Support needs of expectant mothers and fathers: a qualitative study

Screening for perinatal depression and stress: a prospective cohort study

PURPOSE

There is currently a heightened need for perinatal medical services to timely recognize and accurately meet the psychological needs of pregnant women. Psychological disturbances a mother experiences during pregnancy, such as depression and anxiety, can be later associated with inadequate maternal capacity for antenatal care for herself and the baby, and may lead to subsequent mental health problems later in the mother's life. Routine prenatal assessment could significantly benefit from being proactively enriched with early prevention mental health screening tools to assess, appropriately manage vulnerable populations, and subsequently implement preventive actions.

METHODS

178 pregnant women, under routine prenatal medical assessment, were measured regarding depressive symptomatology and stress, through the use of two validated psychometric tools (the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS-14)).

RESULTS

Heightened perceived stress and depressive symptomatology levels were associated with younger maternal age, an obstetrical record of more than one births and a history of abortion. Results additionally showed a connection between the requirement for a psychiatric referral-based on the levels of symptomatology recorded through the psychometric assessment and a clinical interview-and currently running the earlier stages (weeks) of pregnancy.

CONCLUSION

Our revised proposed prenatal screening protocol for depression and stress suggests an amplified follow-up assessment including all pregnant women scoring high in both depression and in perceived stress, regardless of previous history of prenatal depression or of suicidality, to detect earlier or less manifest expressions of distress during pregnancy, in vulnerable perinatal populations.

Emotion regulation strategies and perceived stress during pregnancy in expectant mothers and fathers

BACKGROUND

Stress during pregnancy can increase physical and mental health risks in parents and offspring. Emotion regulation (ER) may protect against prenatal stress; however, ER is understudied in expectant parents, particularly expectant fathers. This study aimed to evaluate associations between ER strategies (reappraisal, suppression, ratio of suppression-to-reappraisal) and perceived stress among expectant parents, and also test whether expectant mothers and fathers differed in ER strategy use and perceived stress levels.

METHODS

N = 83 expectant parents (62.7% mothers) in the third trimester completed measures assessing perceived stress,reappraisal, and suppression. ANCOVA, hierarchical regression, and multilevel models were used to evaluate associations between ER strategies and perceived stress, and test for sex differences.

RESULTS

Controlling for age and education, lower reappraisal and higher suppression were associated with higher perceived stress; in addition, higher suppression-to-reappraisal ratios were associated with greater perceived stress. Mothers and fathers did not differ in perceived stress, reappraisal, or suppression; however, suppression-to-reappraisal ratios significantly differed.

CONCLUSION

Increasing ER skills such as reappraisal while reducing suppression may be beneficial for decreasing stress in expectant parents. Expectant fathers report similar levels of perceived stress to mothers and would benefit from prenatal mental health screening and intervention.

Pregnancy after perinatal loss: A meta-ethnography from a women's perspective

OBJECTIVE

This study uses a meta-ethnography to synthesize qualitative research on the experiences of women during pregnancies after one or more perinatal losses.

DESIGN

This interpretive meta-ethnography followed the Noblit and Hare approach and the eMERGe Meta-ethnography Reporting Guidance. Manual searches and a comprehensive systematic search were conducted in Pubmed, Scopus, Cinahl, Web of Science, and Psycinfo. Eleven studies met the research objective and inclusion criteria.

RESULTS

After reciprocal and refutational translations, the metaphor "The rainbow in the storm" and the following three themes emerged: (i) Between ambivalent feelings; (ii) being careful in the new pregnancy; and (iii) leaning on others. CERQual assessment showed that the results are (highly) reasonable representations of the phenomenon of interest.

CONCLUSIONS

Most women experienced their subsequent pregnancy with ambivalent feelings and needed to reduce expectations, continuously monitor the pregnancy's viability, and eliminate risky behavior to protect themselves. Understanding and recognition by others is needed and appreciated.

IMPLICATIONS FOR PRACTICE

Nurses and midwives play a crucial role in subsequent pregnancies and need to establish a care communion and ethical care during their encounters with affected women whose specific needs need to be incorporated into the guidelines and training curricula of care professionals to equip them with the necessary gender and cultural competences.

An App to Support Fathers' Mental Health and Well-Being: User-Centered Development Study

BACKGROUND

Numerous studies describe the popularity and usefulness of parenting programs. In particular, parenting programs are generally viewed as effective for supporting parents' mental well-being during key transition periods. However, the evidence base for fathers is limited owing to their lack of involvement in parenting programs and scarcity of tailored support.

OBJECTIVE

This paper aimed to describe the co-design process for a universal digital intervention for fathers (fatherli) and the outline of a logic model with its expected outcomes.

METHODS

Following established guidelines for co-designing and developing complex interventions, we conducted a nonsystematic review of the available literature to gather key information, developed market surveys to assess fathers' needs and interests, consulted with key stakeholders to obtain expert opinions, and engaged in a rapid iterative prototyping process with app developers. Each step was summarized, and the information was collated and integrated to inform a logic model and the features of the resulting intervention.

RESULTS

The steps in the co-design process confirmed a need for and interest in a digital intervention for fathers. In response to this finding, fatherli was developed, consisting of 5 key features: a discussion forum for anyone to post information about various topics (the forum), a socializing platform for fathers to create and engage with others in small groups about topics or points of shared interest (dad hub), a tool for fathers to find other fathers with shared interests or within the same geographic location (dad finder), a resource for fathers to access up-to-date information about topics that interest them (dad wiki), and a portal to book sessions with coaches who specialize in different topics (dad coaching space). The evidence-based logic model proposes that if fatherli is successfully implemented, important outcomes such as increased parental efficacy and mental health help-seeking behaviors may be observed.

