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Tang BWJ, Ibrahim BB, Shorey S. Complex journeys of adolescents after induced abortion: A qualitative systematic review. J Pediatr Nurs 2024; 77:e67-e80. [PMID: 38553284 DOI: 10.1016/j.pedn.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 07/07/2024]
Abstract
PROBLEM Adolescents face unique challenges in accessing sexual healthcare, particularly regarding induced abortion experiences. Prior research, often quantitative or biased towards young adults, overlooks this. This review aims to address adolescents' specific post-abortion experiences to inform comprehensive reproductive healthcare needs. ELIGIBILITY CRITERIA Qualitative and mixed-methods studies exploring the experiences of adolescents following induced abortion were included. Studies reporting these experiences from third-person perspectives were excluded. SAMPLE Five electronic databases (CINAHL, PubMed, PsycINFO, Web of Science, and Embase) were searched from the databases' inception through March 2024. Of the 2834 articles retrieved, 45 studies were included in this review. RESULTS Using a meta-synthesis approach combining Sandelowski & Barroso's qualitative metasummary with Braun & Clarke's thematic analysis, three main themes emerged: Post-abortion experiences and emotions, Social dynamics and support, and Life post-abortion and future perspectives. CONCLUSIONS Adolescents who underwent abortion faced physical and emotional challenges, adopted various coping strategies, and had mixed experiences with social support and healthcare providers. To address these challenges, the provision of comprehensive reproductive health information, access to safe and legal abortion options, and support for their physical, social, and emotional well-being is necessary. Healthcare providers must ensure that adolescents are equipped with necessary skills to navigate their reproductive health journeys with informed choices and confidence. IMPLICATIONS Future research exploring adolescents' experiences, considering cultural beliefs, involving multiple stakeholders, and conducting longitudinal studies, is warranted. Healthcare providers should implement practice changes, including providing accurate information, offering tailored mental health support, and undergoing adolescent-friendly training, to enhance care for adolescents.
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Affiliation(s)
- Byoray Wen Jia Tang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Yeşildere Sağlam H, Gürsoy E. Termination of pregnancy due to fetal anomaly: A qualitative study from Turkey on women's experiences. Midwifery 2024; 132:103957. [PMID: 38428136 DOI: 10.1016/j.midw.2024.103957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Termination of pregnancy due to fetal anomaly is an unexpected traumatic event for women. It can cause serious complications that can negatively affect both the physical and psychological health of women. AIM This study aims to examine the experiences of women who underwent medical termination for fetal anomaly in the second trimester. METHODS The study included 12 women whose pregnancies were terminated due to fetal anomaly. Data were collected through in-depth interviews until data sufficiency was reached. Thematic analysis method was used to analyze the data. This study was conducted using an inductive qualitative design. The women's statements were examined and double-coded. By examining the codes, main themes were created after sub-themes. RESULTS Women's experiences were analyzed in five themes: difficulty in decision-making (1), emotional impact (2), stigmatization (3), dilemma between hope and anxiety (4), and post-termination care and support needs (5). Participants stated that they experienced many emotions such as indecision, sadness, helplessness, guilt, and remorse during the medical termination process. Hope, anxiety, fear, social pressure and support needs were also frequently experienced in this process. CONCLUSION Termination of pregnancy in the second trimester due to fetal anomaly caused significant psychological symptoms. In order to prevent long-term health complications, it will be important for health professionals to provide interventions designed to meet the demands of women diagnosed with fetal anomaly.
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Affiliation(s)
- Havva Yeşildere Sağlam
- Faculty of Health Sciences, Department of Nursing, Kütahya Health Sciences University, Kütahya, Turkey.
| | - Elif Gürsoy
- Faculty of Health Sciences, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
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Shorey S, Lalor J, Pereira TLB, Jarašiūnaitė-Fedosejeva G, Downe S. Decision-making and future pregnancies after a positive fetal anomaly screen: A scoping review. J Clin Nurs 2023; 32:5534-5549. [PMID: 36707923 DOI: 10.1111/jocn.16628] [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: 07/13/2022] [Revised: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES To examine and consolidate literature on the experiences and decision-making of parents following a screen positive result for a potential fetal anomaly and/or diagnosis of an actual anomaly in a previous pregnancy. BACKGROUND Prenatal screening consists of any diagnostic modality that is aimed at acquiring information about a fetus or an embryo; however, the entire process is highly stressful for parents, especially if there was a previous screen positive result, but no abnormality was detected in the final result. METHODS Eight electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Theses and Dissertations and ClinicalTrials.gov) were searched from each database's inception until February 2022. This scoping review was guided by Arksey and O'Malley's framework and was reported in accordance with the PRISMA-ScR checklist. Braun and Clarke's thematic analysis framework was utilised. RESULTS Thirty-one studies were eligible for inclusion. Two main themes (reliving the fear while maintaining hope, and bridging the past and future pregnancies) and six subthemes were identified. CONCLUSIONS A fetal anomaly diagnosis in pregnancy had a mixed impact on the attitudes of parents toward a future pregnancy. Some parents were fearful of reliving a traumatic experience, while others were determined to have a healthy child and grow their family. Parents generally expressed a greater preference for non-invasive over invasive prenatal testing due to the procedural risks involved. RELEVANCE TO CLINICAL PRACTICE There is a need for healthcare professionals to provide psychosocial and emotional support to parents so that they can achieve resolution for their previous pregnancy. Healthcare professionals' ability to provide informational support also enables these parents to make informed decision and understand their reproductive outcomes. Additionally, healthcare administration and policymakers should reconsider current neonatal or pregnancy loss bereavement guidelines to improve the inclusivity of fathers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Travis Lanz-Brian Pereira
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Soo Downe
- THRIVE Centre, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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Zhou M, Li X, Huang C, Xie J, Liu L, Wang Y, Xiao G, Zhang T, Qin C. Needs for supporting women undergoing termination of pregnancy for fetal anomaly: A phenomenological study based on the cognitive-emotional-behavioral framework. Midwifery 2023; 123:103726. [PMID: 37192569 DOI: 10.1016/j.midw.2023.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To determine and describe the needs of women undergoing termination of pregnancy for fetal anomaly (TOPFA) in China. STUDY DESIGN Qualitative study with semi-structured interviews. Consolidated Criteria for Reporting Qualitative Studies checklist was used for reporting. SETTING Three general hospitals and one special hospital in Changsha, Hunan, China. PARTICIPANTS 12 women who had undergone TOPFA and 12 healthcare providers who had experienced in caring for these women. METHODS This study was based on the cognitive-emotional-behavioral framework (CEBF) of women who had to undergo TOPFA. Twenty-four participants (12 women and 12 healthcare providers) were recruited from two hospitals in China. Semi-structured face-to-face interviews were conducted based on interview guides. ATLAS.ti software was used to encode and analyze data. Qualitative content analysis was also applied. FINDINGS Four themes emerged: information, emotional, professional psychological, and social supports. Each theme was subdivided into four phases for a detailed description of the temporal order (denial, confirmation, decision-making, and recovery phases) within the framework. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our study analyzes the four needs of women who underwent TOPFA and the specifics of each need at different phases based on the CEBF. The importance of offering professional psychological support, detailed information, timely emotional support, and comprehensive social support for these women is illustrated. This study contributes to the understanding of women's needs, hence providing a theoretical basis for the construction of supportive programs.
