Comparative analysis of general and pregnancy-related prenatal anxiety symptoms: progression throughout pregnancy and influence of maternal attachment

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

The Effects of MBSR Programme on Prenatal Comfort and Fetal Health Anxiety in Pregnant Women

OBJECTIVE

This study was conducted to examine the effect of the online Mindfulness-Based Stress Reduction (MBSR) programme applied to pregnant women on their prenatal comfort and foetal anxiety levels.

MATERIAL AND METHOD

This randomised controlled study was conducted between July and October 2022, with 89 pregnant women registered in a Family Health Centre of Adiyaman, located in the Southeastern Anatolia region of Turkey. In the study, a total of eight sessions of MBSR programme, one session per week for eight weeks, were applied to the pregnant women in the experimental group. Data of the study was collected with the 'Personal Information Form', 'Prenatal Comfort Scale (PCS)', and 'Fetal Health Anxiety Inventory (FHAI)'. Descriptive statistics, chi-square test, and t-test for independent and dependent samples were utilised in the analysis of the data.

RESULTS

It has been determined that the PCS total mean score after the intervention is 58.91 ± 7.18 in the experimental group and 50.56 ± 15.78 in the control group; the post-test FHAI total mean score is 4.52 ± 1.66 in the experimental group and 9.76 ± 5.00 in the control group, and the difference between the groups is statistically significant (p < 0.001).

CONCLUSION

It has been determined that the MBSR programme applied to pregnant women has increased the prenatal comfort levels of pregnant women and has decreased foetal health anxieties. In line with these results, it is recommended that the MBSR programme may be used as an alternative method to relieve pregnant women.

The Prevalence and Risk Factors of Pregnancy-Related Anxiety in Bahrain

Objectives We aim to estimate the prevalence of anxiety among pregnant women, explore the possible risk factors, and compare the presence of anxiety in each gestational trimester in all pregnant women attending the antenatal care clinics at a tertiary care hospital in Manama, Bahrain. Methods This study followed a cross-sectional research design at the antenatal clinics of Salmaniya Medical Complex in Manama, Bahrain. Direct interviews with 513 participants were conducted using the Pregnancy Anxiety Questionnaire-Revised-2 (PRAQ-R2). Results Most participants (63%) were 25-35 years old. The majority (85.6%) were Bahraini nationals, and 52.2% were university-educated. Almost two-thirds were unemployed, 28.1% had associated chronic comorbidities, 3.1% had associated psychiatric disorders, 15% had a high level of anxiety, and 38% had a moderate level of anxiety. Employed participants had a significantly higher level of anxiety (p=0.022) than housewives/unemployed participants. Participants' levels of anxiety differed significantly according to their gestational age (p=0.043), with the highest anxiety among those in their third trimester (15.7%). Participants' anxiety levels were significantly higher among those with previously complicated pregnancies (p=0.002). Moreover, those with unplanned current pregnancy had significantly higher anxiety levels (p=0.019). Conclusions This study showed that anxiety seems to be a common disorder among pregnant women in Bahrain. It was more prevalent during the third trimester, and its occurrence was associated with the pregnant woman's employment, the occurrence of previously complicated pregnancies, and unplanned current pregnancies.

Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting

Point-of-care ultrasound (POCUS) is an imaging modality used to make expedient patient care decisions at bedside. Though its diagnostic utility has been extensively described, POCUS is not yet considered standard of care in inpatient settings. Data from emergency department settings suggest that POCUS may yield socioemotional benefits beyond its diagnostic utility; furthermore, elements of the POCUS experience are known to promote placebo effects. These elements likely contribute to a placebo-like "POCUS positive care effect" (PPCE) with socioemotional benefits for receptive patients. Our objective is to provide the first characterization of the PPCE and its facilitating factors in an inpatient setting. In this novel mixed-methods study, we recruited 30 adult patients admitted to internal medicine floors in an urban academic medical center, recorded observations during their routine POCUS encounters, and administered post-encounter surveys. We conducted complementary quantitative and qualitative analyses to define and assess the magnitude of the PPCE. We also aimed to identify factors associated with and facilitating receptiveness to the PPCE. The results indicated that POCUS improves patients' satisfaction with their hospital providers and care overall, as well as perceived care efficiency. Mutual engagement, strong therapeutic alliances, and interpreting POCUS images to provide reassurance are most closely associated with this PPCE. Patients who have lower anxiety levels, less severe illness, and received efficient care delivery during their hospitalizations are most receptive to the PPCE. We conclude that diagnostic POCUS has the potential to exert a positive care effect for hospitalized patients. This PPCE is associated with modifiable factors at the patient, provider, and environment levels. Together, our findings lay the groundwork for an optimized "therapeutic POCUS" that yields maximal socioemotional benefits for receptive patients.