CONCLUSIONS

We documented the co-design and development process of fatherli, which confirmed that it is possible to use input from end users and experts, integrated with theory and research evidence, to create suitable digital well-being interventions for fathers. In general, the key findings suggest that an app that facilitates connection, communication, and psychoeducation may appeal to fathers. Further studies will now focus on acceptability, feasibility, and effectiveness. Feedback gathered during pilot-testing will inform any further developments in the app to increase its applicability to fathers and its usability.

A systematic review and narrative synthesis of fathers' (including migrant fathers') experiences of pregnancy and childbirth

OBJECTIVE

The purpose of this review was to consider factors that influence the experiences of pregnancy and childbirth by fathers including migrant fathers.

METHOD

A systematic review and narrative synthesis were conducted as per the PRISMA guidelines. The spider tool was used to build a search strategy which was used to conduct literature search in eight identified electronic databases: ASSIA, CINAHL, EMBASE, MEDLINE, PsycINFO, PUBMED, Sage and Scopus. Grey literature was searched through the King's Fund Library database, Ethos, The North Grey Literature Collection, Social Care Online and other charity websites such as the Refugee Council and Joseph Rowntree Foundation. The search was conducted across all the databases in the week commencing January 7, 2019, and restricted to studies published in the English language.

RESULTS

The search across all the eight electronic databases identified 2564 records, 13 records through grey literature databases/websites and an additional 23 records identified through hand-searching/forward citation. The number of records after duplicates were removed was 2229. Record screening based on titles and abstracts identified 69 records for full text screening. Dual screening of these full text records identified 12 full records from 12 separate studies, eight of which were qualitative studies, three of which were quantitative studies and one mixed method study.

FINDINGS

This review has revealed three main themes: influence of society and health professionals; adjustment to a new life of fatherhood; and involvement in maternity care. However, the literature has focused on non-migrant father's experiences of pregnancy and childbirth, with little attention paid to fathers who may be migrants.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

This review has exposed a dearth of research on migrant fathers' experiences of pregnancy and childbirth in an era of increasing globalisation and migration between countries. Midwives and other health professionals should be alert to the needs of any father when providing maternity care. More research is needed which considers experiences of migrants and how choosing to move to a new country or being forced to move could influence migrant father's experiences and therefore their needs.

The good, the bad, and the why: How do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in Sweden?

Although migrant men constitute a large and growing proportion of men in Sweden, literature exploring migrant men's experiences in sexual and reproductive health (SRH) services is scarce. We aimed to explore how Arabic-speaking migrant men perceive and experience information and services related to SRH in Sweden. We conducted 13 semi-structured interviews with Arabic-speaking migrant men and analysed the data using reflexive thematic analysis. We developed four themes: 1) SRH is 'something essential in life'; 2) the good: a transition to a 'new open society'; 3) the bad: barriers to sexual education and health services; and 4) the why: blaming oneself or the system. SRH services and sexual education/information were perceived as needs and rights, and the participants were content with the new possibilities and the 'new open society'. However, sexual education was not provided to most migrants, and SRH services provided to men had shortcomings that deprived some migrant men from fulfilling their needs. Moreover, internalised and cultural racism created a challenge to receive adequate/acceptable SRH services. There is a need to provide comprehensive sexual education for all, strengthen SRH services provided to men, and develop an action plan to reinforce the anti-discrimination/racism policies in healthcare and society.

Explaining the long reach of prenatal behaviors and attitudes in unmarried men at birth on father engagement in early and middle childhood and adolescence

The current study examined three research questions: (a) Are unmarried at birth fathers' prenatal and birth-related behavioral, attitudinal, and identity adjustments directly related to father engagement in child-related activities during early childhood and father-child closeness in middle childhood and adolescence? (b) Do father engagement in child-related activities during early childhood, coresidence, and coparenting at age 5 mediate the association between unmarried fathers' prenatal and birth-related variables and father-child relationship in middle childhood and adolescence? (c) Do father-child closeness, coresidence, and coparenting in middle childhood mediate the association between fathers' prenatal and birth-related variables and father-child relationship during adolescence? Using a subsample of Fragile Families and Child Wellbeing data (N = 2,647), we found support for our hypotheses that fathers' prenatal and birth-related variables significantly predicted father-child engagement during early childhood and father-child closeness during middle childhood and adolescence, although not all prenatal and birth-related variables are related to outcomes during each stage of childhood development. Father involvement and coparenting cooperation significantly mediated the associations among fathers' prenatal and birth-related variables and father-child closeness at ages 9 and 15. Our findings indicate that researchers, practitioners, and policymakers should take advantage of the prenatal period and direct resources to facilitate and strengthen prospective unmarried fathers' early relationships with their partners and children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Investigation of the effect of pregnant women's childbirth-related Internet use on fear of childbirth

This research was carried out to examine the effect of childbirth-related Internet use by pregnant women on fear of childbirth (FOC). The descriptive study was conducted with 350 pregnant women who applied to the Outpatient Polyclinic of Gynaecology and Obstetrics. Of the pregnant women who used the Internet, 72.9% did so to research information about childbirth. The pregnant women used the Internet mostly to obtain information about coping with labour pain (43.4%), the delivery process (46.9%), the needs list at delivery (39.4%), about C-section/epidural analgesia for labour (26.8%), and about the environment of the delivery room (25.7%). It was determined that there was a statistically significant difference (p < .05) between the delivery-related video viewing status of the pregnant women, the mean score of the W-DEQ Version A (p < .05), and the FOC was lower in those who watched videos about delivery.IMPACT STATEMENTWhat is already known on this subject? Previous studies have shown that pregnant women frequently use the Internet as a source of information about childbirth.What do the results of this study add? The findings of this study reveal that watching videos and listening to or reading the narrations significantly affected the FOC.What are the implications of these findings for clinical practice or further research? Nurses who provide preconception and antenatal care should consider Internet use as a risk factor for FOC and should guide pregnant women to reliable sources.

