1
|
Slade L, Obst K, Deussen A, Dodd J. The tools used to assess psychological symptoms in women and their partners after termination of pregnancy for fetal anomaly: A scoping review. Eur J Obstet Gynecol Reprod Biol 2023; 288:44-48. [PMID: 37423121 DOI: 10.1016/j.ejogrb.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
Termination of pregnancy for fetal anomaly (TOPFA) represents a uniquely distressing and challenging situation for women and their partners. Having appropriate screening tools that best highlight the psychological symptoms experienced by women and their partners is important to be able to guide care. Many validated screening tools for pregnancy and psychological distress exist, with variation in the ease of application and the domains addressed in each. We undertook a scoping review of tools used to assess psychological symptoms in women and/or partners after TOPFA. Of 909 studies, 93 studies including 6248 women and 885 partners were included. Most of the included studies assessed symptoms within six months of TOPFA and highlighted high rates of distress, grief and trauma symptoms. There was broad variation in the tools used between studies and the timing of their implementation. Focusing the care of women and families who undergo TOPFA to validated, broadly available and easily applied screening tools that assess a range of psychological symptoms is key in being able to identify the potential interventions that may be of benefit.
Collapse
Affiliation(s)
- Laura Slade
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia.
| | - Kate Obst
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea Deussen
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie Dodd
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Armour S, Keedle H, Gilkison A, Dahlen HG. Midwifery care for late termination of pregnancy: Integrative review. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100889. [PMID: 37454584 DOI: 10.1016/j.srhc.2023.100889] [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: 08/04/2022] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Midwives provide reproductive healthcare to women, including during termination of pregnancy (TOP) after 12 weeks (late TOP). Their expertise, knowledge and woman-centred care approach sees them ideally placed for this role. However, the medical, social and emotional complexities of late TOP can cause midwives significant distress. An integrative review methodology was used to examine the research on midwifery care for late TOP and identify support strategies and interventions available to midwives in this role. Five databases and reference lists were searched for relevant studies published between 2000 and 2021. A total of 2545 records were identified and 24 research studies included. Synthesis of research findings resulted in three themes: Positive aspects, negative aspects and carers need care. Midwives reported a high level of job satisfaction when caring for women during late TOP. Learning new skills and overcoming challenges were positive aspects of their work. Yet, midwives felt unprepared to deal with challenging aspects of late TOP care such as the grief and the psychological burden of the role. Caring for the baby with dignity had both positive and negative aspects. Midwives relied predominantly on close colleagues for help and debriefing as they felt poorly supported by management, judged by co-workers and lacked appropriate support to reduce the emotional effects of late TOP care. Midwives need support, although current evidence has not identified the most appropriate and effective strategy to support them in this role.
Collapse
Affiliation(s)
- Susanne Armour
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia.
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| | - Andrea Gilkison
- Auckland University of Technology, School of Clinical Sciences, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| |
Collapse
|
3
|
Bowman-Smart H, Keogh L, Haining CM, O'Rourke A, de Crespigny L, Savulescu J. 'The tabloid test': a qualitative interview study on the function and purpose of termination of pregnancy review committees in Victoria, Australia. Reprod Health 2023; 20:104. [PMID: 37464379 DOI: 10.1186/s12978-023-01624-w] [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: 12/24/2021] [Accepted: 05/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Termination of pregnancy (TOP) is not an uncommon procedure. Availability varies greatly between jurisdictions; however, additional institutional processes beyond legislation can also impact care and service delivery. This study serves to examine the role institutional processes can play in the delivery of TOP services, in a jurisdiction where TOP is lawful at all gestations (Victoria, Australia). As per the Abortion Law Reform Act 2008, TOPs post-24 weeks require the approval of two medical practitioners. However, in Victoria, hospitals that offer post-24 week TOPs generally require these cases to additionally go before a termination review committee for assessment prior to the service being provided. These committees are not stipulated in legislation. Information about these committees and how they operate is scarce and there is minimal information available to the public. METHODS To trace the history, function, and decision-making processes of these committees, we conducted a qualitative interview study. We interviewed 27 healthcare professionals involved with these committees. We used purposive sampling to gain perspectives from a range of professions across 10 hospitals. Interviews were transcribed verbatim, identifying details removed and inductive thematic analysis was performed. RESULTS Here, we report the three main functions of the committees as described by participants. The functions were to protect: (1) outward appearances; (2) inward functionality; and/or, (3) service users. Function (1) could mean protecting the hospital's reputation, with the "Herald Sun test"-whether the TOP would be acceptable to readers of the Herald Sun, a tabloid newspaper-used as a heuristic. Function (2) related to logistics within the hospital and protecting the psychological wellbeing and personal reputation of healthcare professionals. The final function (3) related to ensuring patients received a high standard of care. CONCLUSIONS The primary functions of these committees appear to be about protecting hospitals and clinicians within a context where these procedures are controversial and stigmatized. The results of this study provide further clarity on the processes involved in the provision of TOPs at later gestations from the perspectives of the healthcare professionals involved. Institutional processes beyond those required by legislation are put in place by hospitals. These findings highlight the additional challenges faced by patients and their providers when seeking TOP at later gestations.
