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Dandy S, Wittkowski A, Murray CD. Parents' experiences of receiving their child's diagnosis of congenital heart disease: A systematic review and meta-synthesis of the qualitative literature. Br J Health Psychol 2024; 29:351-378. [PMID: 37968248 DOI: 10.1111/bjhp.12703] [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: 03/03/2023] [Revised: 07/31/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE This systematic review aimed to synthesize qualitative research on parents' psychological experiences following their child's diagnosis of congenital heart disease (CHD). METHODS A systematic search of six electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed and Web of Science) was completed, inclusive of all years up to May 2022. Any included articles were synthesized using thematic synthesis and appraised using the Critical Appraisal Skills Programme Qualitative Checklist. RESULTS Twenty-six articles were included. Four main themes, and 11 subthemes, emerged from the synthesis. Theme 1 (unpreparedness for the diagnosis) concerned parents' shock, guilt and anger regarding the diagnosis. Theme 2 (the overwhelming reality of CHD) described parental fear about decision-making and the child's prognosis, and the influence of professionals on parents' well-being. Theme 3 (mourning multiple losses) detailed parents' sadness at losing their envisioned pregnancy, birth and parenthood experiences. Theme 4 (redefining hopes to reach an acceptance of CHD) described parents' adjustment to the diagnosis. CONCLUSIONS Receiving a child's CHD diagnosis was a uniquely challenging situation for parents. The findings provided insight into the emotions parents experienced and how they adjusted to the diagnosis psychologically. As parents' experiences were significantly influenced by their interactions with professionals, clinicians should offer compassion, validation and clear information throughout the diagnosis process.
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Tataj‐Puzyna U, Baranowska B, Szlendak B, Szabat M, Węgrzynowska M. Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis. Nurs Open 2023; 10:6817-6826. [PMID: 37391910 PMCID: PMC10495705 DOI: 10.1002/nop2.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
AIM The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. DESIGN A qualitative study. METHODS We employed the phenomenological approach and the Colaizzi strategy to analyse semi-structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. RESULTS We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; 'Searching for communitas' concerned the participation in special AC selected for the opportunity of sharing experiences; 'Searching for an individual way' concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences.
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Affiliation(s)
| | - Barbara Baranowska
- Department of MidwiferyCentre of Postgraduate Medical EducationWarsawPoland
| | | | | | - Maria Węgrzynowska
- Department of MidwiferyCentre of Postgraduate Medical EducationWarsawPoland
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3
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Harris KW, Hammack-Aviran CM, Brelsford KM, Kavanaugh-McHugh A, Clayton EW. Mapping parents' journey following prenatal diagnosis of CHD: a qualitative study. Cardiol Young 2023; 33:1387-1395. [PMID: 35942903 PMCID: PMC10152984 DOI: 10.1017/s1047951122002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To better understand parents' accounts of their prenatal and postnatal experience after prenatal diagnosis of CHD - particularly emotional processing and coping mechanisms - to identify strategies to improve support. METHODS This single-centre, longitudinal qualitative study included pregnant mothers and their support persons seen in Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May through August 2019 for probable complex CHD. Twenty-seven individuals from 17 families participated in 62 phone interviews during pregnancy and postpartum: 27 conducted after the initial prenatal cardiology consultation, 15 after a follow-up prenatal visit, and 20 after birth. Applied thematic analysis approach was used to code and analyse transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was >80%. RESULTS Patients included mothers (16 [59%]), fathers (8 [30%]), and other support persons (3 [11%]). Initial fetal diagnoses included a range of moderate to severe CHD. Prenatally, parents sought to maintain hope while understanding the diagnosis; planning for the future rather than focusing on day-to-day was more common if prognoses were better. Postnatally, with confirmation of prenatal diagnoses, parents' sense of control expanded, and they desired more active engagement in clinical decision making. CONCLUSIONS To enhance effective communication and support, understanding how parents conceptualise hope in relation to diagnosis and how that may evolve over time is critical. Expectant parents whose child has a significant risk of mortality may demonstrate hope by focusing on positivity. As prognostic uncertainty diminishes postpartum, the parental role on the team may shift, requiring clinicians to provide different support.
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Affiliation(s)
- Kelly W. Harris
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ellen Wright Clayton
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Law, Vanderbilt University, Nashville, TN, USA
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Tataj-Puzyna U, Heland-Kurzak K, Sys D, Szlendak B, Ryś M, Krauze M, Baranowska B. The Experiences of Midwives Who Attend Births by Women with Life-Limiting Fetal Conditions (LLFC): A Phenomenological Research Study. Healthcare (Basel) 2023; 11:healthcare11111540. [PMID: 37297680 DOI: 10.3390/healthcare11111540] [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: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Providing care to a woman after a Life-Limiting Fetal Conditions (LLFC) diagnosis is a difficult experience for midwives. This study's aim is to describe the experience of midwives assisting in births following an LLFC diagnosis. It is a qualitative study using Interpretative Phenomenological Analysis (IPA). Semi-structured in-depth interviews were conducted with 15 midwives with experience in caring for women giving birth following an LLFC diagnosis. The data was analyzed through coding using the MAXQDA tool. The main theme emerging from the experience of midwives concerned difficulty in interacting with the woman giving birth. The analysis singled out four subthemes containing the most significant issues arising from the experience of midwives in caring for a woman giving birth to a lethally ill child: in relation with the woman giving birth; in relation with the child and the family; in relation with oneself; and in relation with the workplace. Midwives should have access not only to solid knowledge about this question, but also to courses developing skills in dealing with difficult situations, in coping with stress, in expressing compassion and, most importantly, in communicating with women and their families in such difficult circumstances.
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Affiliation(s)
- Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland
| | - Krystyna Heland-Kurzak
- Department of Social Pedagogy, The Maria Grzegorzewska University, 02-353 Warsaw, Poland
| | - Dorota Sys
- Department of Medical Statistics, School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - Beata Szlendak
- Foundation for Supporting Midwives, 00-112 Warsaw, Poland
| | - Maria Ryś
- Institute of Psychology, Department of Christian Philosophy, Cardinal Stefan Wyszyński University, 01-938 Warsaw, Poland
| | - Magdalena Krauze
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-581 Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland
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5
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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.
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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
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Watkins S, Isichei O, Gentles TL, Brown R, Percival T, Sadler L, Gorinski R, Crengle S, Cloete E, de Laat MWM, Bloomfield FH, Ward K. What is Known About Critical Congenital Heart Disease Diagnosis and Management Experiences from the Perspectives of Family and Healthcare Providers? A Systematic Integrative Literature Review. Pediatr Cardiol 2023; 44:280-296. [PMID: 36125507 PMCID: PMC9895021 DOI: 10.1007/s00246-022-03006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
The experience of diagnosis, decision-making and management in critical congenital heart disease is layered with complexity for both families and clinicians. We synthesise the current evidence regarding the family and healthcare provider experience of critical congenital heart disease diagnosis and management. A systematic integrative literature review was conducted by keyword search of online databases, MEDLINE (Ovid), PsycINFO, Cochrane, cumulative index to nursing and allied health literature (CINAHL Plus) and two journals, the Journal of Indigenous Research and Midwifery Journal from 1990. Inclusion and exclusion criteria were applied to search results with citation mining of final included papers to ensure completeness. Two researchers assessed study quality combining three tools. A third researcher reviewed papers where no consensus was reached. Data was coded and analysed in four phases resulting in final refined themes to summarise the findings. Of 1817 unique papers, 22 met the inclusion criteria. The overall quality of the included studies was generally good, apart from three of fair quality. There is little information on the experience of the healthcare provider. Thematic analysis identified three themes relating to the family experience: (1) The diagnosis and treatment of a critical congenital heart disease child significantly impacts parental health and wellbeing. (2) The way that healthcare and information is provided influences parental response and adaptation, and (3) parental responses and adaptation can be influenced by how and when support occurs. The experience of diagnosis and management of a critical congenital heart disease child is stressful and life-changing for families. Further research is needed into the experience of minority and socially deprived families, and of the healthcare provider, to inform potential interventions at the healthcare provider and institutional levels to improve family experience and support.