The Lay knowledge regarding the prevention of complications related to childbirth: Perceptions of Congolese pregnant women

During pregnancy, women sometimes choose certain practices based upon the experience of their family and/or their vicinity to anticipate complications that may occur during childbirth. The main objective of this study is to understand the motivations and perceptions of pregnant women on lay knowledge in the prevention of complications related to childbirth among a sample of Congolese women. We conducted this study at N’djili Referral Hospital in Kinshasa, Democratic Republic of Congo, using a qualitative phenomenological survey and indepth face-to-face interviews. We interviewed seven women on the phenomenon of lay knowledge practice in the prevention of maternal difficulties and analyzed the data using thematic coding. We provided a consent form to the participants and were careful not to include identifying information. Three main themes emerged: i) discussion of complications related to pregnancy and delivery, ii) perceptions about lay knowledge in preventing complications related to childbirth, and iii) suggestions from participants about using lay knowledge in healthcare settings. Based upon data collected, we argue that lay knowledge about pregnancy can be integrated into formal antenatal training when appropriate and, in doing so, we can build trust among pregnant women toward professional medical instruction.

Pregnancy; an opportunity to return to a healthy lifestyle: a qualitative study

Background

The lifestyle of the mother during pregnancy can affectthe health of their baby. Since lifestyle change is a sociocultural act and the motivations associated with lifestyle patterns during pregnancy cannot be explained in quantitative studies, a comprehensive study of the lifestyle during pregnancy and factors influencing its patterns was needed to investigate it from different aspects. Thus, the present study aimed to explore ‘mothers’ perceptions and experiences about lifestyle patterns during and after pregnancy and the reasons for adopting these lifestyles.

Methods

The present study, conducted on 20 pregnant or postpartum women living in Bushehr, Iran, has used a conventional content analysis approach.

The purposeful sampling method was used with maximum diversity and continued until data saturation. data were collected through face-to-face, in-depth, semi-structured interviews. Informed consent was obtained from all participants, and assuringthe confidentiality of their information. MAXQDA 10 software was used to analyze the data.

Results

Four main themes were defined after data analysis; "Being a mother as motivation for adopting a new healthy lifestyle"; "Access to information from media and supports from physicians as facilitators of adopting healthy lifestyle"; "Aspects of lifestyle modifications" and "Durability of healthy lifestyles". When women become pregnant, they feel a responsibility tohave a healthy pregnancy. They care about their fetuses more than themselves, which motivated them to look for the best lifestyle. In this way, access information from mass media and recommendations from professionals (physicians, midwives, and other health care providers) were helpful factors to have a healthy lifestyle, leading to modifying physical, mental, and religious aspects of lifestyle. However, despite reminding the advantages of a healthy lifestyle, these changesshift to a pre-pregnancy lifestyle due to the cessation of support and care provided during pregnancy.

Conclusion

The study results showed that pregnant women should be motivated to modify their lifestyle andadopt healthy lifestyles. Pregnant women seek to modify their lifestyle because of motherhood responsibility and and having a healthy baby. Access to information and supports from various sources promote a mother’s inner decision to change, leading to modifying different aspects of life. However, these modifications often shift to the pre-pregnancy lifestyle due to cessation of supports and care, despite reminding the benefits of the lifestyle change.

Health care providers should consider supportive measures during pregnancy and postpartum.

"Nobody Listened". Mothers' Experiences and Needs Regarding Professional Support Prior to Their Admission to an Infant Mental Health Day Clinic

Challenges during the perinatal period can lead to maternal distress, negatively affecting mother-infant interaction. This study aims to retrospectively explore the experiences and needs regarding professional support of mothers with difficulties in mother-infant interaction prior to their admission to an infant mental health day clinic. In-depth semi-structured interviews were conducted with 13 mothers who had accessed an infant mental health day clinic because of persistent severe infant regulatory problems impairing the wellbeing of the infant and the family. Data were transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). Three themes were identified: 'experience of pregnancy, birth, and parenthood'; 'difficult care paths'; and 'needs and their fulfillment'. The first theme consisted of three subthemes: (1) 'reality does not meet expectations', (2) 'resilience under pressure', and (3) 'despair'. Mothers experienced negative feelings that were in contradiction to the expected positive emotions associated with childbirth and motherhood. Resilience-related problems affected the mother-child relationship, and infants' regulatory capacities. Determined to find solutions, different healthcare providers were consulted. Mothers' search for help was complex and communication between healthcare providers was limited because of a fragmented care provision. This hindered the continuity of care and appropriate referrals. Another pitfall was the lack of a broader approach, with the emphasis on the medical aspects without attention to the mother-child dyad. An integrated care pathway focusing on the early detection of resilience-related problems and sufficient social support can be crucial in the prevention and early detection of perinatal and infant mental health problems.

First-time fathers' experience of childbirth: a cross-sectional study

OBJECTIVES

The purposes of this study are to report first-time fathers' experiences of childbirth through three dimensions (professional support, worries and prenatal preparation) and to analyse the influence of sociodemographic, antenatal and obstetrical factors on the three dimensions.

SETTING

Participants were recruited in France and Switzerland from two university hospitals that routinely manage high-risk pregnancies (level 3 - perinatal care level), with 4,000 to 5,000 annual births each.

METHODS

This is a secondary analysis of a cross-sectional study. The data initially were collected for the cross-cultural validation of the First-Time Father Questionnaire (FTFQ) into French. Descriptive statistics were used to report the participants' characteristics and their questionnaire responses. Multivariate linear regression analysis was carried out to stress the positive or negative factors linked with fathers' experiences of childbirth.

FINDINGS

Among 350 first-time fathers, 160 completed the FTFQ (response rate of 45.7%). The average age of the participants was 33 years old. We observed 12 questionnaire items with more than 20% unfavourable responses, seven of which involved the measurement of the worry dimension. Antenatal education and the prenatal-preparation dimension were positive factors linked with fathers' experiences. In addition, 57% of participants reported using one means of antenatal education, and 45% accessed information from family or friends.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The results suggest that first-time fathers need more professional support to foster positive experiences of childbirth. Their experiences of childbirth are associated with considerable worry. Antenatal classes specifically for fathers could reduce this worry and support the fatherhood process. Research should be carried out on these topics.