Exploring factors associated with complete mental health of pregnant women during the COVID-19 pandemic

OBJECTIVE

To explore a wide range of factors associated with complete mental health (i.e., positive mental health - the presence of flourishing, and the absence of mental illness - depressive and anxious symptoms) among Portuguese pregnant women, during the COVID-19 pandemic.

DESIGN

Quantitative cross-sectional study.

SETTING

Data were collected through an online survey placed on social media websites targeting pregnant Portuguese adult women between October 2020 and April 2021.

PARTICIPANTS

The sample comprised 207 pregnant women.

RESULTS

A multivariate logistic regression model showed that higher levels of self-compassion and higher engagement in mindful self-care practices increased the likelihood of reporting complete mental health during pregnancy.

CONCLUSIONS

Promoting self-compassion and mindful self-care may be particularly important in pregnant women, as these psychological factors appear to contribute to complete mental health during COVID-19 pandemic.

IMPLICATIONS FOR PRACTICE

The COVID-19 pandemic represented a demanding period for pregnant women. Our findings highlight that targeting the promotion of self-compassion and mindful self-care practices during stressful periods could significantly contribute to their overall mental health.

Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals' Guide to Locating and Assessing Anxiety Apps

Background

Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women’s experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps.

Objective

This review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women.

Methods

A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps.

Results

Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers’ scores and app user rating scores, with higher user rating scores associated with lower reviewer scores.

Conclusions

App developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria.

Concentrating in a Loud Crowd: Sonographer Perceptions of Policies to Limit Distractions in Obstetric Sonography Examinations

Objective

The objective was to identify sonographer perceptions of distractions and policies for improving obstetric sonography examinations (OBUS).

Materials and Methods

A survey, with closed- and open-ended questions, was sent to OBUS practicing members of the Society of Diagnostic Medical Sonography (SDMS). Descriptive analyses, including frequency distributions overall and by various groups, were performed. Chi-square analyses were used to examine the relationships between categorical variables, including level of perceived distraction, and concordance with policies.

Results

Of the 3525 accessed e-mails, 807 responses were eligible for analysis. Over half (62%) of the respondents reported no observer policy. Sonographers reported strong agreement with observer policies and desired limits on observers. Policy disagreement themes included number of observers, children observers, patient satisfaction, and patient truthfulness. Most sonographers reported existence of (85%) and strong agreement (97%) with recording policies. Disagreements centered around the strictness of policies, policy enforcement and notification, distraction of recording, medico-legal issues, and finding anomalies while being recorded.

Conclusion

Discrepancies existed between policies regarding observers and recording in OBUS. Sonographers both desired and agreed with protocols to limit distractions. However, there were concerns regarding stringency, notification, and enforcement of policies. Further research is needed to determine if policies help limit distractions during OBUS.