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Affiliation(s)
- S. Watkins
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - O. Isichei
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - R. Brown
- National Hauora Coalition, Auckland, New Zealand
| | - T. Percival
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | | | - R. Gorinski
- Heart Kids New Zealand, Tamariki Manawa Maia, Auckland, New Zealand
| | - S. Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - E. Cloete
- Te Whatu Ora, Christchurch, New Zealand
| | | | - F. H. Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - K. Ward
- School of Nursing, The University of Auckland, Auckland, New Zealand
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7
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Hope Aspects of the Women's Experience after Confirmation of a High-Risk Pregnancy Condition: A Systematic Scoping Review. Healthcare (Basel) 2022; 10:healthcare10122477. [PMID: 36554001 PMCID: PMC9778290 DOI: 10.3390/healthcare10122477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pregnancy is a period of transformation, hope, expectation, and worry for women and their families. A high-risk pregnancy refers to a pregnancy in which the mother and/or fetus are at greater-than-normal risk of complications, and it evokes a range of emotional and psychological experiences that largely depend on the care and support provided by health professionals. The purpose of this review is to summarize the existing literature on the lived experience of hope in women facing a high-risk pregnancy related to their own health and/or medical conditions related to the fetus. METHODS This review followed the Joanna Briggs Institute's methodology. No limits on a date were applied to the search. Identified titles and abstracts were screened to select original reports and were cross-checked for any overlap of cases. We included studies that emphasized the experience of hope of pregnant women dealing with a pregnancy complication. MAIN RESULTS According to the results of the present scoping review, we found two main dimensions: women experiencing a high-risk pregnancy themselves and prenatal diagnosis. In both cases, the women were in a dilemma between hope and hopelessness. CONCLUSION The findings demonstrate that women facing high-risk pregnancies struggle with multiple fears and concerns about their own health and the fetus's health. Further research is needed to identify best practices for the care provided to the vulnerable populations.
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Maternal Distress in Disclosing a Nonlethal Fetal Anomaly Diagnosis to Family and Friends. MCN Am J Matern Child Nurs 2022; 47:220-226. [PMID: 35749766 DOI: 10.1097/nmc.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe experiences of women disclosing a nonlethal fetal anomaly diagnosis to family and friends from initial prenatal diagnosis through postpartum. STUDY DESIGN AND METHODS A descriptive, qualitative approach was used to explore women's perceptions of nonlethal fetal anomaly diagnosis in a high-risk obstetric clinic. In-depth interviews were conducted with 10 pregnant women, followed by postpartum interviews with 8 women. Data were analyzed using thematic analysis. RESULTS Analysis of semistructured interviews revealed an overarching theme, Pregnancy Forever Changed, which captured the experience when expectant women first heard the news about their fetus. Prenatal themes were News of a Diagnosis, No Going Back; A Mother's Response: Managing Information; and Words from Others Matter. Women's struggles continued into postpartum, The Journey Continues: Echoing Past Concerns; and Not the Journey We Planned. CLINICAL IMPLICATIONS Women with a nonlethal fetal anomaly diagnosis experienced distress and stigma about disclosure of the diagnosis to others. Distress with disclosure continued throughout the pregnancy and extended into postpartum. Women described negative responses from others and ongoing management of information as stressful and painful. Clinicians are aware disclosing a lethal diagnosis is distressing for women but may not understand the experience of women with a nonlethal diagnosis. An appreciation of women's distress on disclosure of nonlethal fetal anomaly diagnoses can guide practice for maternity, neonatal, and pediatric nurses providing interventions that include information and anticipatory guidance.
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9
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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.
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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
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10
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de Barbeyrac C, Roth P, Noël C, Anselem O, Gaudin A, Roumegoux C, Azcona B, Castel C, Noret M, Letamendia E, Stirnemann J, Ville Y, Lapillonne A, Viallard ML, Kermorvant-Duchemin E. The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study. BJOG 2021; 129:752-759. [PMID: 34665920 DOI: 10.1111/1471-0528.16976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. DESIGN Multicentre prospective observational study. SETTING Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. POPULATION All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. METHODS Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. MAIN OUTCOME MEASURE Final decision reached following discussions in the antenatal period. RESULTS We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. CONCLUSIONS Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. TWEETABLE ABSTRACT Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
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Affiliation(s)
- C de Barbeyrac
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - P Roth
- Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France
| | - C Noël
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - O Anselem
- Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France
| | - A Gaudin
- Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Roumegoux
- Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - B Azcona
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Castel
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France
| | - M Noret
- Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - E Letamendia
- Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - J Stirnemann
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - Y Ville
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - A Lapillonne
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - M-L Viallard
- Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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11
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Women's Experiences With Palliative Care During Pregnancy. J Obstet Gynecol Neonatal Nurs 2021; 50:402-411. [PMID: 33775641 DOI: 10.1016/j.jogn.2021.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the experiences of women who received life-limiting fetal diagnoses during pregnancy and support from a perinatal palliative care program. DESIGN Descriptive qualitative. SETTING The perinatal palliative care program is part of a not-for-profit system of 24 hospitals serving the U.S. Intermountain West region. PARTICIPANTS A convenience sample of 12 women who experienced pregnancies with life-limiting fetal diagnoses and received care from a perinatal palliative care program. METHODS Women chose to participate from mailed invitations or responded to a post on private social media and then completed semistructured interviews about their experiences surrounding the fetal diagnoses and support from a perinatal palliative care program. Interviews were approximately 40 minutes in length and were conducted over the phone, recorded, and then transcribed. We performed content analysis by coding, forming categories of similar coded data, and constructing themes by recontextualizing categories through iterative, team-based meetings. RESULTS We identified four themes from the data: Importance of Memorabilia to Cope With the Death and Documentation of Pregnancy, Acceptance of Death as Part of the Pregnancy Experience, Continued Life Without a Child, and Importance of Empathy Throughout the Process. CONCLUSION The themes support the existing research findings about the needs of pregnant women as they cope with difficult situations. Our findings show the necessity and importance of perinatal palliative care programs.
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12
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Martins PH, Duarte IPL, Leite CRVS, Cavalli RC, Marcolin AC, Duarte G. Influence of Religiosity on Situational Coping Scores in Women with Malformed Fetuses. JOURNAL OF RELIGION AND HEALTH 2020; 59:3071-3083. [PMID: 31664656 DOI: 10.1007/s10943-019-00934-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In clinical care settings, religiosity may serve as an important source of support for coping with the prenatal diagnosis of fetal abnormalities. This study evaluated the influence of religiosity on the situational coping of 28 pregnant women with fetal abnormalities. The study was approved by the institutional research ethics committee, and the informed consent document was obtained from all participants included in this study. Validated measures of religiosity and situational coping were used to evaluate data collected. Practical religiosity but not intrinsic religiosity correlated positively and significantly with coping scores. However, the severity of the fetal malformations did not correlate significantly with the scores of maternal coping. The results showed that religious practices were associated with improved coping in women diagnosed with fetal abnormalities and should be encouraged in care settings.