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Affiliation(s)
- Mengjia Zhou
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Xi Li
- School of Medicine, Jishou University, Jishou, China
| | - Chi Huang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Jiaying Xie
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Li Liu
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Ying Wang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Gui Xiao
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Tingting Zhang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
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Zhang T, Chen WT, He Q, Li Y, Peng H, Xie J, Hu H, Qin C. Coping strategies following the diagnosis of a fetal anomaly: A scoping review. Front Public Health 2023; 11:1055562. [PMID: 37089477 PMCID: PMC10118031 DOI: 10.3389/fpubh.2023.1055562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/07/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Many women experience severe emotional distress (such as grief, depression, and anxiety) following a diagnosis of fetal anomaly. The ability to cope with stressful events and regulate emotions across diverse situations may play a primary role in psychological wellbeing. This study aims to present coping strategies after disclosing a fetal anomaly to pregnant women. Methods This is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR). Electronic databases, including Web of Science (WOS, BCI, KJD, MEDLINE, RSCI, SCIELO), CINAHL, and EBSCO PsycARTICLES, were used to search for primary studies from the inception of each database to 2021. The keywords were determined by existing literature and included: "fetal anomaly," "fetal abnormality," "fetal anomaly," "fetal abnormality" AND "cope," "coping," "deal," "manage," "adapt*," "emotion* regulate*," with the use of Boolean operators AND/OR. A total of 16 articles were reviewed, followed by advancing scoping review methodology of Arksey and O'Malley's framework. Results In this review, we identified 52 coping strategies using five questionnaires in seven quantitative studies and one mixed-method study. The relationship between coping strategies and mental distress was explored. However, the results were inconsistent and incomparable. We synthesized four coping categories from qualitative studies and presented them in an intersection. Conclusion This scoping review identified the coping strategies of women with a diagnosis of a fetal anomaly during pregnancy. The relationship between coping strategies and mental distress was uncertain and needs more exploration. We considered an appropriate measurement should be necessary for the research of coping in women diagnosed with fetal anomaly pregnancy.
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Affiliation(s)
- Tingting Zhang
- Department of Health Management, The Third Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wei-Ti Chen
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Qingnan He
- Pediatric Department of the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Li
- Pediatric Department of the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huiting Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaying Xie
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hengfen Hu
- Hunan Polytechnic of Environment and Biology, Hengyang, Hunan, China
| | - Chunxiang Qin
- Department of Health Management, The Third Xiangya Hospital and Xiangya School of Nursing, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Li X, Peng H, Zeng L, Owusua T, Wang Y, Wang Y, Qin C. Stigma and its influencing factors among women with termination of pregnancy for fetal anomaly: A cross-sectional study. Midwifery 2023; 116:103553. [PMID: 36410260 DOI: 10.1016/j.midw.2022.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the level of stigma and identify its influencing factors among women with termination of pregnancy for fetal anomaly(TOPFA) in China. DESIGN This was a cross-sectional study design. SETTING AND PARTICIPANTS A total of 469 women with TOPFA were recruited from a tertiary care hospital in China using a convenience sampling method. MEASUREMENT AND FINDINGS Women with TOPFA participating in the study completed the Demographic Characteristics Questionnaire, Individual Level Abortion Stigma Scale(ILASS), Acceptance and Action Questionnaire- II scale(AQQ- II), Cognitive Fusion Questionnaire scale (CFQ), Multidimensional Perceived Social Support Scale(MPSS), Responses to Stress Questionnaire (RSQ). Women with TOPFA reported moderate levels of stigma(1.49±0.60). Multiple linear regression showed that correlates influencing their stigma included gestational age (β =0.103, P < 0.05), psychological flexibility (β =-0.319, P < 0.01), social support(β =-0.190, P < 0.01), and disengagement coping(β =0.148, P < 0.05). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Gestational age and disengagement coping are positive predictors of stigma, but psychological flexibility and social support are negative predictors of stigma. Further attention should focus on developing targeted intervention strategies to improve protective and reduce harmful factors to confront the stigma-related challenges faced by women with TOPFA.
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Affiliation(s)
- Xi Li
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; Jishou University School of Medical, Jishou, China.
| | - Huiting Peng
- Xiangya School of Nursing, Central South University, Changsha, China; Department of Gynaecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Lihong Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Ying Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yaohan Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
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Heinsen LL. Shouldering Death: Moral Tensions, Ambiguity, and the Unintended Ramifications of State-sanctioned Second-trimester Selective Abortion in Denmark. Med Anthropol Q 2022; 36:515-533. [PMID: 35819201 PMCID: PMC10084180 DOI: 10.1111/maq.12717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article is based on an ethnographic study of pregnant couples' embodied, emotional, and moral experiences of second-trimester selective abortion in Denmark. Drawing on 16 selective abortion stories, I unpack the intense, often highly accelerated, days that follow from the moment a fetal aberration is detected to the moment of fetal disposal or burial. I show that although prenatal screening and diagnostics have come to occupy a routinized part of pregnancy in Denmark, when women and their partners opt for termination, they are faced with a series of bodily events and actions they are entirely unprepared for while at the same time feeling essentially alone in grappling with the moral confusion that ensues. I argue that despite widespread medico-legal sanctioning and social endorsement of selective abortion, the specificities of how such terminations are done in Denmark in ambiguous, and conflicted, ways situate women and their partners in a series of moral tensions around how to relate to the abortion, the dead fetus, their grief, and their entitlement to such mourning. By chronicling the core struggles that the process of termination catalyzes, I point to the social and moral ramifications of the embodied practices and medico-legal choreographing of selective abortion in Denmark. [selective abortion, moral tensions, embodied practices, responsibility, death].
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8
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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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Berry SN, Severtsen B, Davis A, Nelson L, Hutti MH, Oneal G. The impact of anencephaly on parents: A mixed-methods study. DEATH STUDIES 2021; 46:2198-2207. [PMID: 33866956 DOI: 10.1080/07481187.2021.1909669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study used a convergent parallel mixed-method design to explore the impact of an anencephalic pregnancy on parents. Twenty women and four men between 18-59 years old participated. Interview transcripts were analyzed using interpretive phenomenology and synthesized with Perinatal Grief Intensity Scale scores using a Pearson's correlation. Overall, 75% of parents scored intense grief. Qualitative patterns included overwhelming trauma, patient-centeredness as critical, stigmatizing perinatal loss, embracing personhood, and reframing reality. Control over care was associated with decreased grief (p =.019). Health care professionals are ideally positioned to reduce the risk of intense grief in parents experiencing an anencephalic pregnancy.
