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Dyer E, Bell R, Graham R, Rankin J. Healthcare professional perspectives on improving inter-pregnancy care after a baby loss for women with type 1 and type 2 diabetes. Diabet Med 2024:e15401. [PMID: 38950196 DOI: 10.1111/dme.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
AIMS Women with diabetes (WWD) (type 1 and type 2) are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Many WWD become pregnant again soon after loss. This study aimed to explore healthcare professional perspectives on improving inter-pregnancy care for WWD after baby loss, as they play a crucial role in facilitating access to support for WWD to prepare for subsequent pregnancy. METHODS Eighteen healthcare professionals recruited through social media and professional networks between November 2020 and July 2021 participated in a semi-structured remote interview. Data were analysed using thematic analysis. RESULTS Three main themes were identified: (1) supporting WWD who want to become pregnant again after baby loss; (2) recognising multiple hidden burdens in the inter-pregnancy interval after loss; (3) discontinuities and constraints in inter-pregnancy care. Most participants tended to assume WWD wanted time and space before thinking about pregnancy after loss, so they did not routinely broach the subject. Participants reported receiving little or no training on managing sensitive conversations. Care provision varied across providers, and unclear referral pathways were challenging to navigate. Participants reported concerns that not all healthcare professionals knew how to mitigate pregnancy risks. CONCLUSIONS It is unclear who is responsible for supporting WWDs preconception health between baby loss and subsequent pregnancy. Healthcare professionals may be reticent to initiate conversations about pregnancy for fear of causing upset or distress. Future research is required to scope out ways to raise awareness among healthcare professionals and practical tips on sensitively raising the topic of subsequent pregnancy.
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Affiliation(s)
- Eleanor Dyer
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ruth Bell
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ruth Graham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle Upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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2
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Keser E, Kahya Y. Perinatal grief creates vulnerability to anxiety in subsequent pregnancy: the mediating role of bereavement-related guilt. J Reprod Infant Psychol 2024:1-13. [PMID: 38529818 DOI: 10.1080/02646838.2024.2335176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/16/2024] [Indexed: 03/27/2024]
Abstract
AIM This study examines the associations among perinatal grief symptoms, bereavement-related guilt, and pregnancy-related anxiety in subsequent pregnancy within the framework of a hypothesised mourning model. METHOD Pregnant women with history of a perinatal loss were recruited using convenience sampling methods and completed a questionnaire set including the Perinatal Grief Scale, Bereavement Guilt Scale, and Pregnancy-related Anxiety Scale. RESULTS Mediation analysis was performed to evaluate the hypothesised model in a sample of pregnant women with history of a perinatal loss (N = 111). The results indicated that bereavement-related guilt functions as a mediator in the relationship between perinatal grief severity and pregnancy-related anxiety experienced in subsequent pregnancies. CONCLUSION These findings were evaluated in light of previous studies, providing a bereavement-based perspective on the potential transmission of the mental effects of perinatal loss to subsequent pregnancy.
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Affiliation(s)
- Emrah Keser
- Department of Psychology, TED University, Ankara, Turkey
| | - Yasemin Kahya
- Department of Psychology, Social Sciences University of Ankara, Ankara, Turkey
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Pingeton BC, Cochran A, Goodman SH, Laurent H, Sbrilli MD, Knight B, Newport DJ, Stowe ZN. Positive affect improves a transdiagnostic model of perinatal depression symptoms. J Affect Disord 2023; 336:112-119. [PMID: 37230263 PMCID: PMC10448502 DOI: 10.1016/j.jad.2023.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Accurate measurement of perinatal depression is vital. We aimed to 1) test whether a factor that measured positive affect (PA) bettered a transdiagnostic model of depression symptoms and 2) replicate the model in a second sample. METHODS We conducted secondary analyses from two samples (n's = 657 and 142) of women in treatment at perinatal psychiatric clinics. Data were derived from items from seven commonly used measures. We compared fit indices from our original factor model-one general and six specific factors derived from the Research Domain Criteria (Loss, Potential Threat, Frustrative Nonreward, and Sleep-Wakefulness) and depression literatures (Somatic and Coping)-to our novel factor model with a PA factor. The PA factor was created by recategorizing items that measured affective states with a positive valence into a new factor. Sample 1 data were split into six perinatal periods. RESULTS In both samples, the addition of a PA factor improved model fit. At least partial metric invariance was found between perinatal periods, with the exception of trimester 3 - postpartum period 1. LIMITATIONS Our measures did not operationalize PA in the same way as in the positive valence system in RDoC and we were unable to perform longitudinal analyses on our cross-validation sample. CONCLUSIONS Clinicians and researchers are encouraged to consider these findings as a template for understanding symptoms of depression in perinatal patients, which can be used to guide treatment planning and the development of more effective screening, prevention, and intervention tools to prevent deleterious outcomes.
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Affiliation(s)
- Blaire C Pingeton
- Department of Psychology, Emory University, United States of America.
| | - Amy Cochran
- Department of Mathematics, Department of Population Health Sciences, University of Wisconsin, United States of America
| | - Sherryl H Goodman
- Department of Psychology, Emory University, United States of America
| | - Heidemarie Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Marissa D Sbrilli
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, United States of America
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, United States of America
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, United States of America
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Galeotti M, Heaney S, Robinson M, Aventin Á. Evaluation of a pregnancy loss education intervention for undergraduate nursing students in Northern Ireland: A pre- and post-test study. BMC Nurs 2023; 22:268. [PMID: 37580730 PMCID: PMC10424365 DOI: 10.1186/s12912-023-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Research highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students. METHODS Educational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis. RESULTS 96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss. CONCLUSIONS The educational intervention increased student nurses' perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.