Men and sexual and reproductive healthcare in the Nordic countries: a scoping review

CONTEXT

Men generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries.

METHODS

We searched PubMed and SveMed+ for peer-reviewed articles published between January 2010 and May 2020. The analyses identified factors influencing men's experiences of and access to SRHC.

RESULTS

The majority of the 68 articles included focused on pregnancy, birth, infertility and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organisational obstacles, such as women-centred SRHC and no assigned healthcare profession for men's sexual and reproductive health issues, hindered men's access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men's access to SRHC.

CONCLUSIONS

The literature lacked the perspectives of specific groups of men such as migrants, men who have sex with men and transmen, as well as the experiences of men in SRHC related to sexual function, contraceptive use and gender-based violence. These knowledge gaps, taken together with the lack of a clear entry point for men into SRHC, indicate the necessity of an improved health and medical education of healthcare providers, as well as of health system interventions.

"What kind of man gets depressed after having a baby?" Fathers' experiences of mental health during the perinatal period

BACKGROUND

To date, information and support has been focused on mothers, with evidence that healthcare professionals overlook fathers' mental health, and that fathers receive little or no support for themselves during the perinatal period. However, recently, fathers' mental health has become an area of interest.

METHODS

This study explored the support fathers receive for their own mental health during the perinatal period. A qualitative questionnaire was distributed on social media networks and completed by twenty-nine fathers.

RESULTS

Thematic analysis produced three main themes: Factors Influencing Fathers' Mental Health, Consequences of Poor Mental Health in Fathers and Solutions to Improve Fathers' Mental Health.

CONCLUSIONS

The findings from this study highlighted important implications about fathers' mental health and the need to support them more effectively. Fathers' reluctance to seek support and the limited support available need to be addressed. Fathers in this study perceived that perinatal health professionals view 'mothers as the priority'. It is clear that health professionals need more training on how to recognise that fathers are also important and need support for their mental health.

Disjunctures in Experiences of Support During the Transition to Fatherhood of Men Who Have Used Intimate Partner Violence

The transition to fatherhood has been shown to be a stressful time for men, and their experiences of identifying and accessing formal and informal support are mixed. However, research on the experience of men who use intimate partner violence (IPV) during the transition to fatherhood is limited. The evidence documenting the prevalence and short- and long-term impact of violence perpetrated by men against women during pregnancy and postpartum demonstrates the seriousness of this public health issue. To understand the mechanisms of interrupting IPV by engaging men, the gap between what is known about experiences of identifying the need for and access to support during the transition to fatherhood of men with past and current histories of using IPV must be bridged. The study described explores experiences of support during the transition to fatherhood of men who have used IPV. Descriptive findings revealed that men had a range of types of supports from multiple sources; however, most also identified crucial unmet instrumental and socioemotional needs. Four themes surfaced disjunctures in how participants described resources they needed, accessed, and desired. Specifically, these disjunctures were related to men's adherence to a self-reliant identity, a lack of male-specific peer or role model support, the tendency for childbirth classes to be geared toward mothers and not seen by fathers as sources of support, and a gap between men's goals for themselves as fathers, and the actual tools, resources, and modeling that were accessible and "acceptable." The implications include suggestions for group-based programmatic efforts, and three initial steps for organizations to assess and build current capacity to engage-with safety and accountability at the forefront-fathers who use IPV.

NICU and postpartum nurse perspectives on involving fathers in newborn care: a qualitative study

BACKGROUND

Perinatal care nurses are well positioned to provide the education and support new fathers need to navigate the transition to fatherhood and to encourage positive father involvement from the earliest hours of a child's life. To effectively serve fathers in perinatal settings, it is important to understand the attitudes, beliefs, and behaviors of healthcare providers that may encourage and engage them, or alternatively alienate and discourage them.

METHODS

This qualitative study involved structured interviews with ten NICU and postpartum nurses from hospitals in two large Texas cities. The interview protocol was designed to elicit descriptive information about nurses' attitudes and beliefs, sense of efficacy and intention for working with fathers, as well as their father-directed behaviors. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by telephone and lasted approximately 25 to 35 min. Data were analyzed using a qualitative descriptive approach.

RESULTS

Overall, study participants held very positive subjective attitudes toward fathers and father involvement. Nevertheless, many of the nurses signaled normative beliefs based on race/ethnicity, gender, and culture that may moderate their intention to engage with fathers. Participants also indicated that their education as well as the culture of perinatal healthcare are focused almost entirely on the mother-baby dyad. In line with this focus on mothers, participants comments reflected a normative belief that fathers are secondary caregivers to their newborns, there to help when the mother is unavailable.

CONCLUSIONS

Nurse attitudes and practices that place mothers in the role of primary caregiver may be interpreted by fathers as excluding or disregarding them. Further research is needed to validate the results of this small-scale study, and to assess whether and how provider attitudes impact their practices in educating and engaging fathers in newborn care.

Mothers' Worries During Pregnancy: A Content Analysis of Reddit Posts

Qualitative investigations into maternal worries during pregnancy are limited. The aim of this study was to identify the content of women's pregnancy-related worries by completing a content analysis of posts on Reddit. A total of 217 posts by 196 unique users were analyzed. Most worries related to infant factors (32.6%), individual factors (27.1%), and antenatal care factors, such as medical procedures (25.2%). The remaining worries related to situational factors (10.9%) and the partner relationship (4.3%). Although most fears related to fetal well-being, other concerns included problems with family members, women's own mental health, and not being a "good mother." These findings support calls for antenatal education to more adequately address women's psychosocial concerns.