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Affiliation(s)
- Shandeigh N Berry
- College of Arts & Sciences, Saint Martin's University, Olympia, Washington, USA
| | - Billie Severtsen
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Andra Davis
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Lonnie Nelson
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Marianne H Hutti
- College of Nursing, University of Kentucky, Louisville, Kentucky, USA
| | - Gail Oneal
- College of Nursing, Washington State University, Spokane, Washington, USA
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Armour S, Gilkison A, Hunter M. Midwives holding the space for women undergoing termination of pregnancy: A qualitative inquiry. Women Birth 2020; 34:e616-e623. [PMID: 33358489 DOI: 10.1016/j.wombi.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM Hospital midwives are the main care givers for women undergoing termination of pregnancy after 20 weeks. Midwives' role and potential impact of regular involvement in termination of pregnancy (TOP) are poorly understood. SETTING New Zealand. BACKGROUND TOP after 20 weeks may be performed to save a woman's life or preserve her physical and mental health. Throughout the process midwives play a key role in supporting women's complex psychological and clinical needs. OBJECTIVE To gain a deeper understanding of the role of midwives in TOP care after 20 weeks, including the support they might need and the impacts caring for women who are having a TOP may have on them. METHODS Eight midwives from two District Health Boards were interviewed about their experiences of caring for women having a TOP after 20 weeks. Transcripts were analysed by applying a hermeneutic-phenomenological lens. FINDINGS Three themes emerged: "A different kind of midwife", "Staying true to oneself" and "Melting an Iceberg". TOP care is a different role within midwifery as midwives facilitate death in the space of birth. Immersing themselves in women's emotional space they create meaningful connections to support their complex needs and provide a positive birth experience. Yet, midwives are unprepared for the emotional effects of repeatedly caring for women undergoing TOP. Lacking appropriate support they can experience increasing, lasting grief. CONCLUSION Midwives' experiences of providing TOP care are complex, intense and have lifelong impact. Their role in the context of TOP is highly specialised and must be valued and supported.
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Affiliation(s)
- Susanne Armour
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Andrea Gilkison
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Marion Hunter
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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11
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Li Y, Tang S, Lu J, Huang C, Peng H, Xie J, Borjigen A, Liu M, Qin C. Prevalence and Factors Associated With Depressive Symptomatology Among Women Before Termination of Pregnancy for Fetal Anomaly. J Psychosoc Nurs Ment Health Serv 2020; 58:43-50. [PMID: 32976606 DOI: 10.3928/02793695-20200921-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to investigate the prevalence of depressive symptomatology before termination of pregnancy due to fetal anomaly and to analyze associated risk factors. A cross-sectional study was performed in the obstetric departments of six hospitals in Hunan, China. Depressive symptomatology was measured before termination of pregnancy using the Edinburgh Postpartum Depression Scale. t test, analysis of variance, and binary logistic regression tests were used in the data analysis of depressive symptomatology and factors. A total of 65.6% (n = 177) of participants were identified with depressive symptomatology before termination. Risk factors were receipt of spousal support, self-efficacy, religious belief, history of adverse pregnancy outcomes, and sleep disturbance. Protective factors were engagement with health care providers, social support, and higher monthly family income. Nurses should be aware of these factors early on to prevent the occurrence of depressive symptomatology, thereby improving maternal mental health. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 43-50.].
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12
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Hammond J, Klapwijk JE, Hill M, Lou S, Ormond KE, Diderich KEM, Riedijk S, Lewis C. Parental experiences of uncertainty following an abnormal fetal anomaly scan: Insights using Han's taxonomy of uncertainty. J Genet Couns 2020; 30:198-210. [PMID: 32638447 PMCID: PMC8432163 DOI: 10.1002/jgc4.1311] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
For a number of prospective parents, uncertainty during pregnancy starts when an anomaly is found during a routine fetal anomaly scan. This may be followed by numerous tests to determine the etiology and nature of the anomaly. In this study, we aimed to understand how prospective parents perceive and manage uncertainty after being confronted with a structural anomaly during their routine ultrasound. Han's taxonomy of uncertainty was used as a framework to identify and understand the different types of uncertainty experienced. Interviews were held in the UK (n = 8 women and n = 1 male partner) and in the Netherlands (n = 7 women) with participants who had experienced uncertainty in their pregnancy after a fetal scan. Data were analyzed using thematic analysis, and the uncertainties experienced by parents were mapped against the dimensions of the Han taxonomy (sources, issues, and locus). Participants' experience of uncertainty was relevant to all dimensions and subcategories of the Han taxonomy, showing its applicability in the prenatal setting. Sources of uncertainty included receiving probabilistic or ambiguous information about the anomaly, or information that was complex and challenging to understand. Issues of uncertainty included were those that were scientific—such as a probable diagnosis with no further information, personal—such as the emotional impact of uncertainty, and practical—such as limited information about medical procedures and practical aspects of care. Additionally, participants described what helped them to manage uncertainty. This included active coping strategies such as searching for information on the Internet, external coping resources such as seeking social support, and internal coping resources such as using positivity and hope. Several recommendations for the healthcare professional to minimize uncertainty and help the patient deal with uncertainty have been proposed based on these findings.
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Affiliation(s)
- Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly E Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sam Riedijk
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Lou S, Lanther MR, Hagenstjerne N, Bjørn Petersen O, Vogel I. "This is the child we were given": A qualitative study of Danish parents' experiences of a prenatal Down syndrome diagnosis and their decision to continue the pregnancy. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 23:100480. [PMID: 31733609 DOI: 10.1016/j.srhc.2019.100480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Termination rates when Down syndrome (DS) is diagnosed prenatally are high in most countries. Thus, the present study aimed to explore how parents of prenatally diagnosed children with DS experienced the diagnostic process and their decision to continue the pregnancy. METHODS Data from a semi-structured, qualitative interview study with eight mothers and five fathers of prenatally diagnosed children with DS born between 2008 and 2017 were analyzed using thematic analysis. FINDINGS Several couples emphasized how they had not hoped for a child with DS, but following the diagnosis they strongly felt that this was the child that they "were given." The couples stressed that DS was not the worst that could happen. All couples sought experiential knowledge outside the hospital setting to explore the potential for living a fulfilling life with DS. Five couples had positive recollections of the delivery of the DS result. Three couples had negative recollections, mainly because the intention to terminate had been taken for granted. After the decision to continue pregnancy was made, their interaction with health-care professionals was generally experienced as positive and supporting. However, some couples still felt vulnerable because they were aware that their decision was uncommon. CONCLUSIONS Health-care professionals must be careful to speak in unprejudiced ways throughout the diagnostic process and present both termination and continuation of pregnancy as equally legitimate options. Nevertheless, the couples may still experience doubt and feel vulnerable following their decision to continue the pregnancy.