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Affiliation(s)
- Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Martin Robinson
- Stress, Trauma and Related Conditions Research Centre, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
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5
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Stewart CL, Hall JA. Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi. PLoS One 2022; 17:e0279613. [PMID: 36584165 PMCID: PMC9803273 DOI: 10.1371/journal.pone.0279613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is widely accepted that maternal healthcare is vital for improving maternal and neonatal mortality rates. Furthermore, the continuum of care-the integrated delivery of antenatal, delivery and postnatal care-has been shown to be particularly important. Sub-Saharan Africa has the highest neonatal and maternal mortality rates in the world; significant improvements in the provision and utilisation of the continuum are urgently needed, therefore the barriers preventing access need to be better understood. This study aimed to identify key factors associated with the utilisation of maternal healthcare, in the Mchinji District of Malawi. METHODS 4,244 pregnant women from the Mchinji District of Malawi were interviewed between March and December 2013. The overall utilisation of maternal healthcare was calculated by combining the use of antenatal, delivery and postnatal care into one variable-continuum of care. Univariate and multivariate logistic regressions were performed to determine the factors associated with utilisation of maternal healthcare. RESULTS Utilisation of maternal healthcare in the Mchinji District was inadequate; only 24% of women received the recommended package. Being further from a healthcare facility (OR = 0.2, 95%CI = 0.04-0.96), having at least one live child (OR = 0.87, 95%CI = 0.84-0.99), previous experience of miscarriage (OR = 0.64, 95%CI = 0.50-0.82) or abuse (OR = 0.81, 95%CI = 0.69-0.95) reduced utilisation, whereas being in the richest 20% (OR = 1.33 95%CI = 1.08-1.65), having a planned pregnancy (OR = 1.3, 95%CI = 1.11-1.51) or more control over decisions (OR = 1.09, 95%CI = 0.80-1.49) increased utilisation. CONCLUSION Seven groups of women were identified as having an increased risk of low utilisation of maternal healthcare; women living >5km from a healthcare facility, within the poorest socio-economic group, experiencing an unplanned pregnancy, with at least one live child, experience of a previous miscarriage, no control over their healthcare decisions or experience of abuse. Policy makers should pay extra attention to these high-risk groups when designing and delivering strategies to improve maternal healthcare utilisation.
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Affiliation(s)
- Catherine Louise Stewart
- Reproductive Health Research Department, UCL Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom
| | - Jennifer Anne Hall
- Reproductive Health Research Department, UCL Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom
- * E-mail:
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Chichester M, Tepner L, Côté-Arsenault D. Nursing Care of Childbearing Families After Previous Perinatal Loss. Nurs Womens Health 2022; 26:379-388. [PMID: 36065093 DOI: 10.1016/j.nwh.2022.07.011] [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: 05/17/2021] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
Nurses who care for childbearing families facilitate the family's adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman's perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal-child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a "rainbow baby") after a previous perinatal loss.
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Skvirsky V, Taubman – Ben-Ari O, Azuri J, Weissman A, Horowitz E. Mental health of pregnant women with a background of fertility problems: the contribution of meaning in life and cognitive appraisal. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Charrois EM, Mughal MK, Arshad M, Wajid A, Bright KS, Giallo R, Kingston D. Patterns and predictors of depressive and anxiety symptoms in mothers affected by previous prenatal loss in the ALSPAC birth cohort. J Affect Disord 2022; 307:244-253. [PMID: 35339570 DOI: 10.1016/j.jad.2022.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/13/2022] [Accepted: 03/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies investigating the patterns or predictors of psychological distress in expecting and postpartum mothers affected by previous prenatal loss, are limited. The study objectives were to explore longitudinal trajectory patterns of depressive and anxiety symptoms in mothers affected by previous prenatal loss from early in a subsequent pregnancy up to pre-adolescence, and to identify early factors predictive of elevated symptom trajectory patterns. METHODS A total of 2854 mothers from the Avon Longitudinal Study of Parents and Children self-identified as having experienced a previous prenatal loss. A latent class analysis identified trajectory patterns of symptoms across 10 timepoints from 18-weeks' gestation up to 134-months postpartum, multivariate regression analysis identified predictors of elevated symptom trajectories, and hierarchical regression analysis determined predictive accuracy between predictors and elevated trajectory patterns. RESULTS Three distinct longitudinal trajectory patterns of depressive and anxiety symptoms reflected low (54%), sub-clinical (34%), and clinical symptoms (12%). Key factors that predicted elevated symptom trajectory patterns better than increased symptom scores early in subsequent pregnancy include history of severe depression or other psychiatric problem, experiencing three or more stressful events from mid-pregnancy, inadequate social support, history of induced abortion, and history of abuse. Predictive accuracy of elevated trajectories was 0.542 (depression) and 0.432 (anxiety). LIMITATIONS Generalizability may be compromised by attrition, under-reporting, and recall bias. CONCLUSION Including factors predictive of long-term sub-clinical or clinical depressive and anxiety symptoms in early assessments will improve clinician's ability to identify mothers who may benefit from immediate and/or ongoing monitoring, and psychotherapeutic intervention after prenatal loss.
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Affiliation(s)
- Elyse M Charrois
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| | - Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
| | - Muhammad Arshad
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Bioinformatics Core, Centre for Genomics and Systems Biology, New York University, Abu Dhabi, UAE.
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| | - Katherine S Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
| | - Rebecca Giallo
- Deakin University, Geelong, Australia; Murdoch Children's Research Institute.
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
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Dalton ED, Gruber K. Being PAL: Uncertainty and Coping in r/PregnancyAfterLoss. HEALTH COMMUNICATION 2022; 37:850-861. [PMID: 33494615 DOI: 10.1080/10410236.2021.1874641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Women who become pregnant again following miscarriage or stillbirth are in a particularly vulnerable position as they grapple with uncertainty about the current pregnancy's viability and outcomes. In this study, we examine the types of uncertainty that emerge in pregnancy after loss (PAL) and how women manage that uncertainty. Framed by the theory of communication and uncertainty management, we thematically analyzed threads (N = 636) from the online discussion board Reddit, focusing on the specific subreddit community r/PregnancyAfterLoss. Themes of physiological, emotional, and social uncertainty dominated the PAL experiences of these online community members. Uncertainty management and coping strategies included direct information seeking, bracing, mantras, and accepting uncertainty as part of the PAL experience. Theoretical contributions of this study include an initial conceptualization of emotional uncertainty in health communication. In addition, we draw parallels between uncertainty in PAL and in illness and highlight the unique features of PAL that expand our understanding of uncertainty in health. Practical implications are drawn from members' expressed needs and uncertainty management practices, and provide direction for supporting women through the PAL experience.
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Affiliation(s)
| | - Katie Gruber
- Department of Communication Studies, Middle Tennessee State University
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Smorti M, Ponti L, Simoncini T, Mannella P, Bottone P, Pancetti F, Marzetti F, Mauri G, Gemignani A. Pregnancy after miscarriage in primiparae and multiparae: implications for women's psychological well-being. J Reprod Infant Psychol 2020; 39:371-381. [PMID: 32064903 DOI: 10.1080/02646838.2020.1728524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Miscarriage is a stressful life event with negative consequences that can last into the subsequent gestation, increasing women's risk for psychological symptoms. Less clear in literature is whether having a living child may buffer the psychological impact of miscarriage on subsequent pregnancies.Objective: explore levels of depression, anxiety and fear of delivery in women with and without a previous miscarriage, taking into consideration the presence of a living child.Method: 208 women (M = 34.68) were recruited during the third trimester of gestation. The sample was composed of 159 women without a previous miscarriage (72.3% primiparae and 27.7% multiparae) and 49 women with a history of miscarriage (53.1% primiparae and 46.9% multiparae). Participants filled out a battery of questionnaires aimed at assessing anxiety, depression, and fear of delivery.Results: Primiparae reported higher levels of fear of childbirth than multiparae. Moreover, women without a history of previous perinatal loss showed lower levels of depression and fear of childbirth than women with a previous perinatal loss.Conclusions: Data highlight the importance of developing specific support groups, for primiparae, due to their great emotional vulnerability, and for women with past miscarriage, to help them cope in adaptive ways with a new pregnancy.