The Experiences of First-Time Fathers in Perinatal Services: Present but Invisible

Fathers in the UK are becoming more involved in the care of their infants and children. A constructivist grounded theory approach was adopted to explore men’s transition to fatherhood. This paper reports on one of the sub-categories derived from the data. First-time fathers with a child under two were recruited predominantly via social media. Audio-recorded semi-structured interviews were undertaken with an opening question asking men to tell their story of becoming a father. Interviews were transcribed and analysed using constructivist grounded theory methods. This paper reports one core aspect of the research findings which has particular relevance for healthcare professionals. The men in this study were highly appreciative of the care their partner and baby received but consistently reported a lack of father-specific support throughout their journey to fatherhood. This ranged from generally poor communication with healthcare professionals to being ignored and side-lined in maternity settings where they continued to be treated as visitors before, during and after the birth of their baby. Despite similar findings being reported over the last 30 to 40 years and policy directives emphasising the importance of working with fathers, change within healthcare services remains slow. Currently, fathers’ needs are not being adequately met by perinatal services.

Parents who have received 'psycho-prophylaxis training' during pregnancy and their experience of childbirth - An interview study highlighting the experiences of both parents

Background: The form of parental support during pregnancy is constantly changing due to developments in society. 'Psycho-prophylaxis training' is a form of parental support used in preparation for childbirth. Only a few studies describe the childbirth experience of both the parents.The aim was to interview parents receiving 'psycho-prophylaxis training' during pregnancy and to elucidate their experience of childbirth.Method: A total of 22 open interviews were conducted with 11 expectant mothers and their 11 partners. Analysis of the interviews was performed using the content analysis method.Results: Three categories emerged in the manifest phase. 'To gain security from knowledge and focus on breathing and relaxation', 'The couple's sense of proximity and the team collaboration with the maternity staff' and 'Meeting pain'. Two themes emerged during the latent analysis of which one was," Participation gave a sense of security" and the other was 'Manageability'.Conclusion: Knowledge about childbirth and the ability, by the mother, to use various breathing techniques seemed to help both parents, as it made both of them feel that they were themselves involved in the process.

Transition to fatherhood in the prenatal period: a qualitative study

Becoming a father requires a process of personal development, inner reorientation, and adaptation to a new role. The literature on this process has been sparse, devaluing how challenging and problematic the transition to becoming a father can be. This qualitative, exploratory, descriptive, cross-sectional and retrospective study sought to understand the experiences of men in the transition to fatherhood during the prenatal period. It included a sample of 10 men experiencing, for the first time, a partner's pregnancy. The data collection technique used was semi-structured interviews. The content analysis technique with semantic categorization and an inductive approach was used to analyze the data. As a result, 3 topics emerged: "experiencing the transition," "development of the father identity" and "(de)constructing bridges for the transition". This study deepens the understanding of this developmental transition and challenges the restructuring of prenatal care towards the inclusion of the father figure.

Parents' Perspectives on Supporting Father Involvement in African American Families During Pregnancy and Early Infancy

OBJECTIVE

To explore fathers' pregnancy and early infancy experiences in supporting his infant, partner, and himself, using information collected from fathers, mothers, and mother-father dyads in a low-income, urban community.

BACKGROUND

Father involvement is associated with positive child health outcomes and parental well-being. However, little information exists about low-income parents' perceived needs for father involvement during pregnancy and infancy.

METHODS

This was an exploratory qualitative study of parents in low-income communities of Baltimore, Maryland. Participants were conveniently sampled via partnerships with community organizations. Eighty percent of parents were African American. Four focus groups were conducted with fathers (n = 8), 4 with mothers (n = 9), and 4 interviews with father-mother dyads (n = 8). Sessions were audio-recorded, transcribed, and analyzed using iterative, inductive open coding performed independently by two team members (interrater agreement 86%). Frequency tables were generated for identified categories for content analysis and theme development.

RESULTS

Five themes were identified: perspectives on the father role, supporting partners, negotiating co-parenting, parenting logistics, and learning parenting skills. Participants expressed the importance of fathers to "be there" and barriers to being involved (e.g., finances, lack of role models). Fathers discussed needing to learn how to manage partner conflicts, while mothers discussed fathers' need for greater empathy. Dyads discussed the importance of co-parenting strategies (e.g., effective communication, sharing responsibilities). Logistics included direct infant care, finances, and community resources. Fathers discussed learning by trial and error rather than informational resources and relying on healthcare professionals for pregnancy information and female relatives for infant care.

CONCLUSION

Participants discussed various needs of fathers to be effective partners and parents, and lacking informational resources tailored specifically for fathers. Research is needed to explore the best ways to tailor and disseminate information to fathers, especially prenatally.

IMPLICATIONS

Study findings have significant implications for improving the ways in which maternity care, community-based programs, and pediatric providers support father involvement.

Effects of a mindfulness based childbirth and parenting program on pregnant women's perceived stress and risk of perinatal depression-Results from a randomized controlled trial

OBJECTIVES

The aim of this study was to test the efficacy of a Mindfulness-Based Childbirth and Parenting Program (MBCP) in reducing pregnant women's perceived stress and preventing perinatal depression compared to an active control condition.

METHOD

First time pregnant women (n = 197) at risk of perinatal depression were randomized to MBCP or an active control treatment, which consisted of a Lamaze childbirth class. At baseline and post-intervention, participants filled out questionnaires on perceived stress, depressive symptoms, positive states of mind, and five facets of mindfulness.

RESULTS

Compared to the active control treatment, MBCP significantly reduced perceived stress (p = 0.038, d = 0.30) and depressive symptoms (p = 0.004, d = 0.42), and increased positive states of mind (p = 0.005, d = 0.41) and self-reported mindfulness (p = 0.039, d = 0.30). Moreover, change in mindfulness possibly mediated the treatment effects of MBCP on stress, depression symptoms, and positive states of mind. The subscales "non-reactivity to inner experience" and "non-judging of experience" seemed to have the strongest mediating effects.

LIMITATIONS

The outcomes were self-report questionnaires, the participants were not blinded to treatment condition and the condition was confounded by number of sessions.