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Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark; Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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14
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Fernández‐Basanta S, Coronado C, Movilla‐Fernández M. Multicultural coping experiences of parents following perinatal loss: A meta‐ethnographic synthesis. J Adv Nurs 2019; 76:9-21. [DOI: 10.1111/jan.14211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Sara Fernández‐Basanta
- Research group GRINCAR Department of Health Sciences Faculty of Nursing and Podiatry University of A Coruña Ferrol Spain
| | - Carmen Coronado
- Research group GRINCAR Department of Health Sciences Faculty of Nursing and Podiatry University of A Coruña Ferrol Spain
| | - María‐Jesús Movilla‐Fernández
- Research group GRINCAR Department of Health Sciences Faculty of Nursing and Podiatry University of A Coruña Ferrol Spain
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15
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Georgsson S, van der Spoel L, Ferm J, Carlsson T. Quality of web pages about second-trimester medical abortion: A cross-sectional study of readability, comprehensiveness, and transparency. J Adv Nurs 2019; 75:2683-2691. [PMID: 31206760 DOI: 10.1111/jan.14080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the readability, comprehensiveness and transparency of web pages about medical abortion in the second trimester of pregnancy. DESIGN A cross-sectional descriptive study of Swedish web pages. METHODS Six systematic searches were performed in Google during January 2017. The first 10 hits of each search were screened, resulting in 46 included Swedish web pages. The web pages were analyzed with readability index (LIX) to investigate readability, inductive manifest content analysis to investigate comprehensiveness, and Journal of the Medical Association benchmarks to investigate transparency. RESULTS Median LIX was 29.0 and the largest proportion had LIX 31-40 (N = 17), indicating moderate readability. Visual components were observed in 13 websites. Content analysis resulted in 12 categories illustrating comprehensiveness, but eight of these were only included in ≤50% web pages. With regard to transparency, 29 (63%) adhered to no benchmark, 15 (33%) adhered to one benchmark, and 2 (4%) adhered to two benchmarks. Most web pages were written or reviewed by laypersons (N = 25) and health professionals (N = 11). CONCLUSION The results indicate that web pages about medical abortion have moderate readability, varied comprehensiveness and poor transparency. IMPACT Health professionals need to acknowledge the risk of contact with web-based information about poor quality. There is a need for research that aims to increase the chances that patients encounter high-quality web-based information about medical abortion in the second trimester of pregnancy.
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Affiliation(s)
- Susanne Georgsson
- The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Linde van der Spoel
- Department of Women's and Children's Health, Uppsala university, Uppsala, Sweden
| | - Johanna Ferm
- Department of Women's and Children's Health, Uppsala university, Uppsala, Sweden
| | - Tommy Carlsson
- Department of Women's and Children's Health, Uppsala university, Uppsala, Sweden.,Sophiahemmet University, Stockholm, Sweden
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16
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Dekkers FHW, Go ATJI, Stapersma L, Eggink AJ, Utens EMWJ. Termination of pregnancy for fetal anomalies: Parents' preferences for psychosocial care. Prenat Diagn 2019; 39:575-587. [PMID: 30997678 PMCID: PMC6767557 DOI: 10.1002/pd.5464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 11/08/2022]
Abstract
Objective To investigate, from the perspective of women and partners, at what stage of a termination of pregnancy (TOP) for fetal anomalies psychosocial care (PSC) is most meaningful, what topics should be discussed, and who should provide PSC. Method A cross‐sectional retrospective cohort study was conducted with a consecutive series of 76 women and 36 partners, who completed a semi‐structured online questionnaire. Results Overall, women expressed a greater need for PSC than their partners. Parents expressed a preference for receiving support from a maternal‐fetal medicine specialist to help them understand the severity and consequences of the anomalies found and to counsel them in their decision regarding termination. Parents showed a preference for support from mental healthcare providers to help with their emotional responses. Forty‐one percent of the women visited a psychosocial professional outside of the hospital after the TOP, indicating a clear need for a well‐organised aftercare. Conclusion Different disciplines should work together in a complementary way during the diagnosis, decision making, TOP, and aftercare stages. Parents' need for PSC should be discussed at the beginning of the process. During aftercare, attention should be paid to grief counselling, acknowledgement of the lost baby's existence, and possible future pregnancies. What's already known about this topic?
Pregnancy termination for fetal anomalies has multiple psychological consequences for parents. Parents are mostly unaware of the need for psychosocial care during and after pregnancy termination. What does this study add?
Knowledge about which stage parents consider to be most meaningful for psychosocial care, the topics that should be discussed, and who should provide psychosocial care. Awareness that different disciplines should collaborate during and after the pregnancy termination.
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Affiliation(s)
- Frederike H W Dekkers
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Attie T J I Go
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alex J Eggink
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry, the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
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17
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Lafarge C, Rosman S, Ville I. Pregnancy termination for fetal abnormality: Ambivalence at the heart of women's experience. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Guy B. I Poems on Abortion: Women’s Experiences With Terminating Their Pregnancies for Medical Reasons. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/23293691.2018.1523115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Zaręba K, Makara-Studzińska M, Ciebiera M, Gierus J, Jakiel G. Role of Social and Informational Support while Deciding on Pregnancy Termination for Medical Reasons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122854. [PMID: 30558123 PMCID: PMC6313640 DOI: 10.3390/ijerph15122854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/23/2018] [Accepted: 12/10/2018] [Indexed: 12/31/2022]
Abstract
Background: Poland is a country with restrictive laws concerning abortion, which is only allowed if the mother’s life and health are in danger, in case of rape, and severe defects in the fetus. This paper specifies the forms of support expected by women considering termination from their family, people in their surroundings and professional medical personnel. Methods: Between June 2014 and May 2016 patients eligible to terminate a pregnancy for medical reasons were asked to complete an anonymous survey consisting of sixty questions to determine patient profile and forms of support expected from the society, family and professional medical personnel as well as to assess informational support provided. Results: Women do not take into consideration society’s opinion on pregnancy termination (95%). The majority of the respondents think that financial support from the state is not sufficient to provide for sick children (81%). Despite claiming to have a medium standard of life (75%), nearly half of the respondents (45%) say that they do not have the financial resources to take care of a sick child. The women have informed their partner (97%) and closest family members (82%) and a low percentage have informed friends (32%). Nearly one third (31%) have not talked to the attending gynecologist about their decision. Conclusions: The decision to terminate a pregnancy is made by mature women with a stable life situation—supported by their partner and close family. They do not expect systemic support, as they believe it is marginal, and only seek emotional support from their closest family. They appreciate support provided by professional medical personnel if it is personal.