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Affiliation(s)
- Paulo Henrique Martins
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ilmara Pereira Leão Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Ricardo Carvalho Cavalli
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alessandra Cristina Marcolin
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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13
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Carlsson T, Klarare A, Mattsson E. Peer support among parents of children with congenital heart defects: A qualitative analysis of written responses submitted via an online survey. J Adv Nurs 2020; 76:3528-3536. [PMID: 33009854 PMCID: PMC7702174 DOI: 10.1111/jan.14541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/02/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore experiences of peer support among parents of children with congenital heart defects. DESIGN A study analysing written responses to open-ended questions about peer support, collected via an online survey distributed in Sweden. METHODS Respondents were recruited during 3 months in 2018 by means of convenience sampling, through ads via the Swedish foundation for families with children who have heart defects and two closed Facebook groups for peer support. An online survey containing open-ended questions was distributed and responses were analysed with systematic text condensation. RESULTS Peer support was grounded in a mutual understanding among parents and involved highly appreciated emotional support. Listening to the stories of peers meant an opportunity to gain useful insights about what life is like for parents of children with heart defects. Receiving and providing peer support was described as rewarding on a personal level. Negative aspects of peer support were also described, which sometimes led to psychological distress and withdrawal from peer support activities. CONCLUSION Peer support is emotionally relieving and appreciated among parents of children with congenital heart defects, who consider providing the support a rewarding responsibility. While peer support activities may have considerable benefits for individuals, it may also lead to psychological distress for some. IMPACT This study addressed peer support among parents of children with congenital heart defects. The main findings illustrate the potential impact peer support can have on individuals and calls attention to the experienced benefits related to peer support activities, while also providing some insights regarding potential negative aspects. The findings have relevance for nurses, midwives, and other health professionals working in settings providing care for these families.
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Affiliation(s)
- Tommy Carlsson
- The Swedish Red Cross University College, Huddinge, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Klarare
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
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Isaacs NZ, Andipatin MG. A systematic review regarding women's emotional and psychological experiences of high-risk pregnancies. BMC Psychol 2020; 8:45. [PMID: 32362285 PMCID: PMC7197168 DOI: 10.1186/s40359-020-00410-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/15/2020] [Indexed: 02/03/2023] Open
Abstract
Background High-risk pregnancy refers to a pregnancy that negatively affects the health of the mother, the baby, or both. High-risk pregnancy evokes a range of emotional and psychological experiences for the expectant mother, and can adversely affect both the mother and the baby’s health. Medical research on high-risk pregnancy abounds, while women’s emotional/psychological experiences are not sufficiently documented, and hence much less attention and/or programming is directed to support women with high risk pregnancies. Methods The aim of this review is to present published evidence of how studies reported on the emotional and psychological experiences of a woman’s high-risk pregnancy journey. The systematic review examined qualitative studies over a 10 year period that were published between January 2006 and June 2017. These studies were identified on 10 databases. The study utilised three stages of review (i.e. abstract reading, title reading, and full-text reading) and for a successful conduction of the meta-synthesis, this study applied one of the phases provided by Noblit and Hare. Results The findings provide empirical evidence that women’s emotional and psychological experiences (i.e. shock, fear, frustration, grief, isolation and loneliness, anger, sadness, guilt, and mental health disorder) are evident throughout their high-risk pregnancies experience.
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Harris KW, Brelsford KM, Kavanaugh-McHugh A, Clayton EW. Uncertainty of Prenatally Diagnosed Congenital Heart Disease: A Qualitative Study. JAMA Netw Open 2020; 3:e204082. [PMID: 32369178 PMCID: PMC7201310 DOI: 10.1001/jamanetworkopen.2020.4082] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Parents who receive a prenatal diagnosis of congenital heart disease may experience more short- and long-term stress than those who receive a postnatal diagnosis. To identify potential interventions to ameliorate that stress, the longitudinal emotional experience of parents must first be understood. OBJECTIVE To better understand parents' accounts of their own prenatal experience, particularly aspects they found to be stressful or challenging, and to identify strategies to improve support. DESIGN, SETTING, AND PARTICIPANTS This qualitative study included analysis of transcripts of audio recorded telephone interviews with pregnant mothers and their support persons, as applicable, who were referred to and seen at the Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May 2019 to August 2019 with an initial likely diagnosis of complex congenital heart disease at any gestational age. Data analysis was conducted from August 2019 to November 2019. MAIN OUTCOMES AND MEASURES An applied thematic analysis approach was used to code and analyze professionally transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was assessed and confirmed routinely. One author coded all transcripts; a second author independently reviewed one-fifth of the transcripts at fixed intervals to ensure that interrater reliability remained greater than 80%. RESULTS Twenty-seven individuals from 17 families participated in 42 phone interviews during pregnancy, 27 conducted at the first time point after the initial prenatal cardiology consultation and 15 at the second time point after a follow-up prenatal cardiology visit. Most interviewees were mothers (16 interviewees [59%]; median [interquartile range] age, 30.0 [27.3-34.8] years) or fathers (8 interviewees [30%)], with a few support individuals (3 interviewees [11%]) (median [interquartile range] age of family member or support individual, 30.0 [26.0-42.0] years). Initial fetal diagnoses included a range of severe congenital heart disease. Uncertainty was identified as a pervasive central theme and was related both to concrete questions on scheduling, logistics, or next steps, and long-term unknown variables concerning the definitiveness of the diagnosis or overall prognosis. Practitioners helped families through their framing of uncertainty at various time points including before, during, and after the clinic visit. CONCLUSIONS AND RELEVANCE Families walk an uncertain path following a fetal diagnosis of severe congenital heart disease. The challenges faced by the cardiologists caring for them overlap in many ways with those experienced by pediatric palliative care practitioners. Potential future interventions to improve parental support were identified in the areas of expectation setting before the referral visit, communication in clinic, and identity formation after the new diagnosis.
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Affiliation(s)
- Kelly W. Harris
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ellen Wright Clayton
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
- School of Law, Vanderbilt University, Nashville, Tennessee
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African American and Latino bereaved parent health outcomes after receiving perinatal palliative care: A comparative mixed methods case study. Appl Nurs Res 2019; 50:151200. [PMID: 31735485 DOI: 10.1016/j.apnr.2019.151200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/19/2019] [Accepted: 10/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Death of one's infant is devastating to parents, negatively impacting couple relationships and their own health. The impact of a prenatally diagnosed life-limiting fetal condition (LLFC) on parents of minority status is unclear. AIM This comparative mixed methods case study examined the person characteristics, quality of perinatal palliative care (PPC) received and parent health outcomes. METHODS Bereaved couples, 11 mothers and 3 fathers of minority or mixed races (11 African American and Latino, 1 White Latino and 2 White parents) completed the survey; 7 were interviewed. RESULTS Parents rated their general health close to good, physical health close to normal but mental health lower than the population norm. Clinical caseness (abnormal levels) of anxiety were reported in 50% of parents whereas depression scores were normal. The experience of fetal diagnosis and infant death had a negative impact on the health of 40% of participants however, parents could not identify what specifically caused their health problems. Most were satisfied with their PPC but some shared that original providers were not supportive of pregnancy continuation. After the baby's death, 71% reported closer/stronger couple relationships. Two contrasting cases are presented. Once parents found PPC, their baby was treated as a person, they spent time with their baby after birth, and found ways to make meaning through continuing bonds. CONCLUSION Despite high overall satisfaction with PPC, bereaved parents were deeply impacted by their infant's death. Mixed methods case study design illuminated the complicated journeys of parents continuing their pregnancy with a LLFC.
