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Wynter K, Mansour KA, Forbes F, Macdonald JA. Barriers and opportunities for health service access among fathers: A review of empirical evidence. Health Promot J Austr 2024. [PMID: 38494641 DOI: 10.1002/hpja.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
ISSUE ADDRESSED Engagement with health supports benefits the whole family, yet few health services report successful engagement of fathers. Our aim was to describe available evidence on barriers and opportunities relevant to health system access for fathers. METHODS Scoping reviews were conducted seeking empirical evidence from (1) Australian studies and (2) international literature reviews. RESULTS A total of 52 Australian studies and 44 international reviews were included. The most commonly reported barriers were at the health service level, related to an exclusionary health service focus on mothers. These included both 'surface' factors (e.g., appointment times limited to traditional employment hours) and 'deep' factors, in which health service policies perpetuate traditional gender norms of mothers as 'caregivers' and fathers as 'supporters' or 'providers'. Such barriers were reported consistently, including but not limited to fathers from First Nations or culturally diverse backgrounds, those at risk of poor mental health, experiencing perinatal loss or other adverse pregnancy and birth events, and caring for children with illness, neurodevelopmental or behavioural problems. Opportunities for father engagement include offering father-specific resources and support, facilitating health professionals' confidence and training in working with fathers, and 'gateway consultations', including engaging fathers via appointments for mothers or infants. Ideally, top-down policies should support fathers as infant caregivers in a family-based approach. CONCLUSIONS Although barriers and opportunities exist at individual and cultural levels, health services hold the key to improved engagement of fathers. SO WHAT?: Evidence-based, innovative strategies, informed by fathers' needs and healthy masculinities, are needed to engage fathers in health services.
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Affiliation(s)
- Karen Wynter
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Kayla A Mansour
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Faye Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Alexopoulos J, Tmej A, Naderer A, Grussmann M, Tordy K, Stammler-Safar M, Feichtinger K, Gipperich A, Leithner K. Men don't cry: The supporting role as necessary for women's well-being after termination of pregnancy. Int J Gynaecol Obstet 2024; 164:1205-1211. [PMID: 37922219 DOI: 10.1002/ijgo.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The present study investigated similarities and differences of grief between men and women as part of the parental couple 1 year after termination of pregnancy (TOP) following a diagnosis of fetal anomaly. METHODS We applied a method triangulation approach. We assessed several aspects of perinatal grief, depressive symptoms, posttraumatic stress, and anxiety as well as health-related quality of life. In addition, we conducted qualitative interviews with the men to explore the fathers' roles in the partnership during pregnancy, the time of the diagnosis, TOP, and afterwards. RESULTS Women showed a more elevated grief response compared with men. Qualitative data revealed that men in our sample were mainly concerned with their partners' well-being and concentrated on supporting their partners rather than on their own emotions. In addition, the supportive role of the male partner plays a central role in the well-being of women and the man's coping with the situation. CONCLUSION In clinical work, but also when developing new questionnaires, the specific role of the male partners needs to be considered more thoroughly. Particular attention should be paid to identify the men who find it difficult to assume the supporting role.
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Affiliation(s)
- Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Tmej
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Grussmann
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Tordy
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Maria Stammler-Safar
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Gipperich
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Brintow MB, Prinds C, O'Connor M, Möller S, Henriksen TB, Mørk S, Hvidtjørn D. Continuing bonds in parents after a loss in pregnancy, or a death at or shortly after birth: A population-based study. DEATH STUDIES 2023:1-13. [PMID: 38145415 DOI: 10.1080/07481187.2023.2297059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
In this study, we describe continuing bonds and grief reactions and assess their association in 980 parents bereaved in pregnancy, at or shortly after birth. We found that most parents experienced continuing bonds. However, they differed by type of loss. Parents losing their child due to termination of pregnancy or miscarriage experienced bonds less frequently and had the least intense grief reaction. Parents losing their child postpartum experienced bonds most frequently and had the most intense grief reaction. Continuing bonds were associated with intensified grief in parents losing their child after termination or miscarriage, while this relationship was less obvious after stillbirth or postpartum death.
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Affiliation(s)
| | - Christina Prinds
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Tine Brink Henriksen
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sofie Mørk
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Hvidtjørn
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Cifuentes Ochoa M, Flowers NJ, Pertile MD, Archibald AD. "It becomes your whole life"-Exploring experiences of reciprocal translocation carriers and their partners. J Genet Couns 2023; 32:1057-1068. [PMID: 37186486 DOI: 10.1002/jgc4.1716] [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: 06/24/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
Reciprocal translocation carriers are often diagnosed when they are experiencing difficulties conceiving or after a pregnancy affected by an unbalanced set of chromosomes inherited from the balanced carrier parent. Having a reciprocal translocation is not uncommon; carriers can benefit from reproductive options to achieve a healthy, chromosomally balanced, pregnancy. The aim of this study was to explore the lived experience of carriers and their partners. We conducted 13 semi-structured telephone interviews. Participants were recruited through Victorian Clinical Genetics Services and interviews took place between May and September 2020. Interview transcripts were analyzed using thematic analysis. Reciprocal translocation carriers and their partners described long term emotional and reproductive impacts, with carrier status identified at the time of prenatal diagnosis having marked emotional consequences. Couples facing reproductive challenges found the diagnosis created uncertainty for their future. When considering a pregnancy, couples worried about experiencing a miscarriage; during pregnancy, there was a reluctance to have an invasive diagnostic procedure due to fearing the risk of losing an unaffected pregnancy. Adaptation to their new reality involved having access to accurate information, peer support and maintaining hope. Couples valued having the option to know the carrier status of their children. The complex impacts of carrying a reciprocal translocation highlight the importance of access to specialist genetic counseling services to ensure couples are supported in understanding the implications of their translocation.