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Affiliation(s)
- Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Marta Makara-Studzińska
- Faculty of Clinical Health Psychology, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 01-809 Warsaw, Poland.
| | - Jacek Gierus
- Department of Psychiatry, Department of Health Sciences, Medical University of Warsaw, 05-802 Warsaw, Poland.
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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20
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Rocha J, Nunes C, Leonardo A, Correia MJ, Fernandes M, Paúl MC, Almeida V. Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial. Arch Womens Ment Health 2018; 21:453-459. [PMID: 29502281 DOI: 10.1007/s00737-018-0822-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
We have defined a psychological intervention based on cognitive narrative therapy and the Ottawa decision framework to reduce adjustment problems following a termination of pregnancy (TOP) after a positive prenatal diagnosis (PND). The intervention is composed of four sessions: decision, subjectivation, metaphorization, and projecting. This study aims to assess the effectiveness of a cognitive narrative intervention to prevent depression and anxiety symptoms after TOP. The intervention was accepted by 24 participants. The outcome is compared with a control group of 67 women who also terminated a pregnancy after PND. Participants were from several Portuguese institutions; 64.4% had a genetic and 35.6% had ultrasound diagnosis; the mean age was 30.0 years and the mean gestational age was 19 weeks. There are two evaluations: a baseline at the 15th day and a sixth month follow-up after TOP, using Beck Depression Inventory, Zung Anxiety Scale, Perinatal Grief Scale, and an instrument capturing participant satisfaction. Six months after TOP, there is a lower mean of anxiety and depression (p < 0.05), between groups, with effect sizes on the follow-up of 0.54 for depression, 0.41 for anxiety, and 0.23 for perinatal grief. This intervention has very positive effects on women mental health, and we emphasize the importance of the meaning-making process in the context of terminating a wanted pregnancy.
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Affiliation(s)
- José Rocha
- IINFACTS, CESPU, Gandra, Portugal. .,Centro de Psicologia do Trauma e do Luto, Porto, Portugal.
| | - C Nunes
- IINFACTS, CESPU, Gandra, Portugal
| | | | | | | | - M C Paúl
- Universidade do Porto, Porto, Portugal
| | - V Almeida
- IINFACTS, CESPU, Gandra, Portugal.,Centro de Psicologia do Trauma e do Luto, Porto, Portugal
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21
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Lou S, Carstensen K, Petersen OB, Nielsen CP, Hvidman L, Lanther MR, Vogel I. Termination of pregnancy following a prenatal diagnosis of Down syndrome: A qualitative study of the decision-making process of pregnant couples. Acta Obstet Gynecol Scand 2018; 97:1228-1236. [PMID: 29791717 DOI: 10.1111/aogs.13386] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In Denmark, first trimester screening has a very high uptake (>90%). If Down syndrome is diagnosed, termination rates are high (>95%). The aim of this study was to investigate the timing of the decision to terminate pregnancy following a diagnosis of Down syndrome and the factors influencing this decision. MATERIAL AND METHODS Semi-structured, qualitative interview study with 21 couples who had received a prenatal diagnosis of Down syndrome and decided to terminate the pregnancy. Participants were recruited from obstetric departments between February 2016 and July 2017. Data were analyzed using thematic analysis. RESULTS Five themes were identified: "initial decision-making", "consolidating the decision", "reasons and concerns shaping the termination of pregnancy decision", "the right decision is also burdensome", and "perceived influences in decision-making". For most couples, the initial decision to terminate pregnancy was made before or during the diagnostic process, but it was re-addressed and consolidated following the actual diagnosis. Imagining a family future with a severely affected Down syndrome child was the main factor influencing the termination of pregnancy decision. The decision was articulated as "right" but also as existentially burdensome for some, due to fear of regret and concern about ending a potential life. The decision to terminate pregnancy was considered a private matter between the couple, but was refined through interactions with clinicians and social networks. CONCLUSION All couples made an initial decision prior to receiving the Down syndrome diagnosis. Knowledge of the couple's initial decision may facilitate patient-centered communication during and after the diagnostic process. Couples may benefit from counseling to deal with grief and existential concerns.
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Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.,Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Carstensen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Fetal Medicine Unit, Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.,Institute for Public Health, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Maja Retpen Lanther
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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22
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Abortion after diagnosis of fetal anomaly: Psychometric properties of a German version of the individual level abortion stigma scale. PLoS One 2018; 13:e0197986. [PMID: 29894474 PMCID: PMC5997354 DOI: 10.1371/journal.pone.0197986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting. METHODS The Individual Level Abortion Stigma (ILAS) scale was translated into German. Psychometric properties of the ILAS scale were examined among 130 women with a history of an abortion after diagnosis of fetal anomaly. Individual and situational factors associated with stigma in the context of an abortion after diagnosis of fetal anomaly were explored. RESULTS Factor analysis suggested a four-dimensional structure of the German version of the Individual Level Abortion Stigma scale (Cronbach's α, .83-.91), corresponding to the subscales of the original scale. Test-retest reliability was acceptable for the worries about judgment subscale, the self-judgment subscale, and the community condemnation subscale, but less convincing for the isolation subscale. Associations between the subscales and measures of depression, self-esteem and secrecy were found in directions consistent with theory. Women who did not perceive their fetus to have a low survival chance and women whose fetus was at higher gestational age reported higher levels of stigma, whereas higher perceived partner support was associated with lower levels of stigma. LIMITATION Generalizability of study results was limited, as participants were recruited from one clinic in Germany and the study had a response rate of 46.5%. CONCLUSIONS The ILAS subscales are largely reliable and valid measures to assess stigma among women who have had an abortion after diagnosis of fetal anomaly. Suggestions for improving the assessment of stigma experienced in this population are outlined. The scales can be useful in research aiming at investigating psychological outcomes of abortion after diagnosis of fetal anomaly and improving care structures.
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23
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Crowe L, Graham RH, Robson SC, Rankin J. Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: a qualitative study of professional perspectives. BMJ Open 2018; 8:e020815. [PMID: 29500216 PMCID: PMC5855171 DOI: 10.1136/bmjopen-2017-020815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aims to explore the perspectives of professionals around the issue of termination of pregnancy for non-lethal fetal anomaly (TOPFA). METHODS Semi-structured interviews were undertaken with medical professionals (14 consultants in fetal medicine, obstetrics, neonatology and paediatrics) and social care professionals (nine individuals with roles supporting people living with impairment) from the Northeast of England. Analysis adopted an inductive thematic approach facilitated by NVivo. RESULTS The overarching theme to emerge from the interview data was of professionals, medical and social care, wanting to present an acceptable self-image of their views on TOPFA. Professionals' values on 'fixing', pain and 'normality' influenced what aspects of moral acceptability they gave priority to in terms of their standpoint and, in turn, their conceptualisations of acceptable TOPFA. Thus, if a termination could be defended morally, including negotiation of several key issues (including 'fixing', perceptions of pain and normality), then participants conceptualised TOPFA as an acceptable pregnancy outcome. CONCLUSION Despite different professional experiences, these professional groups were able to negotiate their way through difficult terrain to conceptualise TOPFA as a morally acceptable principle. While professionals have different moral thresholds, no one argued for a restriction of the current legislation. The data suggest that social care professionals also look at the wider social context of a person with an impairment when discussing their views regarding TOPFA. Medical professionals focus more on the individual impairment when discussing their views on TOPFA.