Collapse
Affiliation(s)
- Hilary Bowman-Smart
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia
- Monash Bioethics Centre, Monash University, Clayton, VIC, Australia
- Ethox Centre, University of Oxford, Oxford, UK
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Casey M Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Anne O'Rourke
- Monash Business School, Monash University, Clayton, VIC, Australia
| | - Lachlan de Crespigny
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
4
|
Roncoroni J, Whitaker S, Magdamo B, Hendrix T, Zaręba K, Yohannes R. Perceptions of Patient-Centered Care and Their Association With Patient Satisfaction in Abortions for Medical Reasons. Womens Health Issues 2023:S1049-3867(23)00069-5. [PMID: 37230927 DOI: 10.1016/j.whi.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Abortions for medical reasons, which happen in the event of fetal abnormalities or maternal life endangerment, are highly politicized and understudied given their prevalence. Our objective was to understand the health care experiences of U.S. individuals who had an abortion of a wanted pregnancy for medical reasons in the second or third trimester. METHODS Participants were recruited on Facebook and completed surveys with their demographic information, their perception of their health provider's cultural sensitivity, their patient satisfaction, and their satisfaction with their decision to proceed with an abortion for medical reasons. RESULTS Participants were 132 women who were mostly between the ages of 31 and 40 (72.7%), highly educated (84.1% had at least a 4-year college degree), and non-Hispanic White (85.6%). There was no statistically significant difference in patients' rated highest average item score on their providers' Competence or Sensitivity; however, average item scores of providers' Competence and Sensitivity were both higher than Respect scores. Linear regression results show that experiencing patient-centered care significantly predicted patient satisfaction (β = .73, t(131) = 12.03, p < .001) and decision satisfaction (β = .37, t(131) = 4.63, p < .001). CONCLUSION Our findings underscore the importance of training providers to deliver patient-centered care that empowers patients to adapt to challenging situations, such as the diagnosis of medical concerns during pregnancy. Providers understanding and supporting the complex process of an abortion for medical reasons can ameliorate the emotional impact of this procedure.
Collapse
Affiliation(s)
- Julia Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, Colorado.
| | - Salina Whitaker
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Brigid Magdamo
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Tayler Hendrix
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Kornelia Zaręba
- Obstetrics & Gynecology Department, College of Medicine & Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Rebekah Yohannes
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| |
Collapse
|
5
|
Zhou M, Li X, Huang C, Xie J, Liu L, Wang Y, Xiao G, Zhang T, Qin C. Needs for supporting women undergoing termination of pregnancy for fetal anomaly: A phenomenological study based on the cognitive-emotional-behavioral framework. Midwifery 2023; 123:103726. [PMID: 37192569 DOI: 10.1016/j.midw.2023.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To determine and describe the needs of women undergoing termination of pregnancy for fetal anomaly (TOPFA) in China. STUDY DESIGN Qualitative study with semi-structured interviews. Consolidated Criteria for Reporting Qualitative Studies checklist was used for reporting. SETTING Three general hospitals and one special hospital in Changsha, Hunan, China. PARTICIPANTS 12 women who had undergone TOPFA and 12 healthcare providers who had experienced in caring for these women. METHODS This study was based on the cognitive-emotional-behavioral framework (CEBF) of women who had to undergo TOPFA. Twenty-four participants (12 women and 12 healthcare providers) were recruited from two hospitals in China. Semi-structured face-to-face interviews were conducted based on interview guides. ATLAS.ti software was used to encode and analyze data. Qualitative content analysis was also applied. FINDINGS Four themes emerged: information, emotional, professional psychological, and social supports. Each theme was subdivided into four phases for a detailed description of the temporal order (denial, confirmation, decision-making, and recovery phases) within the framework. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our study analyzes the four needs of women who underwent TOPFA and the specifics of each need at different phases based on the CEBF. The importance of offering professional psychological support, detailed information, timely emotional support, and comprehensive social support for these women is illustrated. This study contributes to the understanding of women's needs, hence providing a theoretical basis for the construction of supportive programs.
Collapse
Affiliation(s)
- Mengjia Zhou
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Xi Li
- School of Medicine, Jishou University, Jishou, China
| | - Chi Huang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Jiaying Xie
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Li Liu
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Ying Wang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Gui Xiao
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Tingting Zhang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; 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
|
6
|
Martins MV, Valente VA, Silva AD, Ramalho C, Costa ME. "Death is a sensitive topic when you are surrounded by life": Nurses experiences with pregnancy loss. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100817. [PMID: 36764051 DOI: 10.1016/j.srhc.2023.100817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Although there is increasing evidence on the psychosocial adjustment and experiencing pregnancy loss from the patient's perspective, few studies have investigated the nurses' experience perceptions. This study aimed to understand the experience of nurses involved in pregnancy loss care based on the self-fulfillment model of communication. METHODS A qualitative approach was developed through semi-structured interviews to 16 nurses working in an Obstetrics and Maternal-Fetal Department of a local hospital. Based on grounded theory approach, data was analyzed with NVivo 12 software. RESULTS The analysis revealed three major themes and 11 sub-themes: i) stressful work conditions, comprising care management and institutional practices; ii) personal characteristics, including discomfort with loss, communication skills, work experience and empathy; and iii) the patient's journey, containing the partner's ambiguous role, timing, respect for the patient's individuality, viewing the fetus and facilitating grief rituals. CONCLUSION Nurses daily involved in providing care to patients suffering pregnancy loses have a demanding challenge in trying to assure that patients get the appropriate and better care and ensuring they keep their level of engagement in their profession. Interventions to improve communications skills with patients and with other health professionals are needed to enhance professional realization.