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Affiliation(s)
- Marta Cifuentes Ochoa
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Nicola Jane Flowers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Mark Domenic Pertile
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Alison Dalton Archibald
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
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Sun S, Sun Y, Qian J, Tian Y, Wang F, Yu Q, Yu X. Parents' experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China. BMJ Open 2023; 13:e070288. [PMID: 37734885 PMCID: PMC10514653 DOI: 10.1136/bmjopen-2022-070288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the experiences and need for social support of Chinese parents after termination of pregnancy for fetal anomalies. DESIGN A qualitative study using semistructured, in-depth interviews combined with observations. Data were analysed by Claizzi's phenomenological procedure. SETTING A large, tertiary obstetrics and gynaecology hospital in China. PARTICIPANTS Using purposive sampling approach, we interviewed 12 couples and three additional women (whose spouses were not present). RESULTS Four themes were identified from the experiences of parents: the shock of facing reality, concerns surrounding termination of pregnancy, the embarrassment of the two-child policy and the urgent need for social support. CONCLUSION Parents experienced complicated and intense emotional reactions, had concerns surrounding the termination of pregnancy and an urgent need for social support. Paternal psychological reactions were often neglected by healthcare providers and the fathers, themselves. These findings suggest that both mothers and fathers should receive appropriate support from family, medical staff and peers to promote their physical and psychological rehabilitation.
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Affiliation(s)
- Shiwen Sun
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Yaping Sun
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jialu Qian
- Zhejiang University School of Medicine, Hangzhou, China
| | - Yanping Tian
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Fang Wang
- Nursing Department, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Qing Yu
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
| | - Xiaoyan Yu
- Department of Obstetrics, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, China
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Slade L, Obst K, Deussen A, Dodd J. The tools used to assess psychological symptoms in women and their partners after termination of pregnancy for fetal anomaly: A scoping review. Eur J Obstet Gynecol Reprod Biol 2023; 288:44-48. [PMID: 37423121 DOI: 10.1016/j.ejogrb.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
Termination of pregnancy for fetal anomaly (TOPFA) represents a uniquely distressing and challenging situation for women and their partners. Having appropriate screening tools that best highlight the psychological symptoms experienced by women and their partners is important to be able to guide care. Many validated screening tools for pregnancy and psychological distress exist, with variation in the ease of application and the domains addressed in each. We undertook a scoping review of tools used to assess psychological symptoms in women and/or partners after TOPFA. Of 909 studies, 93 studies including 6248 women and 885 partners were included. Most of the included studies assessed symptoms within six months of TOPFA and highlighted high rates of distress, grief and trauma symptoms. There was broad variation in the tools used between studies and the timing of their implementation. Focusing the care of women and families who undergo TOPFA to validated, broadly available and easily applied screening tools that assess a range of psychological symptoms is key in being able to identify the potential interventions that may be of benefit.
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Affiliation(s)
- Laura Slade
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia.
| | - Kate Obst
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea Deussen
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie Dodd
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
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Fletcher R, Symonds I, StGeorge J, Warland J, Stark M. Testing the acceptability of stillbirth awareness messages in an SMS program for fathers. Health Promot J Austr 2023; 34:149-155. [PMID: 36450663 PMCID: PMC10107767 DOI: 10.1002/hpja.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/04/2022] [Accepted: 11/20/2022] [Indexed: 12/04/2022] Open
Abstract
ISSUE ADDRESSED To raise expectant fathers' awareness of risk factors for stillbirth. METHODS A set of brief text messages was developed addressing recognised risk factors for stillbirth: avoidance of maternal cigarette smoking, maternal going to sleep on side messaging, awareness of the importance of noticing and reporting changes in foetal movement and fathers' involvement in shared decision making for timing of birth. Eight messages were inserted into the SMS4dads pilot program being conducted by NSW Health. Feedback on the messages was requested. Participants rated the quality of the messages on a three-point Likert scale and provided comments. RESULTS Overall, 2528 messages were sent to 626 fathers' mobile phones, 45% of fathers replied with 666 ratings and 115 comments evaluating the texts. The quantitative ratings indicated substantial overall approval of the messages. Within the coding category "Evaluation of Message Content," three themes described fathers' reactions and feelings about the smoking, movement, side sleeping and birth timing messages: "important-good information," "not appropriate/anxiety provoking" and "not relevant-obvious." Three themes reflecting the attributes of the messages within the "Service Quality" category were "need more information," "complements public health" and "child voice fit." CONCLUSIONS Results indicate that the messages are an acceptable way to provide information and suggested actions addressing stillbirth risk factors to fathers-to-be. SO WHAT?: Fathers' awareness of the risk factors for stillbirth can assist mothers to take appropriate actions for a healthy birth. Information on risk factors can be provided to fathers via a father-focused text messaging service.
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Affiliation(s)
- Richard Fletcher
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Ian Symonds
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jennifer StGeorge
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Jane Warland
- School of Nursing, Curtin University, Perth, WA, Australia
| | - Michael Stark
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Heaney S, Tomlinson M, Aventin Á. Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents. BMC Pregnancy Childbirth 2022; 22:441. [PMID: 35619067 PMCID: PMC9137204 DOI: 10.1186/s12884-022-04770-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/16/2022] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly. REVIEW QUESTION What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly? METHODS A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis. RESULTS A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience. CONCLUSION Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service. TRIAL REGISTRATION PROSPERO registration number: CRD42020175970 .
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland.
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland
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