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Affiliation(s)
- Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lucia Ponti
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy
| | - Tommaso Simoncini
- Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Paolo Mannella
- Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Pietro Bottone
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Pancetti
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Marzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Giulia Mauri
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Ladhani NNN, Fockler ME, Stephens L, Barrett JF, Heazell AE. No 369 - Prise en charge de la grossesse aprés une mortinaissance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1684-1700. [DOI: 10.1016/j.jogc.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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No. 369-Management of Pregnancy Subsequent to Stillbirth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1669-1683. [DOI: 10.1016/j.jogc.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lorén-Guerrero L, Gascón-Catalán A, Romero-Cardiel MA. Adapting the revised prenatal coping inventory (NuPCI) for use in a Spanish population. J Psychosom Obstet Gynaecol 2018; 39:156-163. [PMID: 28420307 DOI: 10.1080/0167482x.2017.1315565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To adapt the Revised Prenatal Coping Inventory (NuPCI) for the evaluation of prenatal stress coping strategies utilised by Spanish women. METHODS A cross-sectional study was performed to evaluate the psychometric properties of NuPCI adapted for a Spanish population. Two hundred and sixty one puerperium women completed the NuPCI at the time of discharge after childbirth. Instrument construct validity was evaluated using subscale item correlations. Internal consistency was assessed using Cronbach's α test. RESULTS Items from each subscale (Preparation, Avoidance and Spiritual - Positive Coping) were significantly correlated with the global result (p < .001). The internal reliability of the NuPCI demonstrated suitable values for each of the three coping strategies (α > 0.7). The most frequently used coping strategy was Preparation and the least used was Avoidance. Utilisation of the coping strategies with Preparation decreased with increasing parity (p = .002) and greater prenatal stress was associated with increased use of the Avoidance coping strategy (p < .001). CONCLUSIONS The NuPCI adapted for Spanish women demonstrates good psychometric properties for evaluating the three types of prenatal stress coping strategies: Preparation, Avoidance and Spiritual - Positive Coping. Results were similar to those presented by the instrument in its English language version.
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Affiliation(s)
- L Lorén-Guerrero
- a Nurse and Midwifery , Clinical University Hospital "Lozano Blesa" , Zaragoza , Spain
| | - A Gascón-Catalán
- b Department of Nursing and Physiatry , Zaragoza University , Zaragoza , Spain
| | - M A Romero-Cardiel
- c Department of Surgery, Obstetrics and Gynecology , Zaragoza University , Zaragoza , Spain.,d Clinical University Hospital "Lozano Blesa" , Zaragoza , Spain
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Stevenson EL, Silva S. Multidimensional Psychological Stress During Pregnancies in Women Who Conceived via In Vitro Fertilization. Res Theory Nurs Pract 2018; 31:295-312. [PMID: 28793950 DOI: 10.1891/1541-6577.31.3.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore relationships among the 3 psychological dimensions of stress, stimulus/environmental, perceptual, and emotional response, and then to develop a multidimensional composite measure of overall stress, and to determine demographic and clinical characteristics associated with stress in women who became pregnant via in vitro fertilization (IVF). METHODS Cross-sectional design using self-report questionnaires during the second trimester. Multidimensional stress was assessed with the Prenatal Life Events Scale, Life Event Distress Scale, Perceived Stress Scale, State-Trait Anxiety Index-State, and the Pregnancy-Related Anxiety Measure. RESULTS Participants (n = 144), aged 25-40 years, were enrolled June 2010-August 2011 from a private fertility clinic. Exploratory principal factor analysis was used to develop an overall stress score from the stress measures. Multiple stepwise regression analyses were conducted to determine characteristics related to the stress measures. White race tended to be associated with lower stress scores (p = .079). White participants also had lower perceived stress (p = .007), and those with a history of miscarriage had higher pregnancy-related anxiety (p = .035). CONCLUSIONS White women had lower perceived stress. History of one or more miscarriage was associated with higher pregnancy-related anxiety. Additional research examining multidimensional stress is needed across the pregnancy trimesters as well as comparisons to women who conceived without IVF both in United States and internationally.
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Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø. Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study. BMC Pregnancy Childbirth 2018; 18:41. [PMID: 29361916 PMCID: PMC5781321 DOI: 10.1186/s12884-018-1666-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women’s relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth. Methods This study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors. Results Women pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90–10.32 and aOR 1.91, 95% CI 1.11–3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68–9.24 and aOR 1.91, 95% CI 1.08–3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval < 12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups. Conclusion Women who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.
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Affiliation(s)
- Ida Kathrine Gravensteen
- Institute of Clinical Medicine, University of Oslo, P.O box 1171, Blindern, 0318, Oslo, Norway. .,Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. .,Department of Haematology, Oslo University Hospital, Oslo, Norway.
| | | | - Per Morten Sandset
- Institute of Clinical Medicine, University of Oslo, P.O box 1171, Blindern, 0318, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | | | | | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research support services, Oslo University Hospital, Oslo, Norway
| | - Øivind Ekeberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Tektaş P, Çam O. The Effects of Nursing Care Based on Watson's Theory of Human Caring on the Mental Health of Pregnant Women After a Pregnancy Loss. Arch Psychiatr Nurs 2017; 31:440-446. [PMID: 28927506 DOI: 10.1016/j.apnu.2017.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Pınar Tektaş
- Department of Psychiatric and Mental Health Nursing, Ege Univesity, Faculty of Nursing, Bornova, İzmir, Turkey.
| | - Olcay Çam
- Department of Psychiatric and Mental Health Nursing, Ege Univesity, Faculty of Nursing, Bornova, İzmir, Turkey
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17
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San Lazaro Campillo I, Meaney S, McNamara K, O'Donoghue K. Psychological and support interventions to reduce levels of stress, anxiety or depression on women's subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open 2017; 7:e017802. [PMID: 28882928 PMCID: PMC5595175 DOI: 10.1136/bmjopen-2017-017802] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage. DESIGN A systematic review of randomised controlled trials (RCTs). DATA SOURCE A total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE. ELIGIBILITY CRITERIA This review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention. RESULTS This systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found. CONCLUSION Cohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women's psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.