Collapse
Affiliation(s)
- Mariana V Martins
- Faculty of Psychology and Education Sciences - University of Porto, Portugal; Centre for Psychology at University of Porto, Portugal.
| | - Vanessa A Valente
- Faculty of Psychology and Education Sciences - University of Porto, Portugal
| | - Ana D Silva
- Faculty of Psychology and Education Sciences - University of Porto, Portugal; Centre for Psychology at University of Porto, Portugal; Universidade de Brasília, Departamento de Psicologia Clínica, Brasil
| | - Carla Ramalho
- Universidade do Porto, Faculdade de Medicina, Portugal; I3S- Instituto de Investigação e Inovação em Saúde, Portugal; Centro Hospitalar Universitário São João, EPE, Portugal
| | - Maria E Costa
- Faculty of Psychology and Education Sciences - University of Porto, Portugal; Centre for Psychology at University of Porto, Portugal
| |
Collapse
|
7
|
Life-limiting fetal conditions: Are Australian student midwives prepared? A mixed-methods survey. Nurse Educ Pract 2023; 68:103569. [PMID: 36822015 DOI: 10.1016/j.nepr.2023.103569] [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: 05/30/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
AIM To document current teaching methods, curriculum, and perceived educational preparation related to the teaching of life-limiting fetal conditions, termination, and perinatal palliative care to Australian student midwives. BACKGROUND Australian women receiving a diagnosis of a life-limiting fetal condition are generally offered a choice between termination of pregnancy and perinatal palliative care. Midwives are often involved with caring for these women. What Australian student midwives are being taught about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during their entry-to-practice program is unknown. DESIGN This study utilised a mixed-methods descriptive approach for data collection and analysis. METHODS Academic Leads of all Australian entry-to-practice midwifery programs received a questionnaire exploring topics taught, teaching time, teacher role, and perceived effectiveness of student preparation. Data was analysed statistically and thematically. RESULTS Twelve of 24 Academic Leads responded (50%); only five stated their programs taught all three areas. More respondents taught about termination of pregnancy (10/12) than perinatal palliative care (7/12). On average 5.8 ( ± 2.8) total hours was spent teaching about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during the entire midwifery program, with a range of 1 - 10 h. The free-text data identified three central themes: lack of value within the curriculum; disconnect between the university and the placement hospital; and preparation for practice. Most (10/12) Academic Leads did not believe student midwives are prepared to care for affected families. CONCLUSIONS Entry-to-practice midwifery programs vary considerably in their education surrounding life-limiting fetal conditions, however teaching hours overall were low and most Academic leads did not feel (or know if) their students were adequately prepared. Further research is required to determine if early career midwives find their university education in life-limiting fetal conditions adequate preparation for practice, and to then remediate identified deficiencies.
Collapse
|
8
|
Termination of pregnancy for fetal malformation: A traumatic event? A qualitative analysis of women's perception. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2023; 69:36-55. [PMID: 36927315 DOI: 10.13109/zptm.2023.69.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: To investigate women's experience of termination of pregnancy (TOP) for severe fetal malformation.We focus on women's individual perception of psychological counselling on decision making, experiencing the birth process, seeing and holding the baby as well as emotional processing. Methods: An explorative study was conducted with 42 women (the age range was between 21 and 45 years [mean 36.17; SD±6.66]) on average twelve months after TOP using semi-structured qualitative interviews. All women received psychological counselling before, during and after the time of TOP (mean 5.2; range 2-11), at the initial counselling session all partners were present. Data were analysed by means of qualitative content analysis by Mayring; the main research question focused on women's perception of psychological counselling on experiencing TOP and coping with this incisive life event. Results: After receiving psychological counselling most of the women felt sufficiently prepared to make a decision, to experience the birth process and to bid farewell to their child. Seeing and holding the baby were perceived as helpful for emotional processing. At the time of the interview, despite the emotional distress,most women reported having positivememories and felt they had coped with the loss. Conclusions: Long-term psychological care from the time of diagnosis through TOP and follow up impacts positively on experiencing TOP, saying farewell to the child and integrating the loss into life. Further studies to detect women at risk for prolonged mourning-reactions are needed.
Collapse
|
9
|
Jackson P, Power-Walsh S, Dennehy R, O'Donoghue K. Fatal fetal anomaly: Experiences of women and their partners. Prenat Diagn 2023; 43:553-562. [PMID: 36639719 DOI: 10.1002/pd.6311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study explored the care experiences of parents whose pregnancy was diagnosed with a fatal fetal anomaly following the legalisation of termination of pregnancy in 2019 in Ireland. METHODS A qualitative study using in-depth semi-structured interviews and interpretative phenomenological analysis was undertaken. Purposeful sampling was used to recruit 10 parents, six women and four of their male partners. Parents recruited included those who terminated and continued the pregnancy. RESULTS Three superordinate themes were identified: 'Attachment and coping', 'There's no place for you in the pregnancy world' and 'Consistency of quality care'. Parents shared the different approaches and level of attachment to their baby that supported their coping. Regardless of the level of attachment, many parents benefited from the acts of remembrance. Parents expressed how they no longer felt they belonged in the 'pregnancy world' and described a need for healthcare professionals to recognise their loss and create a safe and supportive environment in which they could share their grief. Despite this, parents' accounts highlighted variations and inconsistencies in care and service provision. CONCLUSION Our study highlighted parents' need for consistent, well communicated, and comprehensive care, which encourages an individualised perinatal palliative care approach to meet parental needs.