CONCLUSIONS

Our results suggest that MBCP is more effective in decreasing perceived stress and risk of perinatal depression compared to a Lamaze childbirth class. The results also contribute to our understanding of the underlying psychological mechanisms through which the reduction of stress and depression symptoms may operate. Thus, this study increases our knowledge about efficient intervention strategies to prevent perinatal depression and promote mental wellbeing among pregnant women.

Mothers' views of health problems in the 12 months after childbirth: A concept mapping study

AIMS

To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth.

BACKGROUND

Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems.

DESIGN

A mixed method concept mapping study.

METHOD

Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth.

RESULTS

Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems.

CONCLUSION

Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support.

IMPACT

Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.

The relationship between support systems and anxiety in couples admitted to the emergency department with vaginal bleeding

INTRODUCTION

First-trimester vaginal bleeding largely occurs due to miscarriage, ectopic pregnancy, gestational trophoblastic diseases. Pregnant women diagnosed with threatened abortion experience and their spouses severe anxiety and stress due to the probability of the pregnancy ending. Couples having difficulty coping with the see motions need support systems. The aim of this study was to examine the relationship between the anxiety levels experienced by couples who present at the emergency department with a complaint of vaginal bleeding and are diagnosed with threatened abortion, as well as their support systems.

METHODS

The study was conducted with 276 participants (138 pregnant women and their spouses) admitted to the obstetrics emergency department of an obstetrics and paediatrics hospital in Turkey between December 2014 and March 2015. Data were collected through a demographic information form developed by the researcher, the State-Trait Anxiety Inventory (STAI), and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

There were significant negative associations between mean the State-Trait Anxiety Inventory scores and Multidimensional Scale of Perceived Social Support scores of the pregnant women and their spouses (p < 0.05). The couples' anxiety levels did not significantly differ according to whether they received support from each other and from emergency nurses (p > 0.05).

CONCLUSION

It was found that both state and trait anxiety levels of the couples decreased as perceived social support increased. However, it was determined that the support couples received from each other and from emergency nurses was not sufficient in terms of reducing anxiety.

The Other Parent: An Exploratory Survey of Providers' Engagement of Fathers in Pediatric Primary Care

Although father engagement in pediatric care is associated with positive child health outcomes, pediatric primary care providers (PCPs) often focus on the mother-child dyad. This study sought to characterize pediatric PCPs' engagement of fathers in care. Pediatric PCPs affiliated with an academic health system were invited to complete an online survey. The primary outcome was the proportion of providers who routinely implement American Academy of Pediatrics recommendations for father engagement. There were 100 respondents. Of the 23 recommended practices for engaging fathers, 18 were routinely implemented by <50% of respondents. The least routinely implemented practices were parenting skills support (4%) and perinatal depression screening (5%). The most commonly endorsed barriers included lack of father attendance at visits (91%) and time constraints (75%). Despite the American Academy of Pediatrics recommendations, pediatric PCPs do not routinely engage fathers in care. Effective strategies are needed to reduce barriers and improve father engagement among pediatric providers.

Social Services Professionals' Views of Barriers to Supporting Homeless Noncustodial Fathers

OBJECTIVE

To investigate barriers to service for homeless non-custodial fathers from the perspective of social service professionals who work directly to assist men with securing housing while meeting the demands of fatherhood.

BACKGROUND

The population of homeless fathers in the United States is increasing. Longitudinal studies show that although homeless noncustodial fathers and mothers face similar risk factors and barriers to services, research on minimizing risk factors and barriers for noncustodial fathers is limited compared with that for noncustodial mothers.

METHOD

The sample included 7 administrators and 12 direct service professionals engaged with fathers transitioning from homelessness. Data were collected via face-to-face, semi-structured interviews and analyzed using a qualitative inductive approach. Multiple cycle coding was employed to capture emerging themes.

RESULTS

Three major themes, encompassing emotional, relational, and systemic factors, emerged regarding participants' experiences serving homeless noncustodial fathers.

CONCLUSION

Effective approaches to supporting fathers require empathy, relationship building, and collaboration between service providers and policymakers.

IMPLICATIONS

Future policies and interventions should be based on input from direct service professionals and homeless noncustodial fathers themselves, with the aim of best supporting their efforts toward securing housing while meeting the demands of fatherhood.

Exploring antenatal education content for couples in Blantyre, Malawi

BACKGROUND

Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness.

METHODS

An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis.

RESULTS

We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care.

CONCLUSION

Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.

Communication Technology Use and Preferences for Pregnant Women and Their Caregivers

The rapid evolution of communication technologies has created new ways for healthcare consumers to manage their health. In a mixed-methods study, we examined technology use and willingness to use in pregnant women and caregivers, using surveys and semi-structured interviews. Most participants had used text messaging, automated phone calls, Skype/FaceTime, social media, and online discussion forums. To communicate with healthcare providers, most were willing to use text messaging and had not, but desired to use Skype/FaceTime. Fewer were willing to use social media or online discussion forums due to concerns about privacy and security. Most were willing to use text messaging, Skype/FaceTime, or online discussion forums to support health in other ways, but few had done so. About half were willing to use automated phone calls, but most did not like them due to the impersonal nature and time required. Developers should consider such preferences in design of health information technologies.

What is learned from Mindfulness Based Childbirth and Parenting Education? - Participants' experiences

BACKGROUND

In the search for effective interventions aiming to prevent perinatal stress, depression and anxiety, we are evaluating a Mindfulness Based Childbirth and Parenting (MBCP) Program. In this study we explore the participants' experiences of the program.

METHOD

This is a descriptive qualitative study with influences of phenomenology. The participants were expectant couples who participated in the program and the pregnant women had an increased risk of perinatal stress, anxiety and depression. Ten mothers and six fathers were interviewed in depth, at four to six months postpartum. Thematic analysis of the transcripts was conducted.