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Affiliation(s)
- Indra San Lazaro Campillo
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork - National University of Ireland, Cork, Ireland
| | - Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork - National University of Ireland, Cork, Ireland
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Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø. Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study. BJOG 2017; 125:202-210. [PMID: 28516500 DOI: 10.1111/1471-0528.14750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes. DESIGN Population-based pregnancy cohort study. SETTING The Norwegian Mother and Child Cohort Study. SAMPLE A total of 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous. METHODS Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway. MAIN OUTCOME MEASURES Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery. RESULTS Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% CI 9.4-10.7) compared with women with a previous live birth (mean 6.0; 95% CI 5.8-6.2) and previously nulliparous women (mean 6.3; 95% CI 6.1-6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3-5.0) compared with women with previous live birth and 3.7 (1.8-7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, whereas dread of childbirth was not a significant mediator for elective CS. CONCLUSIONS Women pregnant after stillbirth were more ample users of healthcare services and more often had induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. TWEETABLE ABSTRACT Women pregnant after stillbirth are ample users of healthcare services and interventions during childbirth.
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Affiliation(s)
- I K Gravensteen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - E-M Jacobsen
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - P M Sandset
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - L B Helgadottir
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - I Rådestad
- Sophiahemmet University, Stockholm, Sweden
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ø Ekeberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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19
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Creation of interdisciplinary guidelines for care of women presenting to the emergency department with pregnancy loss. J Perinatol 2017; 37:757-761. [PMID: 28617428 DOI: 10.1038/jp.2017.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/14/2017] [Accepted: 01/30/2017] [Indexed: 11/08/2022]
Abstract
A research trajectory is reported that created state-of-the-art interdisciplinary guidelines for care of women and their families who arrive in the emergency department with pregnancy loss. These guidelines include attention to mother and family bereavement as well as care of the fetus. Design was a triangulated non-experimental exploratory action research for the purpose of changing practice. Included were: (1) A qualitative study of emergency room nurses and physicians to assess beliefs/barriers to providing optimal care for pregnancy loss patients. (2) A focus group of perinatal bereavement providers; (3) Another focus group in the form of a sponsored National Summit of professional and lay experts and (4) A Delphi Study to craft language for national position statement. Results allowed the creation of interdisciplinary guidelines from the National Perinatal Association. These guidelines are being adopted by organizations and facilities throughout the United States. Training programs for emergency department personnel have been created by pregnancy loss organizations and are available.
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20
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Abstract
Pregnancy after stillbirth presents unique challenges for families and healthcare providers. Medical surveillance and interventions must be optimized to improve outcomes and provide individualized support for families. A key component of acceptable care is psychosocial support that is delivered in a timely and sensitive manner by care providers with knowledge about the pervasive impact of stillbirth. With the lack of existing evidence to guide care, there is an urgent need for global leadership and research to address knowledge gaps.
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Abstract
OBJECTIVE The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men's and women's accounts of miscarriage. DESIGN This was a qualitative study using a phenomenological framework. Following in-depth semistructured interviews, analysis was undertaken in order to identify superordinate themes relating to their experience of miscarriage. SETTING A large tertiary-level maternity hospital in Ireland. PARTICIPANTS A purposive sample of 16 participants, comprising 10 women and 6 men, was recruited. RESULTS 6 superordinate themes in relation to the participant's experience of miscarriage were identified: (1) acknowledgement of miscarriage as a valid loss; (2) misperceptions of miscarriage; (3) the hospital environment, management of miscarriage; (4) support and coping; (5) reproductive history; and (6) implications for future pregnancies. CONCLUSIONS One of the key findings illustrates a need for increased awareness in relation to miscarriage. The study also indicates that the experience of miscarriage has a considerable impact on men and women. This study highlights that a thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for those who experience miscarriage. Consideration should be given to the manner in which women who have not experienced recurrent miscarriage but have other potential risk factors for miscarriage could be followed up in clinical practice.
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Affiliation(s)
- S Meaney
- National Perinatal Epidemiology Centre, University College Cork, Ireland
- Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland
| | - P Corcoran
- National Perinatal Epidemiology Centre, University College Cork, Ireland
| | - N Spillane
- Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland
| | - K O'Donoghue
- Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland
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22
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Lee L, McKenzie-McHarg K, Horsch A. The impact of miscarriage and stillbirth on maternal–fetal relationships: an integrative review. J Reprod Infant Psychol 2016. [DOI: 10.1080/02646838.2016.1239249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Huang Z, Hao J, Su P, Huang K, Xing X, Cheng D, Xiao L, Xu Y, Zhu X, Tao F. The Impact of Prior Abortion on Anxiety and Depression Symptoms During a Subsequent Pregnancy: Data From a Population-Based Cohort Study in China. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20111102040509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Zhaohui Huang
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
- Shaoxing Center for Disease Control and Prevention, Shaoxing 312071, Zhejiang Province, China
| | - Jiahu Hao
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
- Shaoxing Center for Disease Control and Prevention, Shaoxing 312071, Zhejiang Province, China
| | - Puyu Su
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Kun Huang
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiuya Xing
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Daijuan Cheng
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Limin Xiao
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Yuanyuan Xu
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiaoming Zhu
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Fangbiao Tao
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
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Baghdari N, Sadeghi Sahebzad E, Kheirkhah M, Azmoude E. The Effects of Pregnancy-Adaptation Training on Maternal-Fetal Attachment and Adaptation in Pregnant Women With a History of Baby Loss. Nurs Midwifery Stud 2016; 5:e28949. [PMID: 27556052 PMCID: PMC4993030 DOI: 10.17795/nmsjournal28949] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 12/04/2015] [Accepted: 12/06/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies have shown that educating mothers can improve their adaptation to pregnancy and motherhood roles. There are also studies that have investigated the effects of certain interventions on maternal-fetal attachment. However, studies on the effects of maternal adaptation training on maternal-fetal attachment in mothers with a history of fetal or baby loss are rare. OBJECTIVES The aim of this study was to determine the effects of a pregnancy adaptation training package on maternal-fetal attachment in pregnant women with a history of baby loss. PATIENTS AND METHODS This quasi-experimental study was conducted on 60 pregnant women with previous fetal or neonatal death in 2014. The women were randomly divided into an experimental group (n = 30) and a control group (n = 30). The pregnant women in the experimental group received routine prenatal education in addition to four sessions of a pregnancy adaption training package. The control group received only routine prenatal education. The data were collected using a demographic questionnaire, Cranley's maternal-fetal attachment scale, and a prenatal self-evaluation questionnaire at the beginning and at the end of the study. The data analysis was conducted using the Mann-Whitney U, Wilcoxon, chi-square, Fisher's exact, and spearman correlation coefficient tests. RESULTS Before the intervention, there were no statistically significant differences between the study and control groups in terms of maternal-fetal attachment (P = 0.280) and adaptation to pregnancy (P = 0.883). However, following the intervention, the mean score of the maternal-fetal attachment was significantly higher in the experimental group, when compared with the control (77.57 ± 7.23 vs. 61.53 ± 2.62; P = 0.001). In addition, the mean post-intervention adaptation to pregnancy score was significantly lower in the experimental group than in the control group (118.89 ± 8.12 vs. 126.38 ± 4.17; P = 0.001). CONCLUSIONS The pregnancy adaptation training package increased the adaptation and maternal-fetal attachment scores in pregnant women with a history of baby loss.
