Adolescents' description and management of pregnancy and preterm labor

A tale of two pregnancies: A Critical Interpretive Synthesis of women's perceptions about delayed initiation of antenatal care

BACKGROUND

Delayed access to antenatal care in high income countries is associated with poor maternal, fetal and neonatal outcomes. The aim was to synthesise the diverse body of evidence around women's views of early antenatal care and barriers to attendance in such countries. Critical Interpretive Synthesis integrates the process of systematic review with the qualitative methods of meta-ethnography and grounded theory, with a focus on theory generation to inform policy, practice and future research.

METHODS

Database searches were conducted, supplemented with reference and citation tracking and website searching between February 2014 and April 2016. Qualitative data analysis methods were used to extract and summarise the key themes from each study. A taxonomy of constructs was created, with the synthesis developed to thread these together. Fifty-four papers were synthesised, including qualitative, quantitative, mixed method and systematic review, published between 1987 and 2016.

FINDINGS

Seventeen constructs around the core concept of 'acceptance of personal and public pregnancies' were produced. Acceptance of the 'personal' pregnancy considers the contribution of mindset in the recognition and acceptance of pregnancy, influenced by knowledge of pregnancy symptoms, pregnancy planning and desire. Acceptance of the 'public' pregnancy considers women's assessment of the social consequences of pregnancy, and the relevance and priority of antenatal care.

CONCLUSION

Critical Interpretive Synthesis offers a systematic yet creative approach to the synthesis of diverse evidence. The findings offer new perspectives on women's perceptions of early pregnancy and attendance for care, which may be used to facilitate timely antenatal provision for all pregnant women.

Difference in Perception of Pregnancy Risk in Two Maternal Age Groups

INTRODUCTION

Various health risks and complications may happen during pregnancy for both the mother and her child. Women should be informed of the risk associated with their pregnancy.

AIM

To compare the differences of perception of pregnancy risk of two maternal age groups of healthy nulliparous women.

MATERIALS AND METHODS

In an analytical, descriptive cross-sectional study, 240 nulliparous pregnant women (160 women aged 18 to 35 years as a normal age group and 80 women < 18 years as a high risk age group) were randomly selected. Women were asked to complete questionnaire which included sociodemographic characteristics, pregnancy history, perception of pregnancy risk and pregnancy related anxiety.

RESULTS

Overall, women of < 18 years (high-risk group) perceived the risks of pregnancy higher than those of 18-35 years age women (reference group). Women in high-risk group rated their risks for herself, having haemorrhaging, having a cesarean birth and dying during pregnancy to be significantly higher than reference group. There was a statistically significant relationship between maternal age and perception of pregnancy risk (p<0.003). There was also a statistically significant relationship between pregnancy related anxiety and perception of pregnancy risk (p<0.002).

CONCLUSION

Women's perception of pregnancy risk is different in various maternal age groups. Maternal age can be considered as one of the important factors affecting perception of pregnancy risk. By routine screening of perception of pregnancy risk during prenatal care more effective risk consulting model could be designed.

'Weighing up and balancing out': a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries

BACKGROUND

In high-resource settings around 20% of maternal deaths are attributed to women who fail to receive adequate antenatal care. Epidemiological evidence suggests many of these women belong to marginalised groups often living in areas of relative deprivation. Reasons for inadequate antenatal attendance have yet to be fully evaluated.

OBJECTIVES

To identify the factors affecting access to antenatal care for marginalised pregnant women living in developed countries.

SEARCH STRATEGY

We included qualitative studies from developed countries published in English language journals (1980-2007).

SELECTION CRITERIA

Qualitative studies exploring the views of marginalised women living in developed countries who either failed to attend for any antenatal care or did so late or irregularly.

DATA COLLECTION AND ANALYSIS

Eight studies fulfilled the selection criteria and were synthesised in accord with the techniques derived from meta-ethnography.

MAIN RESULTS

Initial access is influenced by late pregnancy recognition and subsequent denial or acceptance. Continuing access appears to depend on a strategy of weighing up and balancing out of the perceived gains and losses. Personal resources in terms of time, money and social support are considered alongside service provision issues including the perceived quality of care, the trustworthiness and cultural sensitivity of staff and feelings of mutual respect.

CONCLUSIONS

A nonthreatening, nonjudgemental antenatal service run by culturally sensitive staff may increase access to antenatal care for marginalised women. Multiagency initiatives aimed at raising awareness of, and providing access to, antenatal care may also increase uptake.

Living With the Threat of Preterm Labor: Women’s Work of Keeping the Baby In

OBJECTIVE

To explore the social organization of women's preterm labor experiences.

DESIGN

Institutional ethnography investigated how the woman's experience is socially organized and for patterns of how something is organized to recur.

PARTICIPANTS/SETTING

Eight women who experienced preterm labor while living in one city in Western Canada volunteered to participate.

DATA ANALYSIS

Institutional ethnographic methodology guided the analysis of audiotaped transcribed interviews to understand the work these women do and the complexities of their everyday lives.

RESULTS

Women spoke about their fear of going home and feeling alone with the responsibility for their work of "keeping the baby in." Overall, preterm labor was experienced as a profound sense of personal responsibility for preventing preterm birth and was practiced as being "careful."

CONCLUSIONS

The assumption that the family is privately responsible for care work in the home results in the lack of assessment of resources for managing the medical plan on discharge and the lack of resources available or offered to assist families. The work of keeping the baby in conflicts with family care work responsibilities and can cause significant hardships for some women and families.