RESULTS

The participants' descriptions show a variety in how motivated they were and how much value they ascribed to MBCP. Those who experienced that they benefitted from the intervention described that they did so at an intra-personal level-with deeper self-knowledge and self-compassion; and on an inter-personal level-being helpful in relationships. Furthermore, they perceived that what they had learned from MBCP was helpful during childbirth and early parenting.

CONCLUSION

Our findings demonstrate that most of the parents experienced MBCP as a valuable preparation for the challenges they met when they went through the life-changing events of becoming parents. The phenomenon of participating in the intervention, integrating the teachings and embodying mindfulness seems to develop inner resources that foster the development of wisdom.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02441595, May 4, 2015.

Avaliação do cuidado pré-natal na atenção primária a saúde na percepção da gestante

Resumo OBJETIVO Avaliar o cuidado pré-natal na Atenção Primária a Saúde na percepção da gestante. MÉTODO Trata-se de um estudo transversal com análise da associação e significância estatística da expectativa e satisfação das gestantes com o cuidado pré-natal em um município da região sudeste do Brasil. A associação foi avaliada pela regressão logística simples e significância estatística entre algumas variáveis e os domínios expectativa e satisfação. RESULTADOS Foi identificado predomínio de baixa expectativa 279 (74%) e alta satisfação 220 (58,8%) das gestantes com o cuidado pré-natal. Os testes de associação demonstraram associação e significância estatística entre a variável “ter utilizado o mesmo serviço de pré-natal” com o domínio satisfação. Não houve diferenças entre os dois modelos de atendimento para ambos os domínios. CONCLUSÃO A baixa expectativa e alta satisfação das gestantes para os dois modelos de atendimento pode ser aperfeiçoada para a melhora da qualidade assistencial de ambos os serviços.

Engaging Men in Prenatal Health via eHealth: Findings From a National Survey

BACKGROUND

Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors.

OBJECTIVE

The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers.

METHODS

A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey.

RESULTS

Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger.

CONCLUSIONS

We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early "teachable moment"-where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States.

"I Didn't Know What to Ask About": First-Time Mothers' Conceptions of Prenatal Preparation for the Early Parenthood Period

The aim of this phenomenographic study was to describe first-time mothers' conceptions of prenatal preparation for the early parenthood period in relation to their experiences of early parenthood. Eighteen first-time mothers were interviewed approximately 1 month after giving birth. The categories identified in the analysis were: accessing appropriate sources of support, gaining knowledge to form realistic expectations, and mobilizing and strengthening personal resources. First-time mothers want health professionals to actively address postnatal issues as they have difficulties in knowing prenatally what knowledge will prepare them for early parenthood. Both professional and peer support during pregnancy were conceived as important for gaining knowledge. Professionals can support by guidance to reliable sources of information and encouraging personal reflections and partner communication.

Fathers' Worries During Pregnancy: A Qualitative Content Analysis of Reddit

Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers' worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work-family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers' experiences of pregnancy and can inform the development of father-inclusive perinatal education.

Engaging Men in Prenatal Health Promotion: A Pilot Evaluation of Targeted e-Health Content

Pregnancy outcomes in the United States continue to rank among the worst in the developed world. Traditional maternal–child health promotion tends to focus exclusively on women, leaving men out of programs that can affect family health. Scholars advocate including men in prenatal health to reduce maternal and infant mortality and morbidity. This study explored the perceived role of men in prenatal health, the use of an e-health application, and participant-suggested ways of improving the application moving forward. This study interviewed men in a large Southwestern U.S. city with an average age of 26.0 years (N = 23). The sample was 52% White, 26% Hispanic, 9% Asian, 9% multiracial or other, and 4% Black. Participants were asked about pregnancy health and used a pregnancy-related e-health application on a tablet computer. Participants provided opinions on content, ease of use of tablets, and recommendations for a stronger application. Despite perceived barriers such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. Most found the application to contain useful and interesting information. Participants recommended the addition of videos and interactive modules to make the application stronger. This study explored the use of a targeted e-health application to introduce men to prenatal health education. Results indicate men feel favorable to this type of intervention. Additional refinement of the application could include interactive tools or “push content” to further engage men in this important topic.

What do expectant fathers expect of antenatal care in Sweden? A cross-sectional study

BACKGROUND

In Sweden expectant fathers are now assumed to be active participants in pregnancy and birth, but few studies have focused on fathers' expectations of antenatal care. Knowledge of expectant fathers' views about what is important in antenatal care will enable the design of care that is more inclusive and meets the expectant fathers' needs.

OBJECTIVES

To identify expectant fathers' expectations regarding the content of antenatal care during pregnancy and to examine associations between expectations and social factors.

METHODS

The current study uses data from a quasi-experimental trial that took place from 2009 to 2010, in which 627 expectant fathers were recruited from different parts of Sweden.

RESULTS

Checking the health of the baby (85.3%) and the mother (80.8%) were rated highest in importance by expectant fathers, whereas attending parent classes (14.9%), becoming acquainted with other expectant parents (7.0%) and paying attention to their own emotional well-being (6.9%) were rated lowest. Furthermore, less than half of the expectant fathers had a very high expectation of being treated in a way that made them feel involved (38.5%).First-time fathers, young fathers and fathers with very good emotional health had higher expectations about most aspects of antenatal care.

CONCLUSION

Expectant fathers had low expectations of receiving support or of meeting other parents as they thought that antenatal care should have a medical focus. First-time fathers, young fathers and fathers with very good emotional health had higher expectations of antenatal care in most areas.

Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals

Sweden has a reputation for gender equality, and its child health services seek to support both parents. However, this meta-ethnographic analysis of 62 studies from 2000 to 2015 covering prenatal clinics, labour and birth wards, postnatal wards and child health centres found programmes had not been designed around paternal needs. Therefore, despite the policy change nearly 50 years ago to include both parents, fathers were still not fully accepted and supported.