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Affiliation(s)
- Nasrin Baghdari
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Elahe Sadeghi Sahebzad
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Masoomeh Kheirkhah
- Department of Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran
| | - Elham Azmoude
- Department of Midwifery, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, IR Iran
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25
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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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26
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Bicking Kinsey C, Baptiste-Roberts K, Zhu J, Kjerulff KH. Effect of previous miscarriage on depressive symptoms during subsequent pregnancy and postpartum in the first baby study. Matern Child Health J 2015; 19:391-400. [PMID: 24894728 DOI: 10.1007/s10995-014-1521-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Our objective was to test the hypothesis that nulliparous women with a history of miscarriage have an increased risk of depression during late pregnancy, and at 1, 6, and 12 months postpartum compared to women without a history of miscarriage. We conducted secondary analysis of a longitudinal cohort study, the First Baby Study, and compared 448 pregnant women with a history of miscarriage to 2,343 pregnant women without a history of miscarriage on risk of probable depression (score >12 on the Edinburgh Postnatal Depression Scale). Logistic regression models were used to estimate odds ratios at each time point and generalized estimating equations were used to obtain estimates in longitudinal analysis. Women with a history of miscarriage were not more likely than woman without a history of miscarriage to score in the probable depression range during the third trimester or at 6 or 12 months postpartum but were more likely at 1 month postpartum, after adjustment for sociodemographic factors (OR 1.66, 95% CI 1.03-2.69). Women with a history of miscarriage may be more vulnerable to depression during the first month postpartum than women without prior miscarriage, but this effect does not appear to persist beyond this time period. We support the promotion of awareness surrounding this issue and recommend that research is planned to identify risk factors that may position a woman with a history of miscarriage to be at higher risk for depression.
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Affiliation(s)
- Cara Bicking Kinsey
- College of Nursing, The Pennsylvania State University, University Park, PA, USA,
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27
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Ruiz RJ, Dwivedi AK, Mallawaarachichi I, Balcazar HG, Stowe RP, Ayers KS, Pickler R. Psychological, cultural and neuroendocrine profiles of risk for preterm birth. BMC Pregnancy Childbirth 2015; 15:204. [PMID: 26334745 PMCID: PMC4558793 DOI: 10.1186/s12884-015-0640-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/28/2015] [Indexed: 12/04/2022] Open
Abstract
Background Preterm birth remains a major obstetrical problem and identification of risk factors for preterm birth continues to be a priority in providing adequate care. Therefore, the purpose of this study was to elucidate risk profiles for preterm birth using psychological, cultural and neuroendocrine measures. Methods From a cross sectional study of 515 Mexican American pregnant women at 22–24 weeks gestation, a latent profile analysis of risk for preterm birth using structural equation modeling (SEM) was conducted. We determined accurate gestational age at delivery from the prenatal record and early ultrasounds. We also obtained demographic and prenatal data off of the chart, particularly for infections, obstetrical history, and medications. We measured depression (Beck Depression Inventory), mastery (Mastery scale), coping (The Brief Cope), and acculturation (Multidimensional Acculturation Scale) with reliable and valid instruments. We obtained maternal whole blood and separated it into plasma for radioimmunoassay of Corticotrophin Releasing Hormone (CRH). Delivery data was obtained from hospital medical records. Results Using a latent profile analysis, three psychological risk profiles were identified. The “low risk” profile had a 7.7 % preterm birth rate. The “moderate risk” profile had a 12 % preterm birth rate. The “highest risk” profile had a 15.85 % preterm birth rate. The highest risk profile had double the percentage of total infections compared to the low risk profile. High CRH levels were present in the moderate and highest risk profiles. Conclusion These risk profiles may provide a basis for screening for Mexican American women to predict risk of preterm birth, particularly after they are further validated in a prospective cohort study. Future research might include use of such an identified risk profile with targeted interventions tailored to the Hispanic culture.
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Affiliation(s)
- R Jeanne Ruiz
- Texas A&M University Health Science Center College of Nursing, 8447 State Highway 47, Bryan, TX, 77807-3260, USA.
| | - Alok Kumar Dwivedi
- Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, A3302 Biostatistical and Epidemiological Consulting Lab, 4801 Alberta Avenue, El Paso, TX, 79905, USA.
| | - Indika Mallawaarachichi
- Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, A3302 Biostatistical and Epidemiological Consulting Lab, 4801 Alberta Avenue, El Paso, TX, 79905, USA.
| | - Hector G Balcazar
- The University of Texas School of Public Health, El Paso Regional Campus, 1100 North Stanton Suite 110, El Paso, TX, 79902, USA.
| | - Raymond P Stowe
- Microgen Laboratories, 903 Texas Avenue, La Marque, TX, 77568, USA.
| | - Kimberly S Ayers
- Texas A&M University Health Science Center College of Nursing, 3950 N A.W. Grimes Blvd, Round Rock, TX, 78665, USA.
| | - Rita Pickler
- The Ohio State University College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA.
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28
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Couples and Miscarriage: The Influence of Gender and Reproductive Factors on the Impact of Miscarriage. Womens Health Issues 2015; 25:570-8. [DOI: 10.1016/j.whi.2015.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
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29
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Gold KJ, Leon I, Boggs ME, Sen A. Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample. J Womens Health (Larchmt) 2015; 25:263-9. [PMID: 26258870 DOI: 10.1089/jwh.2015.5284] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. METHODS We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. RESULTS Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. CONCLUSION This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes.