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Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth H Graham
- Sociology and Politics, School of Geography, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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24
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Coast E, Norris AH, Moore AM, Freeman E. Trajectories of women's abortion-related care: A conceptual framework. Soc Sci Med 2018; 200:199-210. [PMID: 29421467 DOI: 10.1016/j.socscimed.2018.01.035] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
We present a new conceptual framework for studying trajectories to obtaining abortion-related care. It assembles for the first time all of the known factors influencing a trajectory and encourages readers to consider the ways these macro- and micro-level factors operate in multiple and sometimes conflicting ways. Based on presentation to and feedback from abortion experts (researchers, providers, funders, policymakers and advisors, advocates) (n = 325) between 03/06/2014 and 22/08/2015, and a systematic mapping of peer-reviewed literature (n = 424) published between 01/01/2011 and 30/10/2017, our framework synthesises the factors shaping abortion trajectories, grouped into three domains: abortion-specific experiences, individual contexts, and (inter)national and sub-national contexts. Our framework includes time-dependent processes involved in an individual trajectory, starting with timing of pregnancy awareness. This framework can be used to guide testable hypotheses about enabling and inhibiting influences on care-seeking behaviour and consideration about how abortion trajectories might be influenced by policy or practice. Research based on understanding of trajectories has the potential to improve women's experiences and outcomes of abortion-related care.
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Affiliation(s)
- Ernestina Coast
- Dept. of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | | | | | - Emily Freeman
- PSSRU, London School of Economics and Political Science, UK
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25
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Leichtentritt RD, Mahat-Shamir M. Mothers' Continuing Bond With the Baby: The Case of Feticide. QUALITATIVE HEALTH RESEARCH 2017; 27:665-676. [PMID: 26631684 DOI: 10.1177/1049732315616626] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The nature of the ongoing bond maintained by the bereaved with the deceased has attracted considerable attention, but studies have generally ignored postdeath relationships when loss occurs in utero. The goal of this research was to reach an interpretive understanding of the continuing bond experience among Israeli mothers who underwent feticide, examining the strategies they use in maintaining a postdeath relationship with a child they did not know, whose death they chose and witnessed, within a social context that ignores their loss and forces them to silence their grief. The results highlight two themes: (a) strategies for relinquishing connection with the baby and (b) strategies for maintaining a postdeath relationship. These processes partially correspond with two theoretical views that shed light on interpretation of the results: the dual process of coping with bereavement and relational dialectic theory. Implications of the results to the practice of health providers are outlined.
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26
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Jones K, Baird K, Fenwick J. Women's experiences of labour and birth when having a termination of pregnancy for fetal abnormality in the second trimester of pregnancy: A qualitative meta-synthesis. Midwifery 2017; 50:42-54. [PMID: 28388456 DOI: 10.1016/j.midw.2017.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/18/2017] [Accepted: 03/25/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to explore women's experiences of labour and birth in the context of a termination of pregnancy for fetal abnormality in the second trimester of pregnancy. DESIGN meta-synthesis of 10 qualitative studies which included the experiences of 581 women. Data analysis was informed by van Manen's four lifeworld existentials (lived body, lived space, lived time and lived human relationships) and focused only on women's experiences of their labour and birth when terminating a pregnancy in the second trimester for fetal abnormality. KEY FINDINGS eight themes were generated by the analysis. In my head: a storm of emotion reflected the lived or felt space. In this space women make meaning of the experience. Too late to turn back time and Living and escaping the moment considered lived time; it is lived time that enables a woman to reinterpret who they once were and who they are becoming. The existential concept of lived body represented the women's physical or bodily presence and was reflected in the themes; The language of labour: un-describable torture, The meaning of pain; punishment and protection and Being a mother in the space where birth meets death. Relational or the lived human relationship is reflected in See me… talk to me…hear me… be with me and Sorry baby. These themes describe the women's lived sense of others in the interpersonal space that they share with them. KEY CONCLUSIONS the findings of this meta-synthesis provide insight into how emotionally and physically traumatic a woman's labour and birth experiences can be in this context. Women wanted to spend time with their baby constructing lasting memories that they could hold onto and share. They needed acknowledgment that their baby existed and their loss was tangible and real. What happened within the space of the relationship women shared with care providers was seen as vital, especially when respectful and dignified interaction was experienced. The women's need for human contact and support through their experience was also seen as critical. IMPLICATIONS FOR PRACTICE the need for greater understanding and acknowledgement of the woman's experience by all caregivers is required. Woman-centred and situation sensitive care provision should be prioritised. Further research that acknowledges and prioritises the feminine voice and the lived experience of women is required.
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Affiliation(s)
- Kay Jones
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Queensland, Australia.
| | - Kathleen Baird
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Queensland, Australia.
| | - Jenny Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Queensland, Australia.
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27
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Lafarge C, Mitchell K, Breeze ACG, Fox P. Pregnancy termination for fetal abnormality: are health professionals' perceptions of women's coping congruent with women's accounts? BMC Pregnancy Childbirth 2017; 17:60. [PMID: 28178933 PMCID: PMC5299639 DOI: 10.1186/s12884-017-1238-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/31/2017] [Indexed: 01/08/2023] Open
Abstract
Background Pregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts. Methods Fifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences. Results Health professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women. Conclusions Health professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.
