaning of a "poor" childbirth experience was that the women had been exposed to disrespectful care, constituted by neglect, verbal or physical abuse, insufficient information, and denial of their husband as a companion. The actions of carers included abandonment, humiliation, shaming and insult, creating feelings of insecurity, fear and distrust in the women. Two of the women did not report any experience of poor care; their low rating was related to having suffered from medical complications.

CONCLUSION

It is challenging that the main finding is that women are exposed to disrespectful care. In an effort to provide an equitable and high quality maternal health care system in Rwanda, there is a need to focus on activities to implement respectful, evidence-based care for all. One such activity is to develop and provide education programmes for midwives and nurses about professional behaviour when caring for and working with women during labour and birth.