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Affiliation(s)
- Katherine J Gold
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan.,2 Department of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
| | - Irving Leon
- 2 Department of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
| | - Martha E Boggs
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Ananda Sen
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan.,3 Department of Biostatistics, University of Michigan , Ann Arbor, Michigan
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30
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Green J, Darbyshire P, Adams A, Jackson D. Desperately seeking parenthood: neonatal nurses reflect on parental anguish. J Clin Nurs 2015; 24:1885-94. [PMID: 25939675 DOI: 10.1111/jocn.12811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE This paper aims to explore the ways in which neonatal nurses understand the experience of parents who have experienced infertility, conceived a baby via in vitro fertilisation and delivered an extremely premature infant. The chance of a poor long-term outcome for the baby is significant; therefore, parental anguish plays out in the neonatal intensive care. BACKGROUND Current literature suggests that infertility is a significant issue for ageing women and many couples experience multiple cycles of invitro-fertilisation (IVF) treatment to achieve a pregnancy. Babies conceived through IVF are more likely to have genetic disorders, and be born prematurely. When the baby is born through IVF and is also born extremely prematurely, it creates a crisis situation for the parents. This paper will focus on the parental anguish of achieving a pregnancy through IVF to see the baby born extremely prematurely (defined as ≤ 24-week gestation). It will examine parental anguish from caregiver perspective of the neonatal nurse who supports the parents through this very difficult time. DESIGN This study used interviews with neonatal nurses, and drew insights from interpretative phenomenology. METHODS This research used a combination of a questionnaire and a series of interviews in a qualitative study informed by phenomenology. The analysis of the interview data involved the creation of key themes following extensive coding of thematic statements and the analysis of the emerging themes. RESULTS This paper outlines the neonatal nurses' understanding of parental anguish and overwhelming sadness in parents whose baby was conceived by IVF, and was also born extremely prematurely. The theme of 'seeking parenthood' was synthesised from two sub-themes - 'longing for a baby' and 'the desperation to become parents'. CONCLUSION This study identified that neonatal nurses bear witness to parental anguish as their hopes of taking home a live baby might not be realised. The time, effort and money required to achieve a pregnancy does not mean that the baby will be spared the outcomes of extreme prematurity and the risk factors associated with IVF. The parents may be left empty handed. Therefore, the word precious becomes a metaphor for the IVF baby as the neonatal team try desperately to give the parents their much longed baby. RELEVANCE TO CLINICAL PRACTICE Delayed child bearing has an impact on fertility, with maternal age having the most impact on the ability to conceive. Babies conceived through IVF technologies have a higher risk of genetic abnormalities and being born prematurely, and this will impact on the neonatal intensive care availability. Extreme prematurity and IVF can significantly impact on the baby's outcome. Witnessing parental anguish can be a major source of stress for the neonatal nurses. Neonatal nurses need to develop strategies not only to help the parents but also to prevent the parents' overwhelming sadness from affecting their ability to function in the neonatal intensive care unit.
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Affiliation(s)
- Janet Green
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Philip Darbyshire
- Schools of Nursing & Midwifery, Monash University, Clayton, VIC, Australia.,Schools of Nursing & Midwifery, Flinders University, Bedford Park, SA, Australia.,Philip Darbyshire Consulting Ltd, Highbury, SA, Australia
| | - Anne Adams
- Oxford Brookes University, Oxford, United Kingdom.,University of New England, Armidale, Australia
| | - Debra Jackson
- Oxford Brookes University, Oxford, United Kingdom.,University of New England, Armidale, Australia
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Bicking Kinsey C, Baptiste-Roberts K, Zhu J, Kjerulff KH. Effect of Multiple Previous Miscarriages on Health Behaviors and Health Care Utilization During Subsequent Pregnancy. Womens Health Issues 2015; 25:155-61. [DOI: 10.1016/j.whi.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/21/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
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Hutti MH, Armstrong DS, Myers JA, Hall LA. Grief Intensity, Psychological Well‐Being, and the Intimate Partner Relationship in the Subsequent Pregnancy after a Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2015; 44:42-50. [DOI: 10.1111/1552-6909.12539] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ockhuijsen HDL, van den Hoogen A, Boivin J, Macklon NS, de Boer F. Pregnancy After Miscarriage: Balancing Between Loss of Control and Searching for Control. Res Nurs Health 2014; 37:267-75. [DOI: 10.1002/nur.21610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Henrietta D. L. Ockhuijsen
- Department of Reproductive Medicine and Gynaecology; University Medical Centre Utrecht; P.O. Box 85500 3508 GA Utrecht The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Jacky Boivin
- School of Psychology; Cardiff University; Cardiff United Kingdom
| | - Nicholas S. Macklon
- Department of Obstetrics and Gynaecology; University of Southampton; Southampton United Kingdom
| | - Fijgje de Boer
- Department of Medical Humanities; VU University Medical Centre; Amsterdam The Netherlands
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Rallis S, Skouteris H, McCabe M, Milgrom J. The transition to motherhood: towards a broader understanding of perinatal distress. Women Birth 2014; 27:68-71. [PMID: 24461688 DOI: 10.1016/j.wombi.2013.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND A substantial body of research has focused on maternal perinatal mood and wellbeing, with the focus predominantly being on depression, and to a lesser extent, anxiety. Perinatal maternal stress has also been investigated recently, but to a far lesser extent. The present paper questions whether the term 'perinatal distress' accurately captures the range of challenges experienced by women during the perinatal period, when the scope of 'distress' is limited to the experience of depression and anxiety alone. METHOD A review of the perinatal literature was conducted using several databases, to identify studies that have focused on the experience of stress as a distinct affective state in the perinatal period. FINDINGS The findings of two recent studies which have employed a broader conceptualisation of perinatal distress to encompass the experience of stress as well as depression and anxiety are outlined. These recent studies have identified the experience of stress both in conjunction with and independent of depression and anxiety. CONCLUSION It is argued that future studies should investigate the concept of stress as a separate affective state throughout the perinatal period, in order to further assess how it differs from depression and/or anxiety. A more comprehensive understanding of women's experiences during their transition to motherhood, and whether 'stress' plays a critical role in the development and maintenance of perinatal anxiety and/or depression is needed.
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Affiliation(s)
- Sofia Rallis
- School of Psychology, Deakin University, Victoria, Australia.
| | - Helen Skouteris
- School of Psychology, Deakin University, Victoria, Australia.
| | - Marita McCabe
- School of Psychology, Deakin University, Victoria, Australia
| | - Jeannette Milgrom
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
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35
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Abstract
Extensive evidence documents that prenatal maternal stress predicts a variety of adverse physical and psychological health outcomes for the mother and baby. However, the importance of the ways that women cope with stress during pregnancy is less clear. We conducted a systematic review of the English-language literature on coping behaviours and coping styles in pregnancy using PsycInfo and PubMed to identify 45 cross-sectional and longitudinal studies involving 16,060 participants published between January 1990 and June 2012. Although results were often inconsistent across studies, the literature provides some evidence that avoidant coping behaviours or styles and poor coping skills in general are associated with postpartum depression, preterm birth and infant development. Variability in study methods including differences in sample characteristics, timing of assessments, outcome variables and measures of coping styles or behaviours may explain the lack of consistent associations. To advance the scientific study of coping in pregnancy, we call attention to the need for a priori hypotheses and greater use of pregnancy-specific, daily process, and skills-based approaches. There is promise in continuing this area of research, particularly in the possible translation of consistent findings to effective interventions, but only if the conceptual basis and methodological quality of research improve.