Collapse
Affiliation(s)
- Peter Jackson
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Stacey Power-Walsh
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland.,Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| |
Collapse
|
10
|
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
|
11
|
"It's a lot of pain you've got to hide": a qualitative study of the journey of fathers facing traumatic pregnancy and childbirth. BMC Pregnancy Childbirth 2022; 22:434. [PMID: 35610624 PMCID: PMC9128289 DOI: 10.1186/s12884-022-04738-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to explore the emotional and behavioural responses and coping strategies of fathers or expectant fathers who faced a significant traumatic event during a partner's pregnancy, labour, or the postpartum period. METHODS This prospective qualitative study of 24 fathers was conducted at a public teaching hospital in Brisbane, Australia. 'Traumatic pregnancy' was defined as a pregnancy complicated by life-threatening or severe risk to the mother and the fetus, termination of pregnancy, intrauterine fetal death or stillbirth. Semi-structured interviews of participants were conducted 3-4 months after the traumatic event. An initial qualitative analysis with automatic coding was performed using Leximancer and later followed by a six-phase manual thematic analysis. RESULTS A pregnancy-related traumatic event had significant mental and physical impacts on fathers. Participants' reactions and coping strategies were varied and influenced by their background history, pre-existing vulnerabilities, and the gap between expectation and reality. Most fathers described a fluctuating state between their needs 'not being met' and 'being met'. These needs were conceptualised using Maslow's hierarchy and Calman's gap theory to construct a composite thematic model to depict the universal requirements of men facing a traumatic pregnancy or childbirth. CONCLUSIONS A greater understanding of the needs of men and gaps in their care is urgently needed. A targeted effort is required to make maternity services father-inclusive. This approach may assist in preventing long term consequences on fathers, partners, and their children.
Collapse
|
12
|
Tataj-Puzyna U, Węgrzynowska M, Ryś M, Sys D, Bączek G, Baranowska B. "This pregnancy makes sense": Experiences of women who have decided to continue pregnancy after lethal fetal diagnosis. DEATH STUDIES 2022; 47:149-158. [PMID: 35201971 DOI: 10.1080/07481187.2022.2038310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lethal fetal diagnosis defines severe developmental disorders that lead to the death of a fetus or newborn. Using semi-structured interviews, we explored the experiences of women in Poland who actively decided to continue with the pregnancy after diagnosis. We thematically analyzed data collected from 10 women. We identified four themes: pregnancy as an experience of prenatal motherhood; the child as person; birth as encounter and farewell; and the mother experience in retrospect. This study was conducted while the termination of pregnancy due to the irreversible fetal abnormality was legal in Poland. Since October 2021, it is no longer legal.
Collapse
Affiliation(s)
- Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Ryś
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
13
|
González-Ramos Z, Zuriguel-Pérez E, Albacar-Riobóo N, Casadó-Marín L. The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review. Midwifery 2021; 103:103095. [PMID: 34320417 DOI: 10.1016/j.midw.2021.103095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In most countries of the world the only basis for considering a termination of pregnancy is for medical reasons. Depending on the circumstances and determinants of each case, the emotional responses to this event vary greatly. The aim of this study is to map the emotional responses of women when their pregnancy is terminated for medical reasons. METHODS A scoping review was carried out. This covered all types of qualitative and quantitative studies published in English or Spanish since 2014 which included first-person accounts of women's emotional responses when they had a termination. A bibliographic search was made of four databases (CINAHL, Cochrane Library, PsycINFO and Pubmed) along with an additional manual search and backward and forward citation chaining of the studies included. The data were reported in narrative form and the results grouped according to the descriptive characteristics of the study and the emotions involved. FINDINGS The review process resulted in the inclusion of thirty-four studies. nineteen of these followed a qualitative approach and fifteen used quantitative methodology, with six of them being intervention studies. The emotions found ranged from anxiety and depression to guilt and thankfulness, so various authors stressed the need to improve training for health professionals to provide information, advice and support to the women during the entire process of the termination of pregnancy for medical reasons. CONCLUSIONS The available studies cannot be compared given the variety of designs. The predominant emotions underlying the termination for medical reasons were stress, anxiety and depression. Future research should be carried out using samples of participants covering all causes of termination for medical reasons in a particular context so that an intervention can be designed to help lessen the impact of the process on women's mental health.