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Anencephaly; the maternal experience of continuing with the pregnancy. Incompatible with life but not with love. Midwifery 2018; 71:12-18. [PMID: 30640134 DOI: 10.1016/j.midw.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE As advances in prenatal diagnosis increasingly enable detection of life-limiting conditions, end-of-life care may start before birth. Termination of these pregnancies may have been default management, but in the Republic of Ireland, where termination is not a legal option, skilled experience in caring for mothers who continue their pregnancies has developed. This study examines the lived experience of four such mothers. METHOD A qualitative study was designed using interpretive phenomenological analysis, which examined the maternal experience of continuing pregnancy with a prenatal diagnosis of anencephaly. Four mothers participated in semi-structured interviews on their experience of pregnancy and delivery of a baby with anencephaly. RESULTS A profoundly emotional journey represented an adaptive grieving process, which culminated in rich experiences of transformative growth for all the parents. The parents' relationship with their caregivers facilitated this process and the development of a meaningful parenting relationship with their babies. This positive finding coexists alongside a parallel experience of ongoing deep sense of loss and sadness. CONCLUSION Perinatal palliative care for those with a prenatal lethal diagnosis is a positive life experience for some mothers. The role of relationship with healthcare professionals is vital to the process and consideration must be given to a comprehensive multi-disciplinary team approach.
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Hadley DW, Kruszka P, Muenke M. Challenging issues arising in counseling families experiencing holoprosencephaly. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:238-245. [PMID: 30182441 DOI: 10.1002/ajmg.c.31627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 01/01/2023]
Abstract
The provision of information and support to families experiencing holoprosencephaly (HPE) in a loved one is unequivocally challenging, even for the most experienced clinicians. It deserves the balance of pertinent information coupled with medical guidance that forms the basis for shared decision-making; all of which is ideally contained within a supportive environment. It requires a willingness to carefully listen to the specific concerns of the parents and family allowing them to revisit challenging issues as much as needed to encourage existing road blocks to be resolved. It necessitates that professionals see each and every family as unique, without preconceived notions about what is or is not important and being prepared to accept thoughts and decisions that may not fit with the professional's own beliefs. To some, this may sound impractical, inefficient, or even impossible within the time constrained models of modern day clinical services. However, in practice, this patient-focused approach is arguably the most essential step in providing "personalized medicine" to the populations we encounter. This manuscript is intended to provide a brief review of relevant literature and case discussions to highlight issues for families learning of the diagnosis of HPE during a pregnancy, at birth, during childhood or more rarely, in adolescence.
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Affiliation(s)
- Donald W Hadley
- Human Development Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul Kruszka
- Human Development Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Maximilian Muenke
- Human Development Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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A mixed methods sequential explanatory study of the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. Midwifery 2018; 64:69-76. [PMID: 29966879 DOI: 10.1016/j.midw.2018.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Perinatal bereavement is traumatic for many parents. Not only is the experience itself emotionally painful, the impact on their lives is made more difficult if midwives are unable to provide appropriate care to the parents. AIM OF THE STUDY To explore within an Irish context, the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. DESIGN A mixed methods sequential explanatory design was used to complete this two-phased study from August 2013 to July 2014. Ethical approval was granted from Ethics Committees of three maternity hospitals and a University in Ireland. The recruitment process for the survey occurred in August 2013 and July 2014 for the focus groups. METHODS A series of univariate and multivariate analysis were used to analyze the quantitative data using IBM Statistical Package for the Social Sciences (SPSS; version 20). The qualitative data were analyzed using qualitative content analysis. Steps were taken to ensure data validity and reliability. RESULTS The overall meta-inference of this study is that the majority of the midwives did not have adequate levels of confidence to provide bereavement support to grieving parents. The psychosocial factors that impact on midwives' confidence were identified as the midwives' awareness of the needs of bereaved parents, their own inner strength and the organizational support they received at their place of work. CONCLUSION Improving midwives' bereavement support knowledge and skills is essential for promoting their confidence. Midwives also need adequate emotional and practical support from their organizations.
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Emotional and cognitive experiences during the time of diagnosis and decision-making following a prenatal diagnosis: a qualitative study of males presented with congenital heart defect in the fetus carried by their pregnant partner. BMC Pregnancy Childbirth 2018; 18:26. [PMID: 29329527 PMCID: PMC5767070 DOI: 10.1186/s12884-017-1607-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expectant fathers consider the second-trimester obstetric ultrasound examination as an important step towards parenthood, but are ill prepared for a detection of a fetal anomaly. Inductive research is scarce concerning their experiences and needs for support. Consequently, the aim of this study was to explore the emotional and cognitive experiences, during the time of diagnosis and decision-making, among males presented with congenital heart defect in the fetus carried by their pregnant partner. METHODS Twelve expectant fathers were consecutively recruited through two tertiary referral centers for fetal cardiology in Sweden, after they had been presented with a prenatal diagnosis of congenital heart defect in the fetus carried by their pregnant partner. The respondents were interviewed via telephone, and the interviews were analyzed using inductive qualitative content analysis. RESULTS The respondents experienced an intense emotional shock in connection with detection. However, they set their own needs aside to attend to the supportive needs of their pregnant partner, and stressed the importance of an informed joint decision regarding whether to continue or terminate the pregnancy. When terminating the pregnancy, they experienced a loss of a wanted child, an emotionally intense termination procedure, needs of support neglected by professionals, and worries about the risk of recurrence in future pregnancies. When continuing the pregnancy, they tried to keep a positive attitude about the coming birth, but were simultaneously worried about the postnatal situation. CONCLUSIONS The findings illustrate the importance of inclusive care and adequate follow-up routines for both expectant parents following a prenatal diagnosis. This includes the initial emotional shock, the decisional process, and depending on decision reached, the termination or continuation of the pregnancy. Expectant fathers presented with a fetal anomaly need adequate follow-up routines to address worries about risk of recurrence in future pregnancies and worries about the postnatal situation.
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Edvardsson K, Åhman A, Fagerli TA, Darj E, Holmlund S, Small R, Mogren I. Norwegian obstetricians' experiences of the use of ultrasound in pregnancy management. A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 15:69-76. [PMID: 29389504 DOI: 10.1016/j.srhc.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 11/27/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore obstetricians' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy. METHODS A qualitative interview study was undertaken in 2015 with obstetricians (N = 20) in Norway as part of the CROss Country Ultrasound Study (CROCUS). RESULTS Three categories developed during analyses. 'Differing opinions about ultrasound and prenatal diagnosis policies' revealed divergent views in relation to Norwegian policies for ultrasound screening and prenatal diagnosis. Down syndrome screening was portrayed as a delicate and frequently debated issue, with increasing ethical challenges due to developments in prenatal diagnosis. 'Ultrasound's influence on the view of the fetus' illuminated how ultrasound influenced obstetricians' views of the fetus as a 'patient' and a 'person'. They also saw ultrasound as strongly influencing expectant parents' views of the fetus, and described how ultrasound was sometimes used as a means of comforting women when complications occurred. 'The complexity of information and counselling' revealed how obstetricians balanced the medical and social aspects of the ultrasound examination, and the difficulties of 'delivering bad news' and counselling in situations of uncertain findings. CONCLUSION This study highlights obstetricians' experiences and views of ultrasound and prenatal diagnosis in Norwegian maternity care and the challenges associated with the provision of these services, including counselling dilemmas and perceived differences in expectations between caregivers and expectant parents. There was notable diversity among these obstetricians in relation to their support of, and adherence to Norwegian regulations about the use of ultrasound, which indicates that the care pregnant women receive may vary accordingly.