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36
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Huffman CS, Swanson K, Lynn MR. Measuring the Meaning of Miscarriage: Revision of the Impact of Miscarriage Scale. J Nurs Meas 2014; 22:29-45. [DOI: 10.1891/1061-3749.22.1.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: The purpose of this study was to determine a factor structure for the Impact of Miscarriage Scale (IMS). The 24 items comprising the IMS were originally derived from a phenomenological study of miscarriage in women. Initial psychometric properties were established based on a sample of 188 women (Swanson, 1999a). Method: Data from 341 couples were subjected to confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results: CFA did not confirm the original structure. EFA explained 57% of the variance through an 18-item, 4-factor structure: isolation and guilt, loss of baby, devastating event, and adjustment. Except for the Adjustment subscale, Cronbach’s alpha coefficients were ≥.78. Conclusion: Although a 3-factor solution is most defensible, with further refinement and additional items, the 4th factor (adjustment) may warrant retention.
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37
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Bicking Kinsey C, Baptiste-Roberts K, Zhu J, Kjerulff KH. Effect of previous miscarriage on the maternal birth experience in the First Baby Study. J Obstet Gynecol Neonatal Nurs 2013; 42:442-50. [PMID: 23772602 PMCID: PMC3817222 DOI: 10.1111/1552-6909.12216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether a history of miscarriage is related to birth experience and/or maternal fear of an adverse birth outcome for self or infant during a subsequent delivery. DESIGN Secondary analysis of a prospective cohort study, the First Baby Study. SAMPLE Women age 18 to 35 who were expecting to deliver their first live-born infants in Pennsylvania between January 2009 and April 2011. PARTICIPANTS Four hundred fifty-three pregnant women who reported perinatal loss prior to 20 weeks gestation (miscarriage) in a previous pregnancy and 2401 pregnant women without a history of miscarriage were interviewed during pregnancy and again one month after their first live birth. METHODS Maternal birth experience and fear of an adverse birth outcome measured via telephone interview were compared across groups. RESULTS Maternal birth experience scores did not significantly differ between women with and without previous miscarriage. Women with a history of miscarriage reported that they feared an adverse birth outcome for themselves or their infants more frequently than women without a history of miscarriage (52.1% vs. 46.6%; p = .033), however, this relationship was not significant after adjustment for confounders. CONCLUSION Our findings indicate that there is no association between miscarriage history and birth experience. Additional research on this topic would be beneficial including an in-depth examination of fear of adverse outcome during birth. However, nurses and midwives may consider using therapeutic communication techniques to ensure that women with a history of miscarriage receive strong emotional support and reassurance during birth.
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Affiliation(s)
- Cara Bicking Kinsey
- School of Nursing, The Pennsylvania State University, 600 Centerview Drive, Hershey, PA 17033, USA.
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38
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Zanardo V, Messina P, Trivellato P, Cavallin F, Giustardi A, Straface G, Trevisanuto D. Coping strategies in low-risk pregnant women: the influence of low and late fertility. J Matern Fetal Neonatal Med 2013; 27:145-8. [DOI: 10.3109/14767058.2013.806903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yilmaz SD, Beji NK. Effects of perinatal loss on current pregnancy in Turkey. Midwifery 2013; 29:1272-7. [PMID: 23434020 DOI: 10.1016/j.midw.2012.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 09/16/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE to evaluate how a history of pregnancy loss in the perinatal period (from 20 weeks of gestation to seven days post partum) affects women during subsequent pregnancies. DESIGN cross-sectional, descriptive study. SETTING Istanbul Medical School, Istanbul University between January and October 2009. PARTICIPANTS 128 pregnant women with a history of pregnancy loss and 214 pregnant women without a history of pregnancy loss. MEASUREMENTS AND FINDINGS in all women, antenatal attachment was measured using the Prenatal Attachment Inventory, depression was measured using the Center for Epidemiologic Studies' Depression Scale, and coping with stress was measured using the Scale of Ways of Coping with Stress. The rates of undergoing tests (other than routine tests) (p<0.001), calling medical professionals (p<0.001) and visiting an obstetrician more than once per month (p<0.001) were higher in women with a history of pregnancy loss compared with women without a history of pregnancy loss. No difference was found between the groups in terms of coping with stress (p>0.05) and antenatal attachment (p=0.384). However, depressive symptoms were higher in women with a history of pregnancy loss (p=0.008). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE levels of depression, antenatal attachment and coping with stress should be evaluated meticulously in women with a history of pregnancy loss, and appropriate interventions should be performed.
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Affiliation(s)
- Sema Dereli Yilmaz
- Department of Midwifery, Health Sciences Faculty, Selcuk University, Selcuklu, Konya 42250, Turkey.
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40
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Ockhuijsen HDL, Boivin J, van den Hoogen A, Macklon NS. Coping after recurrent miscarriage: uncertainty and bracing for the worst. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2013; 39:250-6. [DOI: 10.1136/jfprhc-2012-100346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Peñacoba-Puente C, Carmona-Monge FJ, Marín-Morales D, Naber K. Coping strategies of Spanish pregnant women and their impact on anxiety and depression. Res Nurs Health 2012; 36:54-64. [PMID: 23080536 DOI: 10.1002/nur.21513] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 11/10/2022]
Abstract
The aims of this study were to analyze the coping strategies used by women in the first trimester of low-risk pregnancies, their relationships to sociodemographic and pregnancy variables, and their ability to predict anxiety and depression in the third trimester. Participants in the first trimester were 285 Spanish pregnant women, of whom 122 were followed into the third trimester. The use of problem-focused coping was stable, whereas variations occurred in emotion-focused coping. Age, educational level, employment, planned pregnancy, previous childbirth, and previous miscarriage were associated with adaptive coping. Coping strategies predicting anxiety and depressive symptoms were overt emotional expression and social support seeking. Coping through religion predicted anxiety. Coping is a complex process influenced by sociodemographic and obstetric factors that can contribute to the onset of psychological symptoms.