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Affiliation(s)
- Caroline Lafarge
- School of Human and Social Sciences, University of West London, Paragon, Boston Manor Road, Brentford, TW8 9GA, UK.
| | - Kathryn Mitchell
- The Office of the Vice-Chancellor, University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Andrew C G Breeze
- Fetal Medicine Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| | - Pauline Fox
- School of Human and Social Sciences, University of West London, Paragon, Boston Manor Road, Brentford, TW8 9GA, UK
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Carlsson T, Marttala UM, Wadensten B, Bergman G, Mattsson E. Involvement of persons with lived experience of a prenatal diagnosis of congenital heart defect: an explorative study to gain insights into perspectives on future research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:35. [PMID: 29507769 PMCID: PMC5831892 DOI: 10.1186/s40900-016-0048-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/25/2016] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY Ultrasound examinations during pregnancy have led to an increased number of detected heart defects in fetuses. Pregnant women and their partners are often unprepared for these news, and experience several difficulties following the diagnosis. We asked persons with personal experience to participate in group discussions about relevant future research topics. The discussions revealed that future research should investigate supplemental written information or follow-up appointments with health professionals. Researchers were also encouraged to focus their efforts on structures that offer emotional support. The emotional support could be from those that share similar experiences, or additional support from a health professional. The results of this study illustrate the need for researchers to continue their work to test ways to support persons faced with these diagnoses. ABSTRACT Background A prenatal diagnosis of a congenital heart defect in the fetus is a traumatic life event for pregnant women and their partners. Previous research indicates a need for research that takes steps to support these individuals following the diagnosis. Patient and public involvement is a proposed method of identifying relevant research topics, leading to patient-focused research protocols and relevant support interventions.The overarching aim of this study was to gain insights into relevant future research topics among persons faced with a prenatal diagnosis of congenital heart defect in the fetus. Methods One group of parents to prenatally diagnosed children with a congenital heart defect (n = 5) and one group of individuals with experience of termination of a pregnancy following a prenatal diagnosis of a congenital heart defect (n = 5) were purposefully recruited. Each group of representatives was involved in a face-to-face focus group discussion, analyzed through qualitative content analysis. Results The representatives suggested a need for future research that addresses informational support in the forms as supplemental written information or follow-up consultations. Moreover, interventions that offer emotional support were suggested, in the forms of peer support or additional professional psychosocial support. Conclusion Several interventions were suggested by patient representatives, indicating a need for multiple intervention studies to be conducted in the context of a prenatal diagnosis of a congenital heart defect in the fetus. We recommend that future studies test supplemental written information, follow-up consultations, peer support, and additional professionals psychosocial support following the diagnosis.
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Affiliation(s)
- Tommy Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, S-75122 Uppsala, Sweden
| | | | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, S-75122 Uppsala, Sweden
| | - Gunnar Bergman
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Public Health and Caring Sciences, Uppsala University, BMC Husargatan 3, Box 564, S-75122 Uppsala, Sweden
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
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No one sees the fathers: Israeli fathers' experience of feticide. Soc Sci Med 2016; 168:159-166. [DOI: 10.1016/j.socscimed.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 11/19/2022]
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Carlsson T, Bergman G, Karlsson AM, Wadensten B, Mattsson E. Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages. Midwifery 2016; 41:54-60. [PMID: 27543968 DOI: 10.1016/j.midw.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly. DESIGN cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis. SETTING two large and active Swedish virtual communities. SAMPLE 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination). MEASUREMENTS AND FINDINGS before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child. KEY CONCLUSIONS spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences. IMPLICATIONS FOR PRACTICE information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies.
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Affiliation(s)
- Tommy Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden.
| | - Gunnar Bergman
- Department of Women's and Children's Health, Karolinska Institutet, SE-17176, Stockholm, Sweden
| | - Anna-Malin Karlsson
- Department of Scandinavian Languages, Uppsala University, SE-75120, Uppsala, Sweden
| | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden; Department of Health Care Sciences, Ersta Sköndal University College, SE-10061, Stockholm, Sweden
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Embodied experiences of prenatal diagnosis of fetal abnormality and pregnancy termination. REPRODUCTIVE HEALTH MATTERS 2016; 24:168-77. [DOI: 10.1016/j.rhm.2016.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/05/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023] Open
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Lau Y, Wang Y, Kwong DHK, Wang Y. Are Different Coping Styles Mitigating Perceived Stress Associated With Depressive Symptoms Among Pregnant Women? Perspect Psychiatr Care 2016; 52:102-12. [PMID: 25639982 DOI: 10.1111/ppc.12105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 12/09/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To test the direct and moderating effects of different coping styles in mitigating perceived stress associated with antenatal depressive symptoms among 755 women. DESIGN AND METHODS The Perceived Stress Scale, the Trait Coping Styles Questionnaire, and the Edinburgh Depressive Postnatal Scale were used to test different effects in multiple linear regression models. FINDINGS Direct effects of positive and negative coping styles were found. Positive coping styles have moderating effects on perceived stress but negative coping styles do not. PRACTICE IMPLICATIONS Health services should dedicate resources to teach women positive coping styles to decrease their vulnerability to developing antenatal depressive symptoms.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,School of Health Sciences, Macao Polytechnic Institute, Macao, China
| | - Yuqiong Wang
- Chengdu Women and Children's Central Hospital, Chengdu, China
| | | | - Ying Wang
- Chengdu Women and Children's Central Hospital, Chengdu, China
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Johansson C. The 2015 Pregnancy Summit, London, UK. WOMENS HEALTH 2016; 12:167-70. [PMID: 26900652 DOI: 10.2217/whe.15.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pregnancy Summit, Cineworld, The O2, London, UK, 29 September to 1 October 2015 The 2015 Pregnancy Summit was held over 3 days from 29 September to 1 October at Cineworld, The O2, London, UK. The event brings together a multidisciplinary faculty of international researchers and clinicians to discuss both scientific and clinical aspects of pregnancy-related issues in an informal setting. The goal of the meeting was to provide delegates with an update of recent advances in management of pregnancy-related conditions, to present research data and to discuss the current attitudes and practices in relevant topics. An extensive range of topics were discussed, from preeclampsia and treatment of hypertension, to the psychological impact of termination of pregnancy and feticide. This report will summarize a selection of the lectures presented.
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Affiliation(s)
- Cherynne Johansson
- Department of Obstetrics & Gynaecology, Liverpool Hospital, Elizabeth & Campbell Streets, Liverpool, New South Wales 2170, Australia
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Ummel D, Achille M. Transplant Trajectory and Relational Experience Within Living Kidney Dyads. QUALITATIVE HEALTH RESEARCH 2016; 26:194-203. [PMID: 25700284 DOI: 10.1177/1049732315570128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Living kidney donation is considered common practice across most Westernized countries. While extensive research has documented the experience of living donors, few studies have addressed the perspective of recipients, and even fewer have examined the experience of donor and recipient as an interactive dyad. In this study, our aim was to examine the reciprocal influence between donors and recipients across the transplantation process. We recruited a homogeneous sample of 10 donors and recipients, who were interviewed individually. Data were analyzed using interpretative phenomenological analysis. The presentation of results follows the stages of the transplantation process: the disease experience, the experience of offering and accepting a kidney, the screening period, the surgery, and the post-transplantation period. Results are discussed within the framework of Mauss's gift exchange theory, social roles, and altruism. This comprehensive description of the dyadic experience provides a way to frame and understand psychosocial aspects and relational implications of living renal transplantation.