Qualitative research on adolescent pregnancy: a descriptive review and analysis

This study examined qualitative research on adolescent pregnancy to determine designs and methods used and to discover emergent themes across studies. Most of the 22 studies reviewed were described as qualitative or phenomenological by design and included samples comprising either African-American and Caucasian participants or African-Americans exclusively. Based on analysis of the collective primary findings of the sample articles, four themes were identified: (a) factors influencing pregnancy; (a) pregnancy resolution; (c) meaning of pregnancy and life transitions; and (d) parenting and motherhood. Overall, the studies revealed that most adolescent females perceive pregnancy as a rite of passage and a challenging yet positive life event. More qualitative studies are needed involving participants from various ethnic backgrounds, on males' perceptions relative to adolescent pregnancy and fatherhood, and about decision-making relevant to pregnancy resolution, intimacy, and peer relationships.

Pregnant Adolescents’ Perspectives of Pregnancy

PURPOSE

To gain a clearer understanding of teens' perspectives on pregnancy and parenting. DESIGN Descriptive qualitative study using grounded theory.

METHODS

The sample was comprised of 20 pregnant 15- to 19-year-old teens in the second or third trimester of pregnancy who planned to keep their child. A taped interview of each participant was performed either in the school the teen was attending or in the privacy of her home. Data were analyzed using the constant comparative method. Interviews were compared with each other to confirm/disconfirm emerging themes.

RESULTS

The comparison of the data from the 20 interviews resulted in themes clearly describing the teens' perceptions of the changes related to pregnancy, how they managed these changes, and their views on mothering. Three major themes emerged: "The pregnant me--unexpected changes," "Transformed relationships," and "Envisioning mothering."

CLINICAL IMPLICATIONS

Nurses caring for pregnant adolescents who have made the decision to keep their babies should carefully assess each individual's strengths, weaknesses, hopes, and goals prior to developing a plan of care. Identifying the teens' living situations and support from family, father of the baby, and/or friends and recognizing and building upon the strengths the teens bring to the pregnancy may influence the pregnancy's outcome. Encouraging attendance and participation in programs specifically designed for pregnant adolescents and adolescent parents may be a helpful strategy for these teens.

Nursing's Contribution to the Literature on Preterm Labor and Birth

Although preterm labor and birth continues to plague us as an unsolved mystery in maternal/child health, much has actually been learned over the past few decades. Most reviews of the preterm labor literature examine the research in an interdisciplinary manner; this article instead looks at the active role that nurses have taken in the research concerning preterm labor and birth. This article will categorize research conducted by nurses over the past 30 years on preterm labor and birth, emphasizing some of the changes in nursing practice engendered by nursing's important research effort.

An explanatory model of preterm labor

The purpose of this article is to describe women's explanatory model of their preterm labor (PTL) experiences. Fourteen young adult (20 to 23 years of age) women living in the southeast, who were hospitalized for the treatment of PTL, participated in this naturalistic study. Stress was the dominant theme that all participants used to explain what had precipitated PTL. All women described multiple stressors and chaos in their lives, which preceded their admission to the hospital for PTL. Meanings of PTL were intertwined with dysfunctional families and problematic relationships. All 9 women who delivered at term were able to find a friend or family member to provide support that allowed the women to relax and reduce the stress in their lives. In contrast, women who delivered preterm had no one in their lives that could provide help and support. Women's conceptualizations of PTL suggest that culturally appropriate interventions to reduce stress and mobilize support may help improve birth outcomes after an episode of PTL.

Stress, pre-term labour and birth outcomes

Stress, pre-term labour and birth outcomes Preliminary studies have suggested that stress may be associated with the onset, treatment and outcomes of pre-term labour; however, a systematic comparison of the stress of women with and without pre-term labour has not been reported. Therefore, the purpose of this exploratory study was to compare the stress (daily hassles and mood states) and birth outcomes of black and white women who experienced pre-term labour (PTL) during pregnancy with those who did not. The convenience sample consisted of 35 pregnant women hospitalized in 1996-1997 for the treatment of PTL (24-35 weeks gestation) and 35 controls matched on age, race, parity, gestational age and method of hospital payment. Women in the PTL group had significantly higher tension-anxiety and depression-dejection on the Profile of Mood States (POMS), lower mean birthweight and mean gestational age, and a higher percentage of babies born <37 weeks and weighing 2500 g or less. Black women in the PTL group and white women in the control group had significantly higher scores on the fatigue sub-scale of the POMS and the work and future security sub-scales of the Daily Hassles Scale. Women in the PTL group whose babies weighed 2500 g or less had significantly higher scores on the health, inner concern and financial responsibility sub-scales of the Daily Hassles Scale. The findings from this study indicate the need for further exploration of the interaction of race and stress in understanding and preventing PTL and low birthweight and the need to examine the role of social support in preventing pre-term birth after an episode of PTL.

The preterm labor experience: a balancing act

The purpose of the study was to identify how women described, interpreted, and managed their preterm labor experience. Ten married, middle-class women participated in an in-depth, tape-recorded interview in the hospital after preterm labor was stabilized; periodically over the telephone after discharge from the hospital; and in the hospital, home, or via telephone after birth, for a total of 31 interviews. Using qualitative data analysis techniques, the findings were conceptualized as five recursive stages: becoming aware that something was wrong and feeling unbalanced, making sense of the experience as they sought to understand why preterm labor occurred, trying different strategies to re-create a balance in their lives, addressing other life stressors that threatened restoring balance, and emerging from the preterm labor experience with added growth. An increased understanding of the preterm labor experience from the women's perspective can be helpful to health care professionals and others who support women during pregnancy.