Collapse
Affiliation(s)
- Zuleika González-Ramos
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain; Hospital Vall d'Hebron. Passeig de la Vall d'Hebron, 119-129, Postal Code 08035 Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain; Hospital Vall d'Hebron. Passeig de la Vall d'Hebron, 119-129, Postal Code 08035 Barcelona, Spain
| | - Núria Albacar-Riobóo
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain
| | - Lina Casadó-Marín
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain
| |
Collapse
|
14
|
Kamranpour B, Noroozi M, Bahrami M. Termination of Pregnancy for Fetal Anomalies: A Qualitative Study of the Informational and Educational Needs of Women. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:97-103. [PMID: 34036055 PMCID: PMC8132862 DOI: 10.4103/ijnmr.ijnmr_94_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/03/2020] [Accepted: 01/03/2021] [Indexed: 11/21/2022]
Abstract
Background: Diagnosing congenital fetal anomalies before birth is considered an emotionally devastating experience. To facilitate the process of compatibility with this event, healthcare providers should determine various needs of these women. The present study was conducted to explore the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies. Materials and Methods: The present study was a qualitative content analysis. Forty participants (women, their spouses, and healthcare providers) in Rasht city, Iran, were selected using purposive sampling method with maximum variety and their data were gathered using in-depth interviews and field notes. Data were analyzed using conventional qualitative content analysis with Graneheim and Lundman approach. Results: After analyzing the text of the interviews, the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies were categorized in three main categories of “receiving information tailored to the client's circumstances,” “learning life skills to cope,” and “getting prepared for the next pregnancy.” Conclusions: The results, by exploring and magnifying the informational and educational needs of these women, could present an appropriate context for providing principal care and cultural-based interventions with an emphasis on comprehensive education and counseling. Also, proper implementation of the process of obtaining informed consent from the women to terminate the pregnancy is essential. These could facilitate the conditions for their return to normal life and ultimately promote their health.
Collapse
Affiliation(s)
- Bahareh Kamranpour
- Department of Midwifery, College of Nursing and Midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Bahrami
- Department of Adult Health Nursing, Nursing an Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
15
|
Armour S, Gilkison A, Hunter M. Midwives holding the space for women undergoing termination of pregnancy: A qualitative inquiry. Women Birth 2020; 34:e616-e623. [PMID: 33358489 DOI: 10.1016/j.wombi.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM Hospital midwives are the main care givers for women undergoing termination of pregnancy after 20 weeks. Midwives' role and potential impact of regular involvement in termination of pregnancy (TOP) are poorly understood. SETTING New Zealand. BACKGROUND TOP after 20 weeks may be performed to save a woman's life or preserve her physical and mental health. Throughout the process midwives play a key role in supporting women's complex psychological and clinical needs. OBJECTIVE To gain a deeper understanding of the role of midwives in TOP care after 20 weeks, including the support they might need and the impacts caring for women who are having a TOP may have on them. METHODS Eight midwives from two District Health Boards were interviewed about their experiences of caring for women having a TOP after 20 weeks. Transcripts were analysed by applying a hermeneutic-phenomenological lens. FINDINGS Three themes emerged: "A different kind of midwife", "Staying true to oneself" and "Melting an Iceberg". TOP care is a different role within midwifery as midwives facilitate death in the space of birth. Immersing themselves in women's emotional space they create meaningful connections to support their complex needs and provide a positive birth experience. Yet, midwives are unprepared for the emotional effects of repeatedly caring for women undergoing TOP. Lacking appropriate support they can experience increasing, lasting grief. CONCLUSION Midwives' experiences of providing TOP care are complex, intense and have lifelong impact. Their role in the context of TOP is highly specialised and must be valued and supported.
Collapse
Affiliation(s)
- Susanne Armour
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Andrea Gilkison
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Marion Hunter
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
16
|
Kamranpour B, Noroozi M, Bahrami M. A qualitative study exploring the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies in Iran. BMC Pregnancy Childbirth 2020; 20:573. [PMID: 32993553 PMCID: PMC7526095 DOI: 10.1186/s12884-020-03274-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background In order to provide appropriate and adequate care to women who have experienced termination of pregnancy due to fetal anomalies, the health needs of this group should be assessed. Considering the lack of information about the care and services required by these women in Iran, this study was conducted with the aim of exploring the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies. Methods This study was conducted with a qualitative approach. 40 participants were selected through purposive sampling, and the data were collected through in-depth semi structured interviews and field notes, and analyzed using conventional qualitative content analysis. Results After analyzing the texts, the needs related to the health system in women with experience of pregnancy termination due to fetal anomalies were categorized in the three main categories: “efficient treatment team”, “optimal organizational structure in providing services” and “financial support for families”. Conclusions The findings of the present study by exploring and highlighting the needs related to the health system in different dimensions in women with experience of pregnancy termination due to fetal anomalies can be helpful for designing and providing basic and comprehensive care programs.
Collapse
Affiliation(s)
- Bahareh Kamranpour
- Department of Midwifery, College of Nursing and Midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Masoud Bahrami
- Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
17
|
Li Y, Tang S, Lu J, Huang C, Peng H, Xie J, Borjigen A, Liu M, Qin C. Prevalence and Factors Associated With Depressive Symptomatology Among Women Before Termination of Pregnancy for Fetal Anomaly. J Psychosoc Nurs Ment Health Serv 2020; 58:43-50. [PMID: 32976606 DOI: 10.3928/02793695-20200921-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to investigate the prevalence of depressive symptomatology before termination of pregnancy due to fetal anomaly and to analyze associated risk factors. A cross-sectional study was performed in the obstetric departments of six hospitals in Hunan, China. Depressive symptomatology was measured before termination of pregnancy using the Edinburgh Postpartum Depression Scale. t test, analysis of variance, and binary logistic regression tests were used in the data analysis of depressive symptomatology and factors. A total of 65.6% (n = 177) of participants were identified with depressive symptomatology before termination. Risk factors were receipt of spousal support, self-efficacy, religious belief, history of adverse pregnancy outcomes, and sleep disturbance. Protective factors were engagement with health care providers, social support, and higher monthly family income. Nurses should be aware of these factors early on to prevent the occurrence of depressive symptomatology, thereby improving maternal mental health. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 43-50.].