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Affiliation(s)
- Deborah Ummel
- Department of psychology, Université de Montréal, Montréal, Québec, Canada
| | - Marie Achille
- Department of psychology, Université de Montréal, Montréal, Québec, Canada
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Lau Y, Wang Y, Kwong DHK, Wang Y. Testing direct and moderating effects of coping styles on the relationship between perceived stress and antenatal anxiety symptoms. J Psychosom Obstet Gynaecol 2015; 36:29-35. [PMID: 25541216 DOI: 10.3109/0167482x.2014.992410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to test the direct and moderating effects of different coping styles in mitigating perceived stress associated with antenatal anxiety symptoms among 755 pregnant women in Chengdu. METHODS A cross-sectional study using a questionnaire survey was carried out. The Perceived Stress Scale, the Trait Coping Style Questionnaire and the Zung Self-rating Anxiety Scale were used to measure stress, coping and anxiety symptoms, respectively. Hierarchical regression analysis was used to test the direct and moderating effects of coping styles in the relationship between perceived stress and antenatal anxiety symptoms. RESULTS Direct effects of negative coping (NC) styles were found. Women with higher NC scores were more likely to have anxiety symptoms. Positive coping (PC) styles had moderating effects on perceived stress, whereas NC styles did not. CONCLUSION The findings of this study highlight the direct and moderating effects of coping styles. This knowledge is important to healthcare professionals in planning health service provision. Health services should dedicate resources to teaching pregnant women how to enhance PC styles, alter NC styles and cultivate optimistic thinking to alleviate anxiety symptoms.
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Affiliation(s)
- Ying Lau
- School of Health Sciences, Macao Polytechnic Institute , Macao , China
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Vanstone M, Yacoub K, Giacomini M, Hulan D, McDonald S. Women's Experiences of Publicly Funded Non-Invasive Prenatal Testing in Ontario, Canada: Considerations for Health Technology Policy-Making. QUALITATIVE HEALTH RESEARCH 2015; 25:1069-84. [PMID: 26063605 DOI: 10.1177/1049732315589745] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Non-invasive prenatal testing (NIPT) via fetal DNA in maternal blood has been publicly funded in Ontario, Canada, for high-risk women since 2014. We solicited women's experiences and values related to this new health technology to describe how this test is currently being used in Ontario and to provide information about patient priorities to inform future policy decisions about the use of NIPT. Guided by constructivist grounded theory methodology, we interviewed 38 women who had diverse personal experiences with NIPT. Participants' accounts of their values for decision making about NIPT heavily relied on three mutually modulating factors: timing, accuracy, and risk. The values expressed by women conflict with the way that publicly funded NIPT has typically been implemented in Ontario. We offer recommendations for how NIPT might be integrated into prenatal care pathways in a way more consistent with women's values.
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Basile ML, Thorsteinsson EB. Parents' evaluation of support in Australian hospitals following stillbirth. PeerJ 2015; 3:e1049. [PMID: 26137430 PMCID: PMC4485727 DOI: 10.7717/peerj.1049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/03/2015] [Indexed: 11/20/2022] Open
Abstract
The present study evaluated the level of support and satisfaction among parents of stillborn babies in Australian hospitals. One-hundred and eighty-nine mothers and fathers completed an online survey designed by the researcher based on the guidelines designed by the Perinatal Society of Australia and New Zealand. Support was inconsistent with guidelines implemented on average only 55% of the time. Areas of support regarding creating memories, birth options and autopsy were most problematic. A significant positive correlation was found between support and satisfaction and there is indication that there has been some increase in support and satisfaction over time. There has been a significant increase in both support and satisfaction since the release of the guidelines in 2009. Creating memories was regarded by parents as the most influential to their grief. It is recommended that health professionals review guidelines and seek feedback from parents as to how they can improve the support they provide.
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Affiliation(s)
- Melanie L. Basile
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Einar B. Thorsteinsson
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
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Ramdaney A, Hashmi SS, Monga M, Carter R, Czerwinski J. Support Desired by Women Following Termination of Pregnancy for a Fetal Anomaly. J Genet Couns 2015; 24:952-60. [DOI: 10.1007/s10897-015-9832-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
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Lafarge C, Mitchell K, Fox P. Termination of pregnancy for fetal abnormality: a meta-ethnography of women’s experiences. REPRODUCTIVE HEALTH MATTERS 2014; 22:191-201. [DOI: 10.1016/s0968-8080(14)44799-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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40
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Experiences, feelings and thoughts of women undergoing second trimester medical termination of pregnancy. PLoS One 2014; 9:e115957. [PMID: 25546416 PMCID: PMC4278807 DOI: 10.1371/journal.pone.0115957] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
Main Objective The objective of this study was to explore women's expectations and experiences of undergoing second trimester abortion. Methods This is a cross-sectional study using a screening questionnaire and semi-structured interviews for data collection. Thirty-one women filled out the questionnaire and 23 of them were later interviewed. The questionnaires were analyzed by descriptive statistics. The interviews were recorded, transcribed verbatim and analyzed with qualitative content analysis. Most Important Findings Indications for the abortion were fetal malformation or unintended pregnancy. The women expressed similar feelings and these were irrespective for the reason for having an abortion. Both physical and mental pain was experienced during the abortion process and described by the women. Taking the mifepristone-pill was experienced as especially emotionally difficult for many participants. Professional support from the staff together with support from the partner, a friend or relative helped in transforming the worries related to something unknown to feelings of coping with a new and hard experience. Prior to the abortion most women stated that they did not want to view the fetus but women who chose to view the fetus described this as a way of confronting the reality and an opportunity to say farewell to the pregnancy/fetus. The analysis of the interview transcripts revealed five themes mirroring the women's experiences, thoughts and feelings related to the abortion. Conclusions The decision to undergo second trimester abortion sometimes exposes women to strong and conflicting emotions which are irrespective for the reason for having an abortion. Despite this women do not regret their decision to terminate the pregnancy. This analysis shows that their rational thinking outweighs their emotionally difficult feelings. It is important for the attending staff to be responsive to the needs of each individual woman whatever the indication is for the abortion.
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Fisher J, Lafarge C. Women’s experience of care when undergoing termination of pregnancy for fetal anomaly in England. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.970149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Lafarge C, Mitchell K, Fox P. Perinatal grief following a termination of pregnancy for foetal abnormality: the impact of coping strategies. Prenat Diagn 2013; 33:1173-82. [PMID: 23943597 DOI: 10.1002/pd.4218] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/23/2013] [Accepted: 08/10/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Caroline Lafarge
- School of Psychology, Social Work & Human Sciences; University of West London; Brentford UK
| | - Kathryn Mitchell
- Office of the Vice-Chancellor; University of West London; London UK
| | - Pauline Fox
- School of Psychology, Social Work & Human Sciences; University of West London; Brentford UK
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