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Affiliation(s)
- Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Tove Anita Fagerli
- National Center for Fetal Medicine, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway.
| | - Elisabeth Darj
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway; Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden.
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
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Lou S, Jensen LG, Petersen OB, Vogel I, Hvidman L, Møller A, Nielsen CP. Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies. Prenat Diagn 2017; 37:731-743. [DOI: 10.1002/pd.5093] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/24/2017] [Accepted: 06/10/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
| | - Lotte Groth Jensen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Olav Bjørn Petersen
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ida Vogel
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Møller
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Department of Public Health; Aarhus University; Aarhus Denmark
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Gesser-Edelsburg A, Shahbari NAE. Decision-making on terminating pregnancy for Muslim Arab women pregnant with fetuses with congenital anomalies: maternal affect and doctor-patient communication. Reprod Health 2017; 14:49. [PMID: 28376917 PMCID: PMC5379523 DOI: 10.1186/s12978-017-0312-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study focused on decision-making on terminating pregnancy for Arab Muslim women in Israel who were pregnant with fetuses diagnosed with congenital anomalies. It examined the impact of the doctor-patient interaction on the women's decision, especially in light of social and religious pressures not to terminate under any circumstances. Our goal was to identify perceptions and attitudes of Muslim Arab women who choose to continue their pregnancy following the detection of congenital anomalies in prenatal tests. Specific objectives included (1) To examine the Muslim Arab women's perceptions on genetic testing, and ascertain the reasons for their decision to continue the pregnancy following the detection of a congenital anomaly in the fetus; and (2) To examine risk communication of gynecologists regarding genetic testing and abortions, and regarding the decision of continuing or terminating a pregnancy following detection of a congenital anomaly. METHODS The research framework used the constructivist classical qualitative method to understand the experience of women at high risk for congenital anomalies and their experience of how doctors communicate the risk. RESULTS It showed that the emotional element is no less dominant than religious and social elements. The findings emphasized the disparities between doctors and women regarding emotional involvement (non-directive counselling). The women interviewees (N = 24) felt that this expressed insensitivity. As far as we know, the emotional component has not been raised in previous studies of Muslim women at high risk for congenital defects in their fetus, and therefore comprises a significant contribution of the present study. CONCLUSIONS To mitigate gaps, doctors should take affect into consideration in their communication with patients. It is important for doctors to understand the emotional element in risk communication, both in how they respect women's emotions and in creating an emotional interaction between themselves and the women.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel.
| | - Nour Abed Elhadi Shahbari
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel
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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.
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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.
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Kratovil AL, Julion WA. Health-care provider communication with expectant parents during a prenatal diagnosis: an integrative review. J Perinatol 2017; 37:2-12. [PMID: 27513325 DOI: 10.1038/jp.2016.123] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/09/2022]
Abstract
The pregnancy and health-care experience of expectant parents who receive a prenatal diagnosis of their unborn infant is distinctively fraught with uncertainty. Health-care providers (HCPs) that care for parents during this uncertain time have an exceptional opportunity to positively impact parental outcomes. An integrative literature review was conducted to explore HCPs' impact on parents' experiences of receiving a prenatal diagnosis. Thirty-three articles met study inclusion criteria (n=18 qualitative; 6 quantitative; 9 mixed methods). HCP communication was the major theme identified, because of its overarching impact on parents' experiences of receiving a prenatal diagnosis of their unborn infant. Parents' perception of the information communicated to them about their unborn infant's diagnosis by their HCP, and the manner in which that information is communicated to them, affects parents' ability to cope with the diagnosis. Recommendations for health-care delivery models, and for future research are discussed.
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Affiliation(s)
- A L Kratovil
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - W A Julion
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
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Carlsson T, Marttala UM, Wadensten B, Bergman G, Mattsson E. Involvement of persons with lived experience of a prenatal diagnosis of congenital heart defect: an explorative study to gain insights into perspectives on future research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:35. [PMID: 29507769 PMCID: PMC5831892 DOI: 10.1186/s40900-016-0048-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/25/2016] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY Ultrasound examinations during pregnancy have led to an increased number of detected heart defects in fetuses. Pregnant women and their partners are often unprepared for these news, and experience several difficulties following the diagnosis. We asked persons with personal experience to participate in group discussions about relevant future research topics. The discussions revealed that future research should investigate supplemental written information or follow-up appointments with health professionals. Researchers were also encouraged to focus their efforts on structures that offer emotional support. The emotional support could be from those that share similar experiences, or additional support from a health professional. The results of this study illustrate the need for researchers to continue their work to test ways to support persons faced with these diagnoses. ABSTRACT Background A prenatal diagnosis of a congenital heart defect in the fetus is a traumatic life event for pregnant women and their partners. Previous research indicates a need for research that takes steps to support these individuals following the diagnosis. Patient and public involvement is a proposed method of identifying relevant research topics, leading to patient-focused research protocols and relevant support interventions.The overarching aim of this study was to gain insights into relevant future research topics among persons faced with a prenatal diagnosis of congenital heart defect in the fetus. Methods One group of parents to prenatally diagnosed children with a congenital heart defect (n = 5) and one group of individuals with experience of termination of a pregnancy following a prenatal diagnosis of a congenital heart defect (n = 5) were purposefully recruited. Each group of representatives was involved in a face-to-face focus group discussion, analyzed through qualitative content analysis. Results The representatives suggested a need for future research that addresses informational support in the forms as supplemental written information or follow-up consultations. Moreover, interventions that offer emotional support were suggested, in the forms of peer support or additional professional psychosocial support. Conclusion Several interventions were suggested by patient representatives, indicating a need for multiple intervention studies to be conducted in the context of a prenatal diagnosis of a congenital heart defect in the fetus. We recommend that future studies test supplemental written information, follow-up consultations, peer support, and additional professionals psychosocial support following the diagnosis.
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Affiliation(s)
- Tommy Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, S-75122 Uppsala, Sweden
| | | | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, S-75122 Uppsala, Sweden
| | - Gunnar Bergman
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, S-75122 Uppsala, Sweden
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
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Attachement, parentalité et diagnostic prénatal : perspectives théorique, clinique et de recherche en psychologie de la santé. PRAT PSYCHOL 2016. [DOI: 10.1016/j.prps.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
BACKGROUND The diagnosis of a fetal anomaly in perinatal medicine forces expectant parents and healthcare providers to face the difficult process of breaking bad news. OBJECTIVES This exploratory literature review was aimed at providing a medical and psychological view of the psychological experience in expectant parents and physicians in the context of prenatal diagnosis of a fetal anomaly. METHOD An exploratory search of PubMed and PsycINFO/PsycARTICLES databases performed by an interdisciplinary team composed of a physician and psychologists. Search terms were: prenatal diagnosis AND bad news; prenatal diagnosis AND psychological consequences; prenatal diagnosis AND psychological sequelae; prenatal diagnosis AND fetal abnormality. The processing of selected articles followed a standardised five-step procedure. RESULTS A total of 860 articles were screened of which 32 were retained for analysis. Four main themes emerged from the explanatory content analysis: (1) parents' subjective experience; (2) physicians' subjective experience; (3) encounters between expectant parents and professionals; and (4) ethical challenges in breaking bad news in prenatal medicine. CONCLUSION Expectant parents go through a complex and multidimensional experience when the diagnosis of a fetal anomaly is disclosed. Simultaneously, physicians consider breaking bad news as a very stressful event and are poorly prepared in this regard. A better knowledge of factors underlying psychological adjustment of the parental dyad and on the subjective experience of physicians delivering these diagnoses could enable better adaptation for both patients and professionals.