Collapse
|
18
|
Paton A, Armstrong N, Smith L, Lotto R. Parents' decision-making following diagnosis of a severe congenital anomaly in pregnancy: Practical, theoretical and ethical tensions. Soc Sci Med 2020; 266:113362. [PMID: 32957025 DOI: 10.1016/j.socscimed.2020.113362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/27/2023]
Abstract
Patient involvement, in the form of shared decision-making, is advocated within healthcare. This is informed by the principlist account of patient autonomy that prioritises informed understanding, and decision-making free from coercion. This arguably over-simplifies the role of the social, whilst overlooking the role of culture and context in medical decision-making. Clinicians encourage patients to demonstrably make decisions in the principlist 'style' that fit with their understandings of ethically 'correct' ways to support patient decision-making. However, this expected 'style' is often not achieved in practice. In this article, we use empirical data from a qualitative study exploring parental decision-making following diagnosis or suspicion of a severe congenital anomaly in pregnancy. Our study was based in four fetal medicine clinics in England, comprising semi-structured interviews with 38 parents whose pregnancy was affected by a severe congenital anomaly, 18 interviews with fetal medicine clinicians, and audio-recordings of 48 consultations. Examination of the dynamics at play within different approaches to decision-making highlights how the idealised concepts proposed in theory fail to capture real-life experiences of medical decision-making. The influence of the patient-clinician relationship on decisions is brought to the fore, highlighting the influence of power dynamics in implicitly and explicitly influencing patient decisions, and the need to better address this in policy and practice.
Collapse
Affiliation(s)
- Alexis Paton
- Department of Sociology and Policy, Aston University, Birmingham, B4 7ET, UK.
| | | | - Lucy Smith
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Robyn Lotto
- School of Nursing and Allied Health, Liverpool John Moores University, Tithebarn Building, 79 Tithebarn Street, Liverpool, L2 2ER, UK
| |
Collapse
|
19
|
Fleming V, Robb Y, Matteo C, Meier-Magistretti C. When New Life Meets Death: Three Hermeneutic Case Studies From Switzerland. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:204-224. [PMID: 32460671 PMCID: PMC9039318 DOI: 10.1177/0030222820927231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pregnant women in Switzerland expect safe and healthy birth outcomes for themselves and their babies. However, in 2018, 691 died in infancy with gaps identified in the provision of services to parents in such circumstances. Our study aims to illustrate these gaps and how, from participants’ perspectives, they were addressed. A hermeneutic method was employed to analyze three cases: one from each major language region was via primary health-care providers. A thematic analysis was carried out with individual participants followed by a cross-case comparison which showed a hermeneutic of rupture, the juxtaposition of time and reshaping the family. This article shows the unique journeys experienced by parents whose baby dies before or shortly after birth in one country where neither the language nor experience is shared. The derivation of three hermeneutic themes may resonate with other parents or health professionals.
Collapse
Affiliation(s)
- Valerie Fleming
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Yvonne Robb
- School of Nursing and Midwifery, Glasgow Caledonian University, Glasgow, UK
| | - Caroline Matteo
- School of Nursing and Midwifery, Glasgow Caledonian University, Glasgow, UK
| | | |
Collapse
|
20
|
Lotto R, Jones I, Seaton SE, Dhannapuneni R, Guerrero R, Lotto A. Congenital Cardiac Surgery and Parental Perception of Risk: A Quantitative Analysis. World J Pediatr Congenit Heart Surg 2019; 10:669-677. [PMID: 31701827 DOI: 10.1177/2150135119872489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Interpretation of risk by parents of children undergoing congenital cardiac surgery is poorly documented. The available evidence highlights a dichotomy where clinicians suggest parents may not grasp the complexity and risk associated with procedures, while some parents suggest risk is unnecessarily overemphasized. AIM To quantify how risk is perceived by parents. METHODS One hundred six parents of children undergoing cardiac surgery were recruited and completed a Likert-type scale from 1 (perceived low risk) to 6 (perceived high risk), at 5 points: arrival at preadmission, post discussion with anethetist/surgeon, day of surgery, discharge from intensive care, and at outpatient follow-up. The surgical sample was stratified according to Risk Adjustment in Congenital Heart Surgery level. ANALYSIS Data were analyzed using Wilcoxon rank tests for differences in distributions of scores and Krippendorff α to examine the level of agreement. RESULTS Median parental risk scores varied over time, with no consistent risk scores observed. Maternal scores were consistently higher than paternal scores at every time point (P < .001). Postoperative complications resulted in a persistent rise in risk perception at follow-up (P < .001). Analysis of parental risk scores and objective measures of surgical risk highlighted poor agreement that was particularly marked at the extremes of risk. CONCLUSIONS Parents perceived higher risk scores than those reported by the clinical team. Mothers reported statistically significantly higher scores than their partners, highlighting potential tensions. In addition, the changing perception of risk over time emphasizes the need for flexible levels of support and information as parents navigate uncertainty.