Anxiety and Worries among Pregnant Women during the COVID-19 Pandemic: A Multilevel Analysis

Background. Several studies have identified pregnant women as a vulnerable group during the COVID-19 pandemic. The perinatal period has been identified as a stage of great risk for the mental health of pregnant women, due to a large increase in mental pathologies during this period. In this context, the objective of the present study was to assess the associations between socioeconomic and demographic factors, health concerns and health information management, and anxiety level during the COVID-19 pandemic in pregnant Spanish women. Method. The sample of this cross-sectional study was comprised of 353 pregnant women, aged 18 or older and residing in Spain. Data collection was carried out from 1 June to 30 September 2020. Participants were recruited from Quirónsalud University Hospital of Madrid. Multilevel regression models were built to value the associations between demographic factors, health concerns and health information management, and anxiety level during the COVID-19 pandemic among pregnant women. Results. Reduced working hours and income due to the COVID-19 pandemic were related to increased anxiety levels, as was the level of concern about COVID-19 symptoms, potential complications, contagion and consequences for the baby. Worries caused by restrictive measures adopted against COVID-19 and resulting isolation, delivery, postpartum and breastfeeding were also associated with increased anxiety levels. Being a separated or divorced woman and being informed to a greater extent by a midwife were related to lower anxiety levels. An increase in the degree of information obtained about COVID-19 symptoms, complications, contagion and consequences for the baby, restrictive measures and isolation adopted against COVID-19, delivery, postpartum and breastfeeding, were also related to decreased anxiety levels. Conclusions. The most vulnerable future mothers in terms of anxiety levels are those with reduced working hours and income due to the COVID-19 pandemic, those with a higher level of concern and who had access to a lesser degree of information about COVID-19 (symptoms and complications, contagion and consequences on the baby, restrictive measures and isolation, delivery, postpartum and breastfeeding), as well as pregnant women who have obtained information about COVID-19 during pregnancy from TV.

Indeterminate Prenatal Ultrasounds and Maternal Anxiety: A Prospective Cohort Study

INTRODUCTION

Prenatal ultrasounds often yield indeterminate (incomplete or minor abnormality) findings with limited clinical utility. We evaluate impact of indeterminate findings on maternal anxiety.

METHODS

A single-U.S.-center prospective cohort study administered the Perinatal Anxiety Screening Scale (PASS; control mean = 13.4; > 20 denotes clinically significant anxiety) before and after prenatal ultrasounds in February-May 2017. Ultrasound reports were coded as: normal; indeterminate; or major abnormality. Primary outcome was anxiety after indeterminate vs. normal ultrasounds. Secondary outcomes included anxiety change from pre-to-post-ultrasound and relative to women's characteristics. Linear regression adjusted for confounders.

RESULTS

Of 286 ultrasounds, 51.0% were normal, 40.5% indeterminate (22.0% incomplete; 18.5% minor abnormality), and 8.0% major abnormalities. Indeterminate findings were unrelated to age, race, parity, infertility, or psychiatric history, but associated with gestational age (26.6%/45.0%/52.5% for first/second/third trimesters; p < 0.001), and obesity (48.8 vs. 37.0%; p = 0.031). Pretest anxiety was highest in second/third trimesters (p = 0.029), and in subjects aged age ≤ 24 or younger(p < 0.001), with a history of anxiety (p < 0.001),) or with prior pregnancy loss (p = 0.011). Mean anxiety score decreased pre-to-posttest across all groups. Indeterminate findings were associated with higher PASS scores than normal findings: pretest 20.1 vs. 16.4 (p = 0.026) and posttest 16.9 vs. 12.2 (p = 0.009; adjusted-p = 0.01). Versus normal ultrasounds, incomplete findings were associated with higher post-ultrasound anxiety (p = 0.007; adjusted-p = 0.01) and smaller decreases from pre-to-posttest (adjusted-p = 0.03), whereas minor abnormalities had higher pretest anxiety (p = 0.029) with larger pre-to-posttest decreases (adjusted-p =0.010).

DISCUSSION

Indeterminate ultrasounds, especially incomplete findings, are associated with significantly higher anxiety than normal findings, suggesting need for evidence-based counseling, management and strategies for decreasing number of indeterminate results.

Impact of ectogenesis on the medicalisation of pregnancy and childbirth

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis-the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor's duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction.