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Affiliation(s)
- Rita Luz
- a Université de Lorraine , Metz , France.,c Centre Hospitalier Régional Universitaire, Lorraine Centre for Prenatal Diagnosis, Maternité Régionale , Nancy , France
| | | | | | - Rachel Vieux
- b Université de Lorraine , Vandœuvre-lès-Nancy , France.,d Pediatric Department 1 , Centre Hospitalier Régional Universitaire , Besançon , France.,e Université de Franche-Comté, UFR SMP , Besançon , France
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Quality Indicators and Parental Satisfaction With Perinatal Palliative Care in the Intrapartum Setting After Diagnosis of a Life-Limiting Fetal Condition. ANS Adv Nurs Sci 2016; 39:346-357. [PMID: 27608148 DOI: 10.1097/ans.0000000000000147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Measurement of quality indicators (QIs) in perinatal palliative care has not been addressed. Parents who chose to continue pregnancy after a diagnosis of a life-limiting fetal condition described perceptions of quality care and their satisfaction with care. This research identified which QIs explained parental satisfaction. High QI scores are associated with parental satisfaction. Parents who were satisfied reported 2.9 times the odds that their baby was treated with dignity and respect and 3.4 times the odds their medical care was addressed. This research is a first step in developing a robust measure of QIs in perinatal palliative care.
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Carlsson T, Bergman G, Karlsson AM, Wadensten B, Mattsson E. Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages. Midwifery 2016; 41:54-60. [PMID: 27543968 DOI: 10.1016/j.midw.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly. DESIGN cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis. SETTING two large and active Swedish virtual communities. SAMPLE 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination). MEASUREMENTS AND FINDINGS before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child. KEY CONCLUSIONS spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences. IMPLICATIONS FOR PRACTICE information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies.
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Affiliation(s)
- Tommy Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden.
| | - Gunnar Bergman
- Department of Women's and Children's Health, Karolinska Institutet, SE-17176, Stockholm, Sweden
| | - Anna-Malin Karlsson
- Department of Scandinavian Languages, Uppsala University, SE-75120, Uppsala, Sweden
| | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden; Department of Health Care Sciences, Ersta Sköndal University College, SE-10061, Stockholm, Sweden
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Coping strategies of pregnant women following unexpected ultrasound results, Alexandria, Egypt. J Egypt Public Health Assoc 2016; 91:65-72. [PMID: 27455083 DOI: 10.1097/01.epx.0000482538.95764.4b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Receiving a diagnosis of a potential fetal anomaly causes severe stress to a pregnant woman. Little is known about the coping strategies used by these women, especially in Egypt. OBJECTIVE This study explored the coping strategies used by women following unexpected findings in routine antenatal ultrasound scan in Alexandria, Egypt. PATIENTS AND METHODS A mixed method (convergent parallel) quantitative and qualitative approach was used to target pregnant women at 20-32 weeks of gestation. The quantitative study included 93 women, whereas the qualitative one included a purposively chosen subsample of 30 women representing diverse diagnoses. A 10-item questionnaire was used in the quantitative part to assess active, avoidant, and negative coping strategies. In the qualitative part, coping was assessed by analyzing the transcripts of women's experiences. RESULTS Although women used equal numbers of avoidant and active strategies (3.34±0.56 vs. 3.30±0.73, Z=0.273, P=0.78), the reported effectiveness of active strategies ranked higher than that of the avoidant ones (χ=54.64, P<0.001). Women with an education level up to high school or higher perceived high effectiveness of active and/or avoidant strategies compared with women with less education (χ=4.087, P<0.05). CONCLUSION AND RECOMMENDATIONS Women concurrently used more than one coping strategy. The effectiveness of active strategies was higher than that of the avoidant ones. The educational level was the only factor associated with perceived high effectiveness of active and/or avoidant strategies. Helping future mothers acquire active coping skills through counseling sessions and support groups are recommended.
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Wool C, Repke JT, Woods AB. Parent reported outcomes of quality care and satisfaction in the context of a life-limiting fetal diagnosis. J Matern Fetal Neonatal Med 2016; 30:894-899. [DOI: 10.1080/14767058.2016.1195362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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The Psychological Impact of Prenatal Diagnosis and Disclosure of Susceptibility Loci: First Impressions of Parents' Experiences. J Genet Couns 2016; 25:1227-1234. [PMID: 27220741 PMCID: PMC5114319 DOI: 10.1007/s10897-016-9960-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 04/14/2016] [Indexed: 11/21/2022]
Abstract
Genomic microarray may detect susceptibility loci (SL) for neurodevelopmental disorders such as autism and epilepsy, with a yet unquantifiable risk for the fetus. The prenatal disclosure of susceptibility loci is a topic of much debate. Many health care professionals fear that reporting susceptibility loci may put a psychological burden on pregnant couples. It is our policy to disclose prenatal susceptibility loci as we recognize them as actionable for prospective parents. The aim of this report was to evaluate the psychological impact of disclosing a prenatal diagnosis of susceptibility loci. The psychological impact of disclosing susceptibility loci was evaluated in the first patients who received such results. Eight out of 15 women who had a susceptibility locus disclosed and four of their partners consented to share their experiences through a telephonic evaluation (n = 12). Follow-up time ranged from 3 to 15 months after their prenatal test result. The reporting of susceptibility loci was initially ‘shocking’ for five parents while the other seven felt ‘worried’. Ten out of 12 participants indicated they would like to be informed about the susceptibility locus again, two were unsure. Most had no enduring worries. Participants unanimously indicated that pregnant couples should have an individualized pre-test choice about susceptibility loci (non)disclosure. We observed no negative psychological impact with the prenatal diagnosis and disclosure of SL on participants. A key factor in mitigating parental anxiety with SL disclosure appears to be post-test genetic counseling. Our report confirms that pregnant women and their partners prefer an individualized choice regarding the scope of prenatal testing.
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Carlsson T, Bergman G, Wadensten B, Mattsson E. Experiences of informational needs and received information following a prenatal diagnosis of congenital heart defect. Prenat Diagn 2016; 36:515-22. [PMID: 26991536 PMCID: PMC5074242 DOI: 10.1002/pd.4815] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/08/2016] [Accepted: 03/14/2016] [Indexed: 11/09/2022]
Abstract
Objective To explore the need for information and what information was actually received following prenatal diagnosis of a congenital heart defect, in a country where termination of pregnancy beyond 22 weeks of gestation is not easily possible because of legal constraints. Methods Twenty‐six Swedish‐speaking pregnant women (n = 14) and partners (n = 12) were consecutively recruited for semi‐structured telephone interviews following the prenatal diagnosis of a congenital heart defect. Data were analyzed using content analysis. Results Although high satisfaction with the specialist information was described, the information was considered overwhelming and complex. Objective, honest, and detailed information about multiple subjects were needed, delivered repeatedly, and supplemented by written information/illustrations. Eighteen respondents had used the Internet to search for information and identified issues involving searching difficulties, low quality, and that it was too complex, insufficient, or unspecific. Those who terminated their pregnancy criticized that there was a lack of information about termination of pregnancy, both from health professionals and online sources, resulting in unanswered questions and unpreparedness. Conclusion Individuals faced with a prenatal diagnosis of a congenital heart defect need individualized and repeated information. These needs are not all adequately met, as individuals are satisfied with the specialist consultation but left with unanswered questions regarding pregnancy termination. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's Already Known About This Topic?The introduction of ultrasound screening during the second trimester of pregnancy has increased the detection rate of major congenital heart defects. Information matched to individual needs is crucial for women to cope with the situation following a prenatal diagnosis.