Collapse
Affiliation(s)
- Robyn Lotto
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom
| | - Ian Jones
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom
| | - Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ram Dhannapuneni
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rafael Guerrero
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Attilio Lotto
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom.,Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| |
Collapse
|
21
|
Abstract
INTRODUCTION The way risk is interpreted by parents of children undergoing congenital cardiac surgery is poorly documented. Literature suggests clinicians have concerns that parents may not understand the complexity of procedures. Conversely, some parents perceive an unnecessary over-emphasis of risks. AIM To explore how risk is encountered by parents of children who are undergoing cardiac surgery, in order to deliver effective and compassionate care. METHODS A qualitative approach was adopted. Interviews were undertaken with 18 parents (mothers n = 10; fathers n = 8). Recordings were transcribed verbatim and analysed using a constant comparative-based approach. FINDINGS Three themes emerged from the data: the nature of risk, reflecting the complexity of parental perception of risk and the influence of the doctor-parent relationship; presenting risk, highlighting the way in which risk is presented to and interpreted by parents; and risk and responsibility, examining the way in which parents engaged with risk and the impact of this on their relationship. CONCLUSIONS The way in which risk is perceived by parents is complex and multi-factorial. The doctor-parent relationship is key to parental engagement. However, parents manage risk and uncertainty through a number of mechanisms, including those perceived as being not rational. This can cause tension, particularly when required to engage in informed decision-making.
Collapse
|
22
|
Blakeley C, Smith DM, Johnstone ED, Wittkowski A. Parental decision-making following a prenatal diagnosis that is lethal, life-limiting, or has long term implications for the future child and family: a meta-synthesis of qualitative literature. BMC Med Ethics 2019; 20:56. [PMID: 31395047 PMCID: PMC6688313 DOI: 10.1186/s12910-019-0393-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Information on the factors influencing parents' decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. METHODS Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden's (2008) thematic synthesis method was used to synthesise data from identified studies. RESULTS Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled 'all life is precious', described parents' perception of the importance of the fetus' life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 ('hope for a positive outcome') contained two sub-themes which considered the parent's own imagined future and the influence of other people's experiences. Finally, Theme 3 ('a life worth living') presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. CONCLUSION The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents' decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other's quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices.
Collapse
Affiliation(s)
- Claire Blakeley
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, UK
| | - Debbie M Smith
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Leeds Trinity University, Brownberrie Lane, Horsforth, LS18 5HD, Leeds, UK
| | - Edward D Johnstone
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Central Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Anja Wittkowski
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, UK.
| |
Collapse
|
23
|
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]
|
24
|
Qin C, Chen WT, Deng Y, Li Y, Mi C, Sun L, Tang S. Cognition, emotion, and behaviour in women undergoing pregnancy termination for foetal anomaly: A grounded theory analysis. Midwifery 2019; 68:84-90. [DOI: 10.1016/j.midw.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/22/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
|
25
|
Hanschmidt F, Treml J, Klingner J, Stepan H, Kersting A. Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression. Arch Womens Ment Health 2018; 21:391-399. [PMID: 29288285 DOI: 10.1007/s00737-017-0807-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022]
Abstract
Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women's psychological reactions. This study examined the influence of perceived and internalized stigma on women's long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.
Collapse
Affiliation(s)
- Franz Hanschmidt
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Julia Treml
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Johanna Klingner
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| |
Collapse
|
26
|
|
27
|
Crowe L, Graham RH, Robson SC, Rankin J. Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: a qualitative study of professional perspectives. BMJ Open 2018; 8:e020815. [PMID: 29500216 PMCID: PMC5855171 DOI: 10.1136/bmjopen-2017-020815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aims to explore the perspectives of professionals around the issue of termination of pregnancy for non-lethal fetal anomaly (TOPFA). METHODS Semi-structured interviews were undertaken with medical professionals (14 consultants in fetal medicine, obstetrics, neonatology and paediatrics) and social care professionals (nine individuals with roles supporting people living with impairment) from the Northeast of England. Analysis adopted an inductive thematic approach facilitated by NVivo. RESULTS The overarching theme to emerge from the interview data was of professionals, medical and social care, wanting to present an acceptable self-image of their views on TOPFA. Professionals' values on 'fixing', pain and 'normality' influenced what aspects of moral acceptability they gave priority to in terms of their standpoint and, in turn, their conceptualisations of acceptable TOPFA. Thus, if a termination could be defended morally, including negotiation of several key issues (including 'fixing', perceptions of pain and normality), then participants conceptualised TOPFA as an acceptable pregnancy outcome. CONCLUSION Despite different professional experiences, these professional groups were able to negotiate their way through difficult terrain to conceptualise TOPFA as a morally acceptable principle. While professionals have different moral thresholds, no one argued for a restriction of the current legislation. The data suggest that social care professionals also look at the wider social context of a person with an impairment when discussing their views regarding TOPFA. Medical professionals focus more on the individual impairment when discussing their views on TOPFA.