CONCLUSION

To provide fathers in Sweden with greater support throughout the child health field, organisational changes should be considered, as this could provide further beneficial outcomes for children, families and society.

Content and Presentation of Content in Parental Education Groups in Sweden

This study investigated parents' experiences of parental education groups at antenatal and child health care centers, including content, presentation of content, the leader's role, and the importance of other participating parents. Twenty-one interviews with 26 parents from 6 cities across Sweden were analyzed with 3 content analysis approaches. Parents expressed both satisfaction and dissatisfaction with the content, presentation of content, and the leader's role. They reported that social contact with other parents was important, that parenthood topics were covered less frequently than child and childbirth-related topics, and that group activities were less frequent than lectures. When designing future parental education groups, it is important to consider expanding parenthood topics and group activities because this structure is considered to provide support to parents.

"It's like a puzzle": Pregnant women's perceptions of professional support in midwifery care

PROBLEM

Pregnant women are not always satisfied with the professional support they receive during their midwifery care. More knowledge is needed to understand what professional support pregnant women need for childbirth and parenting.

BACKGROUND

Childbearing and the transition to becoming a parent is a sensitive period in one's life during which one should have the opportunity to receive professional support. Professional support does not always correspond to pregnant women's needs. To understand pregnant women's needs for professional support within midwifery care, it is crucial to further illuminate women's experiences of this support.

AIM

To explore pregnant women's perceptions of professional support in midwifery care.

METHODS

A qualitative study using semi-structured interviews. Fifteen women were interviewed during gestational weeks 36-38. Data was analysed using phenomenography.

FINDINGS

The women perceived professional support in midwifery care to be reassuring and emotional, to consist of reliable information, and to be mediated with pedagogical creativity. The professional support facilitated new social contacts, partner involvement and contributed to mental preparedness. The findings of the study were presented in six categories and the category Professional support contributes to mental preparedness was influenced by the five other categories.

CONCLUSION

Pregnant women prepare for childbirth and parenting by using several different types of professional support in midwifery care: a strategy that could be described as piecing together a puzzle. When the women put the puzzle together, each type of professional support works as a valuable piece in the whole puzzle. Through this, professional support could contribute to women's mental preparedness for childbirth and parenting.

A SYSTEMATIC REVIEW OF INTERVENTIONS TARGETING PATERNAL MENTAL HEALTH IN THE PERINATAL PERIOD

Interventions targeting parents' mental health in the perinatal period are critical due to potential consequences of perinatal mental illness for the parent, the infant, and their family. To date, most programs have targeted mothers. This systematic review explores the current status and evidence for intervention programs aiming to prevent or treat paternal mental illness in the perinatal period. Electronic databases were systematically searched to identify peer-reviewed studies that described an intervention targeting fathers' mental health in the perinatal period. Mental health outcomes included depression, anxiety, and stress as well as more general measures of psychological functioning. Eleven studies were identified. Three of five psychosocial interventions and three massage-technique interventions reported significant effects. None of the couple-based interventions reported significant effects. A number of methodological limitations were identified, including inadequate reporting of study designs, and issues with the timing of interventions. The variability in outcomes measures across the studies made it difficult to evaluate the overall effectiveness of the interventions. Father-focused interventions aimed at preventing perinatal mood problems will be improved if future studies utilize more rigorous research strategies.

Association between parental depressive symptoms and impaired bonding with the infant

Impaired bonding with the infant is associated with maternal postpartum depression but has not been investigated extensively in fathers. The primary study aim was to evaluate associations between maternal and paternal depressive symptoms and impaired bonding with their infant. A secondary aim was to determine the associations between parents' marital problems and impaired bonding with the infant. The study is part of a population-based cohort project (UPPSAT) in Uppsala, Sweden. The Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postpartum and the Postpartum Bonding Questionnaire at 6 months postpartum were completed by 727 couples. The prevalence of impaired bonding was highest among couples in which both spouses had depressive symptoms. Impaired bonding was associated with higher EPDS scores in both mothers and fathers, as well as with experiencing a deteriorated marital relationship. The association between maternal and paternal impaired bonding and the mothers' and fathers' EPDS scores remained significant even after adjustment for relevant confounding factors. Depressive symptoms at 6 weeks postpartum are associated with impaired bonding with the infant at 6 months postpartum for both mothers and fathers. It is critical to screen for and prevent depressive symptoms in both parents during early parenthood.

What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women

BACKGROUND

Global uptake of antenatal care (ANC) varies widely and is influenced by the value women place on the service they receive. Identifying outcomes that matter to pregnant women could inform service design and improve uptake and effectiveness.

OBJECTIVES

To undertake a systematic scoping review of what women want, need and value in pregnancy.

SEARCH STRATEGY

Eight databases were searched (1994-2015) with no language restriction. Relevant journal contents were tracked via Zetoc.

DATA COLLECTION AND ANALYSIS

An initial analytic framework was constructed with findings from 21 papers, using data-mining techniques, and then developed using meta-ethnographic approaches. The final framework was tested with 17 more papers.

MAIN RESULTS

All continents except Australia were represented. A total of 1264 women were included. The final meta-theme was: Women want and need a positive pregnancy experience, including four subthemes: maintaining physical and sociocultural normality; maintaining a healthy pregnancy for mother and baby (including preventing and treating risks, illness and death); effective transition to positive labour and birth; and achieving positive motherhood (including maternal self-esteem, competence, autonomy). Findings informed a framework for future ANC provision, comprising three equally important domains: clinical practices (interventions and tests); relevant and timely information; and pyschosocial and emotional support; each provided by practitioners with good clinical and interpersonal skills within a high quality health system.

CONCLUSIONS

A positive pregnancy experience matters across all cultural and sociodemographic contexts. ANC guidelines and services should be designed to deliver it, and those providing ANC services should be aware of it at each encounter with pregnant women.

TWEETABLE ABSTRACT

Women around the world want ANC staff and services to help them achieve a positive pregnancy experience.