What Does This Study Add?There is a need for information on multiple subjects following the prenatal diagnosis of congenital heart defect, including termination of pregnancy. Although information is available on the Internet on congenital heart defects, it is not easily searchable and its quality may be less than desired. Apparently, there is insufficient information about termination of pregnancy following the prenatal diagnosis of congenital heart defect.
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Affiliation(s)
- Tommy Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Bergman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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"Have no regrets:" Parents' experiences and developmental tasks in pregnancy with a lethal fetal diagnosis. Soc Sci Med 2016; 154:100-9. [PMID: 26954999 DOI: 10.1016/j.socscimed.2016.02.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 02/11/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022]
Abstract
SIGNIFICANCE Lethal fetal diagnoses are made in 2% of all pregnancies. The pregnancy experience is certainly changed for the parents who choose to continue the pregnancy with a known fetal diagnosis but little is known about how the psychological and developmental processes are altered. METHODS This longitudinal phenomenological study of 16 mothers and 14 fathers/partners sought to learn the experiences and developmental needs of parents who continue their pregnancy despite the lethal diagnosis. The study was guided by Merleau-Ponty's philosophic view of embodiment. Interviews (N = 90) were conducted with mothers and fathers over time, from mid-pregnancy until 2-3 months post birth. Data analysis was iterative, through a minimum of two cycles of coding, theme identification, within- and cross-case analysis, and the writing of results. RESULTS Despite individual differences, parents were quite consistent in sharing that their overall goal was to "Have no regrets" when all was said and done. Five stages of pregnancy were identified: Pre-diagnosis, Learning Diagnosis, Living with Diagnosis, Birth & Death, and Post Death. Developmental tasks of pregnancy that emerged were 1) Navigating Relationships, 2) Comprehending Implication of the Condition, 3) Revising Goals of Pregnancy, 4) Making the Most of Time with Baby, 5) Preparing for Birth and Inevitable Death, 6) Advocating for Baby with Integrity, and 7) Adjusting to Life in Absence of Baby. Prognostic certainty was found to be highly influential in parents' progression through developmental tasks. CONCLUSION The framework of parents' pregnancy experiences with lethal fetal diagnosis that emerged can serve as a useful guide for providers who care for families, especially in perinatal palliative care. Providing patient-centered care that is matched to the stage and developmental tasks of these families may lead to improved care and greater parent satisfaction.
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Oscarsson M, Gottvall T, Swahnberg K. When fetal hydronephrosis is suspected antenatally--a qualitative study. BMC Pregnancy Childbirth 2015; 15:349. [PMID: 26694546 PMCID: PMC4689046 DOI: 10.1186/s12884-015-0791-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/11/2015] [Indexed: 12/28/2022] Open
Abstract
Background The information about fetal malformation findings during the ultrasound examination often comes unexpectedly, and the women and their partners may not necessarily receive any conclusive statement on the prognosis. A finding such as fetal hydronephrosis range from being a soft markers or mild anomaly, to a serious condition associated with neonatal morbidity and mortality. The aim of this study was to explore women’s reactions to the discovery of fetal hydronephrosis in the context of uncertainty regarding the prognosis. Methods Ten women were interviewed and the interviews were conducted six to twelve months after the women gave birth. They had experience of suspected fetal hydronephrosis in gestational week 18–20. The interviews were recorded, transcribed verbatim and analysed using constant comparative analysis. Results The core category, ‘Going through crisis by knowing that you are doing the right thing’ illustrates the meaning of women’s reactions and feelings. It illuminates the four categories: ‘When the unexpected happens’– on the one hand, women had positive views that the suspicious malformation could be discovered; however, on the other hand, women questioned the screening. ‘To live in suspense during pregnancy’ – the suspicious malformation caused anxiety and was a stressful situation. ‘Difficulties in understanding information’ – the women thought they had limited knowledge and had difficulties in understanding the information. ‘Suppress feelings and hope for the best’ – the women tried to postpone the problem and thought they should deal with it after delivery. Conclusions Women are worried irrespective of suspicious or severe malformations, and in need of information and counselling tailored to their individual needs. Other sources of support could be: written information, links to reliable sources on the Internet and possibilities for ongoing follow-ups.
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Affiliation(s)
- Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan, 14, 391 82, Kalmar, Sweden.
| | - Tomas Gottvall
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan, 14, 391 82, Kalmar, Sweden. .,Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Cobb AD. Acknowledged Dependence and the Virtues of Perinatal Hospice. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 41:25-40. [PMID: 26661051 DOI: 10.1093/jmp/jhv032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Prenatal screening can lead to the detection and diagnosis of significantly life-limiting conditions affecting the unborn child. Recognizing the difficulties facing parents who decide to continue the pregnancy, some have proposed perinatal hospice as a new modality of care. Although the medical literature has begun to devote significant attention to these practices, systematic philosophical reflection on perinatal hospice has been relatively limited. Drawing on Alasdair MacIntyre's account of the virtues of acknowledged dependence, I contend that perinatal hospice manifests and facilitates virtues essential to living well with human dependency and vulnerability. For this reason, perinatal hospice deserves broad support within society.
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Wool C. Instrument Psychometrics: Parental Satisfaction and Quality Indicators of Perinatal Palliative Care. J Palliat Med 2015; 18:872-7. [DOI: 10.1089/jpm.2015.0135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charlotte Wool
- Stabler Department of Nursing, York College of Pennsylvania, York, Pennsylvania
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Bratt EL, Järvholm S, Ekman-Joelsson BM, Mattson LÅ, Mellander M. Parent's experiences of counselling and their need for support following a prenatal diagnosis of congenital heart disease--a qualitative study in a Swedish context. BMC Pregnancy Childbirth 2015; 15:171. [PMID: 26276642 PMCID: PMC4537590 DOI: 10.1186/s12884-015-0610-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal screening for foetal cardiac abnormalities has been increasingly practiced in Sweden during the last 25 years. A prenatal diagnosis may have medical benefits but may also cause sustained parental psychological distress. The aim of this study was to explore pregnant women's, and their partner's, experiences of counselling and need for support during continued pregnancy following a prenatal diagnosis of a cardiac defect. A second aim was to use this information to propose a structured follow-up programme for continued support after the first counselling. METHOD DESIGN Qualitative study, using interviews performed 5-9 weeks after a prenatal diagnosis of congenital heart disease. SETTING A tertiary foetal cardiology unit in Sweden Sample: Six pregnant women and their 6 partners, consecutively recruited after a prenatal diagnosis of an isolated and significant cardiac defect. DATA ANALYSIS Qualitative content analysis. RESULTS The analysis resulted in three themes. 1/ Counselling and making a decision--the importance of knowledge and understanding: Short waiting time for specialist evaluation together with clear and straightforward information was essential. Parents called for written information together with a high-quality website with relevant information about congenital heart disease. 2/ Continued support during pregnancy: Continued and easy access to health care professionals, including a paediatric specialist nurse, throughout pregnancy, was important. Contact with couples with similar experiences and social media were also considered valuable sources of support. 3/ Next step--the near future: Practical and economical issues during the postnatal hospital stay and the initial period following the hospital stay were common concerns. CONCLUSIONS The following aspects should be considered in a structured follow up program during pregnancy after a prenatal diagnosis of CHD; written information, access to a safe web-site with information of high quality in their native language, support from parents with similar experiences and continued contact with a specialist liaison nurse with experience of paediatric cardiology.