Collapse
Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth H Graham
- Sociology and Politics, School of Geography, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
28
|
Lotto R, Smith LK, Armstrong N. Diagnosis of a severe congenital anomaly: A qualitative analysis of parental decision making and the implications for healthcare encounters. Health Expect 2018; 21:678-684. [PMID: 29392858 PMCID: PMC5980539 DOI: 10.1111/hex.12664] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 01/18/2023] Open
Abstract
Objective To explore parental decision making following diagnosis of a severe congenital anomaly, and implications for healthcare encounters. Design Qualitative semi‐structured interviews with 38 parents‐to‐be were collated and triangulated with data generated from consultation recordings. Analysis Data were analysed using a constant comparative‐based approach. Setting Recruitment was undertaken across four fetal medicine sites in two tertiary referral trusts. Participants Parents‐to‐be whose pregnancy was suspected or diagnosed as being affected by a severe congenital anomaly. This sample was purposive to include known factors affecting the decision to terminate or continue the affected pregnancy. Findings In trying to make a decision about how to proceed with their pregnancy, parents‐to‐be typically had to work hard to negotiate multiple uncertainties around the diagnosis and prognosis of the suspected anomaly. This was influenced by parents’ capacity to cope with uncertainty and the way in which uncertainty was managed by the clinical team. This negotiation of uncertainty was enacted within a fluid, nonlinear three‐phase process: “information seeking,” reflecting the way parents‐to‐be face the uncertainty associated with a fetal diagnosis and associated prognosis; “implications,” where consideration is given to future consequences of the decision; and “decision making,” which reflects the way in which the decision is made (head‐ or heart‐led). Spectrums of responses were apparent within each phase. Conclusions This study provides important insights into how parents‐to‐be make decisions following diagnosis or suspicion of a severe congenital anomaly. The impact of these on healthcare encounters is discussed, alongside recommendations for clinical practice.
Collapse
Affiliation(s)
- Robyn Lotto
- Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
29
|
Lotto R, Smith LK, Armstrong N. Clinicians' perspectives of parental decision-making following diagnosis of a severe congenital anomaly: a qualitative study. BMJ Open 2017; 7:e014716. [PMID: 28588110 PMCID: PMC5729983 DOI: 10.1136/bmjopen-2016-014716] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore clinicians' perspectives on supporting parents' decision-making following diagnosis of a severe congenital anomaly, and how this is shaped by current policy. METHODS This paper reports data collated as part of a larger project examining parents' decision-making following antenatal diagnosis. The focus of this paper is the data arising from semistructured interviews conducted with 18 clinicians, with findings further supported by data generated from consultations between clinicians and parents. All interviews and consultations were audio-recorded and transcribed verbatim, with analysis based on the constant comparative approach. RESULTS Three key themes emerged which together shape the practice of clinicians working in this area: first, the law governing termination of pregnancy (TOP) and how clinicians believe this influences the context in which decisions about whether to terminate or continue an affected pregnancy are made; second, approaches to the management of cases seen as particularly challenging; and third, how clinicians understand their role when working with parents. These themes combine to create a strong desire on the part of clinicians for parents to engage in a particular 'rational' form of decision-making and to be able to demonstrate the enactment of this. This is seen as important in order to ensure the 'right' decision has been reached and, particularly when the decision is to terminate, will withstand possible scrutiny. CONCLUSIONS The policy context in which these decisions are made strongly shapes how clinicians practise and what they want to see from the parents with whom they work. The ways in which they seek to overcome the difficulties in interpreting the law may result in variations in the offer of late TOP, both between and within units. This may inadvertently affect the options available to women least able to engage in this idealised form of decision-making.
Collapse
Affiliation(s)
- Robyn Lotto
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
30
|
Jones K, Baird K, Fenwick J. Women's experiences of labour and birth when having a termination of pregnancy for fetal abnormality in the second trimester of pregnancy: A qualitative meta-synthesis. Midwifery 2017; 50:42-54. [PMID: 28388456 DOI: 10.1016/j.midw.2017.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/18/2017] [Accepted: 03/25/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to explore women's experiences of labour and birth in the context of a termination of pregnancy for fetal abnormality in the second trimester of pregnancy. DESIGN meta-synthesis of 10 qualitative studies which included the experiences of 581 women. Data analysis was informed by van Manen's four lifeworld existentials (lived body, lived space, lived time and lived human relationships) and focused only on women's experiences of their labour and birth when terminating a pregnancy in the second trimester for fetal abnormality. KEY FINDINGS eight themes were generated by the analysis. In my head: a storm of emotion reflected the lived or felt space. In this space women make meaning of the experience. Too late to turn back time and Living and escaping the moment considered lived time; it is lived time that enables a woman to reinterpret who they once were and who they are becoming. The existential concept of lived body represented the women's physical or bodily presence and was reflected in the themes; The language of labour: un-describable torture, The meaning of pain; punishment and protection and Being a mother in the space where birth meets death. Relational or the lived human relationship is reflected in See me… talk to me…hear me… be with me and Sorry baby. These themes describe the women's lived sense of others in the interpersonal space that they share with them. KEY CONCLUSIONS the findings of this meta-synthesis provide insight into how emotionally and physically traumatic a woman's labour and birth experiences can be in this context. Women wanted to spend time with their baby constructing lasting memories that they could hold onto and share. They needed acknowledgment that their baby existed and their loss was tangible and real. What happened within the space of the relationship women shared with care providers was seen as vital, especially when respectful and dignified interaction was experienced. The women's need for human contact and support through their experience was also seen as critical. IMPLICATIONS FOR PRACTICE the need for greater understanding and acknowledgement of the woman's experience by all caregivers is required. Woman-centred and situation sensitive care provision should be prioritised. Further research that acknowledges and prioritises the feminine voice and the lived experience of women is required.
Collapse
Affiliation(s)
- Kay Jones
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Queensland, Australia.
| | - Kathleen Baird
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Queensland, Australia.
| | - Jenny Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Queensland, Australia.
| |
Collapse
|