Mental health outcomes among Chinese prenatal and postpartum women after the implementation of universal two-child policy

BACKGROUND

Poor mental health status among both pregnant and postpartum women is commonly reported worldwide. The associations between mental health outcomes and giving birth to the second child since the implementation of China's universal two-child policy have not been identified.

METHODS

A large-scale based mental health survey was conducted between March 2017 and December 2018 in Suzhou, China. The survey evaluated the symptoms of anxiety, hypomania, depression and poor sleep quality among both pregnant and postpartum women.

RESULTS

A total of 3113 questionnaires were collected, the prevalence of anxiety, hypomanic and depressive symptoms and poor sleep quality in our sample were 3.2% (95%CI: 2.6%-3.9%), 51.7% (95%CI: 49.9%-53.4%), 12.4% (95%CI: 11.3%-13.6%) and 37.8% (95%CI: 36.0%-39.5%), respectively. Logistic regression showed that giving birth to the second child was positively associated with women's age, and was negatively correlated with higher educational level and living in rented housing. Women with the second pregnancy or child were positively associated with anxiety symptoms in the whole sample (OR = 1.75, 95%CI: 1.11-2.75) and among prenatal women (OR = 2.11, 95%CI: 1.16-3.83), while it was inversely correlated with depressive symptoms among postpartum women (OR = 0.63, 95%CI: 0.41-0.99).

CONCLUSIONS

Women giving birth a second time were more prone to have anxiety symptoms among the prenatal women and the whole sample, and less likely to have depressive symptoms among the postpartum women. Efficacious measures and interventions are essential to improve maternal mental health.

Pregnancy-related anxiety during COVID-19: a nationwide survey of 2740 pregnant women

The aim of this study is to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify factors most strongly associated with greater changes in anxiety. An anonymous, online, survey of pregnant women (distributed April 3-24, 2020) included a modified pregnancy-related anxiety scale (PRAS) reflecting respondents' perception of pregnancy anxiety before COVID-19 and a current assessment of pregnancy-related anxiety. The difference between these scores was used as the outcome variable. Data were analyzed using bivariate and multivariate linear regression analyses. Two thousand seven hundred forty pregnant women from 47 states completed the survey. 25.8% (N = 706) stopped in-person visits, 15.2% used video visits (N = 415), and 31.8% (N = 817) used phone visits for prenatal care as a result of COVID-19. Those planning a hospital birth dropped from 2641 (96.4%) to 2400 (87.7%) following COVID-19. More than half of women reported increased stress about food running out (59.2%, N = 1622), losing a job or household income (63.7%, N = 1745), or loss of childcare (56.3%, N = 1543). More than a third reported increasing stress about conflict between household members (37.5%, N = 1028), and 93% (N = 2556) reported increased stress about getting infected with COVID-19. Slightly less than half of respondents (either selves or family members) were healthcare workers (41.4%, N = 1133) or worked in essential services (45.5%, N = 1246). In multivariate analysis, those reporting higher agreement with COVID-19-related stressors had greater changes in pre- to post-COVID-19 pregnancy-related anxiety. The COVID-19 pandemic is profoundly affecting pregnant women's mental health, and factors independent of pregnancy appear to be driving changes in pregnancy-specific anxiety.

Fetal health anxiety: development and psychometric properties of the fetal health anxiety inventory

Objective: To develop a measure to assess fetal health anxiety and examine its factor structure, convergent and divergent validity. Methods: In Study 1, the Short Health Anxiety Inventory-14 item version (SHAI) (Salkovskis et al., Psychol Med. 2002;32:843-853) was adapted for use with pregnant women to examine fetal health anxiety named the Fetal Health Anxiety Inventory (FHAI). Four pregnant women and three subject matter experts (SMEs) reviewed the FHAI. In Study 2, 100 pregnant women completed the FHAI and related self-report measures. Results: In Study 1, both reviewer groups provided feedback directing minor changes to the FHAI. In Study 2, a revised version was used. The revised FHAI demonstrated excellent internal consistency (α = 0.91). Results from an EFA suggested that the FHAI may be conceptualized as a one- or two-factor scale. Convergent (pregnancy-related anxiety [r = 0.56, p = .0001], parental health anxiety [r = 0.53, p = .0001], anxiety [r = 0.57, p = .0001], anxiety sensitivity [r = 0.28, p = .004] and intolerance of uncertainty [r = 0.29, p = .003]) and divergent (parental depression [r = 0.16, p = .12]) validity was evidenced with additional measures of interest. Conclusion: Preliminary findings suggest that the FHAI represents a psychometrically sound instrument to measure the construct of fetal health anxiety. Practical and theoretical implications of the present results are discussed.

Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study

Background

Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound.

Methods

We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA.

Results

Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one.

Conclusions

Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study

BACKGROUND

An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5-14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care.

METHODS

We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen's behavioral model, we collected data on potential determinants from the digital midwifery's practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier.

RESULTS

The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35-6.77)) and exposure to sexual violence (OR = 2.17 (1.11-4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66-4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02-3.35) or OR = 2.99 (1.43-6.25)), overweight (OR = 1.88 (1.09-3.24)), and deprived area (OR = 0.50 (0.27-0.92)).

CONCLUSION

Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons.

IMPLICATION FOR PRACTICE

A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs.

Gestating bodies: sensing foetal movement in first-time pregnancy

A large body of literature engages with personal accounts of pregnancy to illustrate the subjugation of women's embodied experience by practices of biomedicine. This article explores this issue through women's accounts of sensing initial foetal movement, drawn from qualitative interviews with 15 women resident in the UK. Participants depict this aspect of pregnant embodiment as ambiguous and indefinite, in contrast to clinical and popular representations of foetal movement. In highlighting the uncertainties characteristic of this corporeal event, the article adds to literature destabilising understandings of pregnant women's and foetal bodies as bounded and distinct. Ambiguous experiences of foetal movement arise in the context of sociocultural framings of pregnancy as 'at risk', and in turn, may be seen to contribute to these representations, with some participants articulating that uncertain sensations could provoke anxiety. In this article, perceptions of foetal movement are emphasised as valuable to women, and as inextricable from the social settings in which they emerge. This research has implications for sociological and feminist discussions of pregnancy, and work exploring the mutual shaping of corporeality and sociocultural contexts more widely.

Provisionally pregnant: uncertainty and interpretive work in accounts of home pregnancy testing

Upon their availability for purchase in the 1970s, home pregnancy testing devices were hailed as a ‘revolution’ for women’s reproductive rights. Some authors, however, have described these technologies as further enabling the medicalisation of pregnancy and as contributing to the devaluing of women’s embodied knowledge. The home pregnancy test is one of many technological devices encountered by women experiencing pregnancy in the United Kingdom today. Existing literature has described how engagement with medical technologies during pregnancy might address uncertainties experienced at this time, providing women with reassurance and alleviating anxieties. Drawing on interviews with women living in Scotland, this article explores accounts of testing for a first pregnancy, and women’s descriptions of the impacts of home pregnancy testing upon experiences of early gestation. Participants engaged with pregnancy tests in varying ways, with uses shaping and shaped by their experiences of early pregnancy more broadly. Particular technical characteristics of the home pregnancy test led many participants to question their interpretation of a positive result, as well as the accuracy of the test itself. Rather than addressing the unknowns of early gestation by confirming a suspected pregnancy, a positive result could thus exacerbate uncertainty. Through participants’ accounts, this article shows how uncertainty is lived out by users of mundane techno-medical artefacts and sheds new light on women’s experiences of the first trimester of pregnancy.