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Affiliation(s)
- Cecilia Peñacoba-Puente
- Facultad de Ciencias de la Salud, Department Psychology, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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42
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Marín-Morales D, Carmona-Monge FJ, Peñacoba-Puente C, Díaz-Sánchez V, García-Huete ME. Influence of coping strategies on somatic symptoms in pregnant Spanish women: differences between women with and without a previous miscarriage. Appl Nurs Res 2012; 25:164-70. [DOI: 10.1016/j.apnr.2011.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 01/02/2011] [Accepted: 01/17/2011] [Indexed: 11/29/2022]
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43
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Sutan R, Miskam HM. Psychosocial impact of perinatal loss among Muslim women. BMC WOMENS HEALTH 2012; 12:15. [PMID: 22708998 PMCID: PMC3492027 DOI: 10.1186/1472-6874-12-15] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 06/05/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. METHODS A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. RESULTS Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. CONCLUSION Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.
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Affiliation(s)
- Rosnah Sutan
- Community Health Department, UKM Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
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44
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Kingston D, Heaman M, Fell D, Dzakpasu S, Chalmers B. Factors associated with perceived stress and stressful life events in pregnant women: findings from the Canadian Maternity Experiences Survey. Matern Child Health J 2012; 16:158-68. [PMID: 21165763 DOI: 10.1007/s10995-010-0732-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prenatal maternal stress has been linked to multiple adverse outcomes. Researchers have used a variety of methods to assess maternal stress. The purpose of this study was to explore and compare factors associated with stress in pregnancy as measured by perceived stress and stressful life events. We analyzed data from the Canadian Maternity Experiences Survey. A randomly selected sample of 8,542 women who had recently given birth was drawn from the 2006 Canadian Census. Women were eligible if they were at least 15 years of age, had delivered a live, singleton infant, and were living with their infant at the time of the interview (5-14 months postpartum). Prevalence estimates and odds ratios were calculated using sample weights of the survey and their variances were calculated using bootstrapping methods. Bivariate analyses identified statistically significant factors associated with each stress measure. Backward stepwise multivariate logistic regression models were constructed. A total of 6,421 women (78%) participated in the computer assisted telephone interview. Twelve percent of women experienced high levels of perceived stress and 17.1% reported having three or more stressful life events in the year prior to the birth of their baby. In the final model, psychosocial variables were associated with both outcomes, whereas demographic factors were associated only with life event stress. Different factors contributed to perceived stress and life event stress, suggesting that these concepts measure different aspects of stress. These findings can inform routine psychosocial risk assessment in pregnancy.
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Affiliation(s)
- Dawn Kingston
- Faculty of Nursing, University of Manitoba, Helen Glass Centre for Nursing, Winnipeg, MB R3T 2N2, Canada.
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45
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Abstract
This article reviews the different disease entities that fall under the classification of gestational trophoblastic disease (GTD). The conditions included range from molar pregnancy to the malignant forms of gestational trophoblastic neoplasm (GTN). These disorders all arise from abnormal placental trophoblastic development. The different types of GTD, symptomatology, and diagnostic modalities are examined. The various methods of treatment are reviewed. Although the management of GTD and GTN falls outside the scope of midwifery practice, midwives need to be aware of the incidence, risk factors, and symptoms for specific types of GTD in order to be able to diagnose and refer for treatment in a timely manner. Psychosocial aspects that affect the woman who has not only had a pregnancy loss but also may be faced with a life-threatening illness are examined. The role of the midwife in the management, counseling, and follow-up of GTD and GTN is discussed.
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Affiliation(s)
- Ruth Monchek
- University of Dentistry and Medicine of New Jersey, USA
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46
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Côté-Arsenault D, Denney-Koelsch E. “My Baby Is a Person”: Parents' Experiences with Life-Threatening Fetal Diagnosis. J Palliat Med 2011; 14:1302-8. [DOI: 10.1089/jpm.2011.0165] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cowchock FS, Ellestad SE, Meador KG, Koenig HG, Hooten EG, Swamy GK. Religiosity is an important part of coping with grief in pregnancy after a traumatic second trimester loss. JOURNAL OF RELIGION AND HEALTH 2011; 50:901-910. [PMID: 21861239 DOI: 10.1007/s10943-011-9528-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Women (n = 15) who were pregnant after a traumatic late pregnancy loss (termination because of fetal death or serious anomalies) completed psychometric screening tests and scales, including the Perinatal Grief Scale (PGS), the Impact of Event Scale (IES), the Duke Depression Inventory (DDI), the Generalized Anxiety Disorder-7 (GAD), and the Hoge Scale for Intrinsic Religiosity (IR). Despite a mean elapsed time since the prior loss of 27 (range, 7-47) months, half (7/15, 47%) of the combined groups had high levels of grief on the PGS. Multiple positive scores on psychometric tests were frequent: Sixty percent (9/15) had high scores on the PGS Active Grief subscale or on the IES. Forty percent (6/15) had a high score on the DDI, and 17% (3/15) on the GAD. IR scores significantly and negatively correlated with scores on the Despair subscale of the PGS. The results from this pilot study suggest that high levels of grief and PTS symptoms are significant problems for pregnant women who have suffered late loss of a wanted pregnancy. Religiosity may play an important part in maternal coping during these stressful pregnancies.
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Affiliation(s)
- F S Cowchock
- Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, NC 27710, USA.
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48
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‘High-risk’ pregnancy after perinatal loss: understanding the label. Midwifery 2011; 27:452-7. [DOI: 10.1016/j.midw.2010.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 02/22/2010] [Accepted: 02/27/2010] [Indexed: 11/23/2022]
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49
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Chuang LL, Lin LC, Cheng PJ, Chen CH, Wu SC, Chang CL. Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour. J Adv Nurs 2011; 68:170-80. [DOI: 10.1111/j.1365-2648.2011.05765.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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50
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Dunkel Schetter C. Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol 2011; 62:531-58. [PMID: 21126184 DOI: 10.1146/annurev.psych.031809.130727] [Citation(s) in RCA: 534] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psychological science on pregnancy is advancing rapidly. A major focus concerns stress processes in pregnancy and effects on preterm birth and low birth weight. The current evidence points to pregnancy anxiety as a key risk factor in the etiology of preterm birth, and chronic stress and depression in the etiology of low birth weight. Key mediating processes to which these effects are attributed, that is neuroendocrine, inflammatory, and behavioral mechanisms, are examined briefly and research on coping with stress in pregnancy is examined. Evidence regarding social support and birth weight is also reviewed with attention to research gaps regarding mechanisms, partner relationships, and cultural influences. The neurodevelopmental consequences of prenatal stress are highlighted, and resilience resources among pregnant women are conceptualized. Finally, a multilevel theoretical approach for the study of pregnancy anxiety and preterm birth is presented to stimulate future research.
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