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Affiliation(s)
- Ewa-Lena Bratt
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, , 405 30, Gothenburg, Sweden. .,Department of Paediatric Cardiology, The Queen Silvia Childréns hospital, Rondvägen 10, 416 50, Gothenburg, Sweden.
| | - Stina Järvholm
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Blå Stråket 6, 413 45, Gothenburg, Sweden.
| | - Britt-Marie Ekman-Joelsson
- Department of Paediatric Cardiology, The Queen Silvia Childréns hospital, Rondvägen 10, 416 50, Gothenburg, Sweden.
| | - Lars-Åke Mattson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Blå Stråket 6, 413 45, Gothenburg, Sweden.
| | - Mats Mellander
- Department of Paediatric Cardiology, The Queen Silvia Childréns hospital, Rondvägen 10, 416 50, Gothenburg, Sweden.
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Nazaré B, Fonseca A, Canavarro MC. Trauma Following Termination of Pregnancy for Fetal Abnormality: Is This the Path From Guilt to Grief? JOURNAL OF LOSS & TRAUMA 2014. [DOI: 10.1080/15325024.2012.743335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Horsch A, Brooks C, Fletcher H. Maternal coping, appraisals and adjustment following diagnosis of fetal anomaly. Prenat Diagn 2013; 33:1137-45. [DOI: 10.1002/pd.4207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/18/2013] [Accepted: 07/20/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Antje Horsch
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (SUPEA); Unité de Recherche, Université de Lausanne Lausanne Switzerland
- Service de Néonatologie; Université de Lausanne, Lausanne Switzerland
| | - Chloe Brooks
- Children and Young People Learning Disability Service; Evergreen House Cheltenham UK
| | - Helen Fletcher
- Southern Health NHS Foundation Trust; Psychology Services, South Bucks Community Learning Disabilities Team; High Wycombe UK
- North Learning Disability Team; Aylesbury UK
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McNamara K, O'Donoghue K, O'Connell O, Greene RA. Antenatal and intrapartum care of pregnancy complicated by lethal fetal anomaly. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/tog.12028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karen McNamara
- Anu Research Centre; Department of Obstetrics and Gynaecology; University College Cork and Cork University Maternity Hospital; Cork; Ireland
| | - Keelin O'Donoghue
- Anu Research Centre; Department of Obstetrics and Gynaecology; University College Cork and Cork University Maternity Hospital; Cork; Ireland
| | | | - Richard A Greene
- National Perinatal Epidemiology Centre; Department of Obstetrics and Gynaecology; University College Cork and Cork University Maternity Hospital; Cork; Ireland
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Pachón H, Kancherla V, Handforth B, Tyler V, Bauwens L. Folic acid fortification of wheat flour: A cost-effective public health intervention to prevent birth defects in Europe. NUTR BULL 2013. [DOI: 10.1111/nbu.12023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - V. Kancherla
- Department of Epidemiology; Emory University; Atlanta; USA
| | | | | | - L. Bauwens
- International Federation for Spina Bifida and Hydrocephalus; Brussels; Belgium
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Wool C. State of the science on perinatal palliative care. J Obstet Gynecol Neonatal Nurs 2013; 42:372-82; quiz E54-5. [PMID: 23578106 DOI: 10.1111/1552-6909.12034] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report the state of the science since 1995 on the concept of palliative care for parents who opt to continue a pregnancy after receiving a life-limiting fetal diagnosis. DATA SOURCES PubMed, Ovid, PsycInfo, CINAHL, and Medline were searched from 1995 to July 2012 using the terms perinatal palliative care and perinatal hospice. STUDY SELECTION Inclusion criteria included empirical studies written in English that focused on experiences of parents who opted to continue a pregnancy in which the fetus had a life-limiting condition or on perinatal palliative care. Twenty studies met inclusion criteria. DATA EXTRACTION Results from empirical studies contributing to the knowledge base of perinatal palliative care are presented. DATA SYNTHESIS Women are confronted with powerful emotions, challenging decisions, and considerable uncertainty following the news of a life-limiting fetal anomaly. Women choose to continue their pregnancies for a variety of reasons and when doing so embark on a search for meaning. The science suggests that perinatal palliative care is welcomed by parents and is a medically safe and viable option. Women voiced positive feedback about their decisions to continue their pregnancies, and parents cited personal growth in the aftermath. Perinatal palliative care programs provide services that incorporate early and integrative care beginning in the antenatal period. A multidisciplinary coordinated approach provides parents with comprehensive, holistic support. CONCLUSION More research is needed to elucidate the factors that will benefit parents who continue their pregnancies. Investigating the needs and perceptions of clinicians and their willingness to participate in this new model of care is necessary as is examining barriers that may undermine care. Nurses can lead research on these topics and implement evidence-based practice grounded on study findings.
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Affiliation(s)
- Charlotte Wool
- York College of Pennsylvania, 441 Country Club Road, York, PA 17403, USA.
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Asplin N, Wessel H, Marions L, Ohman SG. Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination. SEXUAL & REPRODUCTIVE HEALTHCARE 2013; 4:79-84. [PMID: 23663926 DOI: 10.1016/j.srhc.2013.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/10/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made. DESIGN Descriptive study. SETTING Four fetal care referral centres in Stockholm, Sweden. POPULATION Pregnant women with a detected fetal malformation. METHODS Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed. RESULTS Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p < or = 0.004) of previous abortions than those in the continuing group (23.2%). CONCLUSION The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.
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Affiliation(s)
- Nina Asplin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Fonseca A, Nazaré B, Canavarro MC. Clinical Determinants of Parents’ Emotional Reactions to the Disclosure of a Diagnosis of Congenital Anomaly. J Obstet Gynecol Neonatal Nurs 2013; 42:178-90. [DOI: 10.1111/1552-6909.12010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fonseca A, Nazaré B, Canavarro MC. Parental Psychological Distress and Confidence After an Infant’s Birth: The Role of Attachment Representations in Parents of Infants with Congenital Anomalies and Parents of Healthy Infants. J Clin Psychol Med Settings 2012; 20:143-55. [DOI: 10.1007/s10880-012-9329-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Women's experiences receiving abnormal prenatal chromosomal microarray testing results. Genet Med 2012; 15:139-45. [PMID: 22955112 DOI: 10.1038/gim.2012.113] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Genomic microarrays can detect copy-number variants not detectable by conventional cytogenetics. This technology is diffusing rapidly into prenatal settings even though the clinical implications of many copy-number variants are currently unknown. We conducted a qualitative pilot study to explore the experiences of women receiving abnormal results from prenatal microarray testing performed in a research setting. METHODS Participants were a subset of women participating in a multicenter prospective study "Prenatal Cytogenetic Diagnosis by Array-based Copy Number Analysis." Telephone interviews were conducted with 23 women receiving abnormal prenatal microarray results. RESULTS We found that five key elements dominated the experiences of women who had received abnormal prenatal microarray results: an offer too good to pass up, blindsided by the results, uncertainty and unquantifiable risks, need for support, and toxic knowledge. CONCLUSION As prenatal microarray testing is increasingly used, uncertain findings will be common, resulting in greater need for careful pre- and posttest counseling, and more education of and resources for providers so they can adequately support the women who are undergoing testing.
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