Ultrasound as a technology of reassurance? How pregnant women and health care professionals articulate ultrasound reassurance and its limitations

The premise that ultrasound technologies provide reassurance for pregnant women is well-rehearsed. However, there has been little research about how this reassurance is articulated and understood by both expectant mothers and health care professionals. In this article, we draw on two qualitative UK studies to explore the salience of ultrasound reassurance to women's pregnancy experiences whilst highlighting issues around articulation and silence. Specifically, we capture how expectant parents express a general need for reassurance and how visualisation and the conduct of professionals have a crucial role to play in accomplishing a sense of reassurance. We also explore how professionals have ambiguities about the relationship between ultrasound and reassurance, and how they subsequently articulate reassurance to expectant mothers. By bringing two studies together, we take a broad perspectival view of how gaps and silences within the discourse of ultrasound reassurance leave the claims made for ultrasound as a technology of reassurance unchallenged. Finally, we explore the implications this can have for women's experiences of pregnancy and health care professionals' practices.

Difference in Perception of Pregnancy Risk in Two Maternal Age Groups

INTRODUCTION

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Two sides of the same coin--an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management

BACKGROUND

The extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman's reproductive freedom. The purpose of this study was to explore Swedish obstetricians' experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict.

METHODS

A qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis.

RESULTS

The theme that emerged in the analysis 'Two sides of the same coin' depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman's health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety.

CONCLUSIONS

The widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician's position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop improved ways of enabling pregnant women and their partners to make informed decisions regarding pregnancy management.

"If it helps..." the use of microarray technology in prenatal testing: patient and partners reflections

The objective was to gain insight into the experiences of women and their partners diagnosed with a fetal abnormality on prenatal ultrasound examination and receiving genetic testing including microarray. Twenty-five semi-structured interviews were performed with women +/- their partners after receiving the results of prenatal genetic testing. Framework analysis was performed to elicit themes and subthemes. Five main themes were recognized; diagnosis, genetic testing, family and support, reflections of the treatment received and emotions. Our results showed that women recall being told about QFPCR for trisomy 13, 18, and 21 but often no further testing. Women expected the conventional karyotype and microarray result would be normal following a normal QFPCR result. There were frequent misconceptions by couples regarding aspects of counseling/testing. Communication of variants of unknown (clinical) significance (VOUS) presents a particularly difficult challenge. Good clear communication by health care professionals is paramount. When counseling women and their partners for fetal chromosomal testing it should be reinforced that although the most common, trisomy 13, 18, and 21 only account for some of the chromosomal changes resulting in abnormal scan findings. Couples should have literature to take home summarizing scan anomalies and reinforcing information about genetic testing.

Refugee and migrant women's views of antenatal ultrasound on the Thai Burmese border: a mixed methods study

Background

Antenatal ultrasound suits developing countries by virtue of its versatility, relatively low cost and safety, but little is known about women’s or local provider’s perspectives of this upcoming technology in such settings. This study was undertaken to better understand how routine obstetric ultrasound is experienced in a displaced Burmese population and identify barriers to its acceptance by local patients and providers.

Methodology/Principal Findings

Qualitative (30 observations, 19 interviews, seven focus group discussions) and quantitative methods (questionnaire survey with 644 pregnant women) were used to provide a comprehensive understanding along four major themes: safety, emotions, information and communication, and unintended consequences of antenatal ultrasound in refugee and migrant clinics on the Thai Burmese border. One of the main concerns expressed by women was the danger of childbirth which they mainly attributed to fetal malposition. Both providers and patients recognized ultrasound as a technology improving the safety of pregnancy and delivery. A minority of patients experienced transitory shyness or anxiety before the ultrasound, but reported that these feelings could be ameliorated with improved patient information and staff communication. Unintended consequences of overuse and gender selective abortions in this population were not common.

Conclusions/Significance

The results of this study are being used to improve local practice and allow development of explanatory materials for this population with low literacy. We strongly encourage facilities introducing new technology in resource poor settings to assess acceptability through similar inquiry.

Pregnancy loss in lesbian and bisexual women: an online survey of experiences

BACKGROUND

Although pregnancy loss is a distressing health event for many women, research typically equates women's experiences of pregnancy loss to ‘married heterosexual women's experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women's experiences of miscarriage, stillbirth and neonatal death.

METHODS

This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses.

RESULTS

The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals.

CONCLUSIONS

The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women's experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.