The experiences of pregnant women at an advanced maternal age: an integrative review

"It was not an accident": Women's experiences of renewing motherhood at 40

In recent decades, there has been an increase in motherhood at an advanced age that has raised several medical and social concerns. We conducted a qualitative interview study, guided by Interpretative Phenomenological Analysis, to focus on the motivations and experiences of Belgian women who 'renewed' their motherhood later in life, meaning they had one or several children and then (at least 10 years later) had another child at the age of 40 or older. We focused on ten women's experiences of motherhood later in life, as well as on the way they managed social norms and expectations regarding family building and the appropriate life course. We identified two main themes. The first theme describes the participants' encounters with social norms that challenged their decision to reproduce and parent later in life, and how they managed and anticipated criticism, surprise, disbelief and incomprehension about their renewed motherhood in various ways. The second theme shows how these women talked about taking responsibility as a (renewed) mother of advanced age. For them, responsible motherhood involved making thoughtful reproductive choices, attending to the range of needs of their children, and making extra efforts to safeguard the social and emotional wellbeing of their youngest children, thereby seeking to reduce potential harm resulting from these reproductive choices. This study provides insight into these women's self-conception and their interactions with prejudiced social views of motherhood and family building.

Support provided by healthcare professionals to the mothers of newborns in the neonatal unit

Objective: To evaluate the support offered by health professionals to mothers of newborns admitted to the neonatal unit.Methods: Descriptive cross-sectional study with a quantitative approach conducted at the Regional Hospital of Tucuruí, in the state of Pará, region of the Brazilian Amazon, where 33 mothers who had newborn children admitted to the neonatal unit responded to the structured adapted version of the NPST (Nurse Parent Support Tool ). Results: Most were aged 20-34 years (48%), married or in a stable relationship (69%), multiracial (87%), housewife (57%), with up to 11 years of study (72%). The scores for the NPST subdomains were 3.39 ± 1.65 (Communication and Information Support), 4.13 ± 1.33 (Emotional Support), 3.93 ± 1.46 (Incentive Support), and 4.21 ± 1,27 (Instrumental Support). The findings revealed unsatisfactory communication and information support from health professionals to mothers, although they expressed satisfaction with the care provided. Conclusions: The perception of scarcity of human resources and health education, verified in this study, weakens the communication process during hospitalization and influences the mother's well-being, leading to a decrease in the efficiency of the support provided. The improvement in this area can lead to better results in daily practice. The replication of this study to other locations can lead to more significant assistance to mothers of hospitalized neonates and provide new technologies and strategies in health education.

Characteristics of pregnant women at risk and relationship with type of delivery and complications

OBJECTIVE

to describe characteristics of pregnant women at risk and analyze the relationship with type of delivery and complications during pregnancy and puerperium.

METHODS

a retrospective study with secondary data of 1,574 at-risk pregnant women followed up in an educational intervention by telemedicine.

RESULTS

pregnant women with an average age of 35 years and high educational level participated. Preference for normal delivery was 43.1%, but only 17.3% had normal delivery. During pregnancy, 43.5% sought emergency care. In the postpartum period, 2.0% needed an ICU. Emergency room search was associated with age and contacts with the intervention. Cesarean delivery was associated with age, physical inactivity and overweight/obesity. ICU admission was associated with age and BMI.

CONCLUSION

pregnant women were of high age and education, the younger and who had more contacts with the intervention sought more the emergency room. Older age, physical inactivity and overweight/obesity were factors associated with cesarean delivery.

J. N, P. Y. L, N. H. Factors influencing pregnancy planning of multi-ethnic Asian women with diabetes: A qualitative study

Introduction

Pregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women’s pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women’s pregnancy planning.

Methods

This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis.

Results

From the 33 interviews that were analysed, four important factors influencing participants’ decisions regarding pregnancy planning were identified. Participants’ perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious ‘up to God’ beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care.

Conclusions

This study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.

Factors associated with the length of hospital stay of women undergoing cesarean section

OBJECTIVE

To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section.

METHODS

A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil®). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen’s D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test.

RESULTS

The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay.

CONCLUSIONS

The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.

Experience of pregnant women at an advanced age

OBJECTIVE

To describe the experience of pregnant women at an advanced age.

METHOD

This is a qualitative and descriptive study, which was conducted with 21 pregnant women aged 35 years older or over undergoing high-risk prenatal care, from December 2015 to April 2016. The data were collected by means of semi-structured interviews. The thematic analysis of the data followed the six steps proposed by Creswell.

RESULTS

Six thematic categories have appeared: Ambivalence: from fear to happiness; The (un)planning and the divine; Family (re)organization: from support to non-acceptance; Maturity as a facilitator for motherhood; Advanced age and risk perception; The biological age of the body hindering pregnancy.

CONCLUSION

This study describes the experience of pregnant women at an advanced age and unveils several experienced aspects that could be used as allowances for nursing care to women who become pregnant at an advanced age.