Coping Strategies of Pregnant Women with Detected Fetal Anomalies in Iran: A Qualitative Study

Psychosocial intervention programme based on the needs of women undergoing termination of pregnancy for foetal anomalies: A modified Delphi study

AIM

To construct a psychosocial intervention programme for women diagnosed with foetal anomalies based on their needs in China.

DESIGN

A three round-modified Delphi survey from September to November 2020.

METHODS

In Round 1, based on literature review and qualitative interviews, a face-to-face meeting with eight taskforce members was conducted to generate the initial intervention indicators. In Round 2 and 3, 15 experts and three stakeholders (women undergoing termination of pregnancy for foetal anomalies) were invited by email to evaluate the importance of the indicators and built the final psychosocial intervention programme.

RESULTS

The response rate for both two rounds is 100%. The experts' authority coefficient was 0.86. The Kendall W value of the two rounds ranged between 0.191 and 0.339. A needs-based psychosocial intervention programme was established, including four periods (denial, confirmation, decision-making and recovery), three needs-based supports (information, social and acceptance commitment therapy) and 27 intervention indicators. The mean value of the importance of each index was 4.00-5.00. Further research is required to evaluate whether this programme is realistic and effective for the target audiences.

Prenatal harmful substances: Thai pregnant women's experiences

Background

The exposure of unborn babies to harmful substances during prenatal stages can lead to fetal anomalies, emphasizing the significance of pregnant women's practices in ensuring optimal fetal outcomes. However, there is a lack of understanding regarding this issue from the perspective of pregnant women.

Objective

This study aimed to describe the experiences of pregnant women in avoiding harmful substances to their unborn babies.

Methods

This study used a qualitative descriptive approach. Data were collected between September 2020 and April 2021 through in-depth interviews with 17 pregnant women purposively selected from two hospitals in southern Thailand. Data were transcribed verbatim and analyzed using thematic analysis.

Results

Four themes emerged from the participants' experiences: 1) understanding of harms, which included substance characteristics, exposure characteristics, body's protective mechanism, personal experiences, and obtained information; 2) practices for safety, which consisted of food safety, work safety, ambient air safety, and safety in personal/household products; 3) challenges in avoiding harmful substances, which were unrecognition, unavailability of safe substances, discomfort and inconvenience, inevitability, and family traditions; and 4) overcoming the challenges through personal changes, obtaining support, and ensuring a peaceful mind.

Conclusion

The findings provide valuable insights into prenatal exposure to harmful substances, which can serve as a basis for developing comprehensive guidelines for best practices. It is crucial for nurses to receive training that enables them to educate pregnant women, enhancing their awareness of important harmful substances and promoting effective methods for maintaining safety in their daily activities. Additionally, nurses can develop interventions to empower pregnant women to overcome challenges by involving significant individuals, particularly family members, in providing support and creating an optimal prenatal environment.

Coping strategies following the diagnosis of a fetal anomaly: A scoping review

Introduction

Many women experience severe emotional distress (such as grief, depression, and anxiety) following a diagnosis of fetal anomaly. The ability to cope with stressful events and regulate emotions across diverse situations may play a primary role in psychological wellbeing. This study aims to present coping strategies after disclosing a fetal anomaly to pregnant women.

Methods

This is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR). Electronic databases, including Web of Science (WOS, BCI, KJD, MEDLINE, RSCI, SCIELO), CINAHL, and EBSCO PsycARTICLES, were used to search for primary studies from the inception of each database to 2021. The keywords were determined by existing literature and included: "fetal anomaly," "fetal abnormality," "fetal anomaly," "fetal abnormality" AND "cope," "coping," "deal," "manage," "adapt*," "emotion* regulate*," with the use of Boolean operators AND/OR. A total of 16 articles were reviewed, followed by advancing scoping review methodology of Arksey and O'Malley's framework.

Results

In this review, we identified 52 coping strategies using five questionnaires in seven quantitative studies and one mixed-method study. The relationship between coping strategies and mental distress was explored. However, the results were inconsistent and incomparable. We synthesized four coping categories from qualitative studies and presented them in an intersection.

Conclusion

This scoping review identified the coping strategies of women with a diagnosis of a fetal anomaly during pregnancy. The relationship between coping strategies and mental distress was uncertain and needs more exploration. We considered an appropriate measurement should be necessary for the research of coping in women diagnosed with fetal anomaly pregnancy.

Women's worries about prenatal screening tests suspected of fetal anomalies: a qualitative study

BACKGROUND

Pregnant women with suspected fetal anomalies experience a great deal of stress following prenatal screening tests. The present study aimed to investigate women's worries about prenatal screening tests suspected of fetal anomalies.

METHODS

Through the use of qualitative content analysis, the reports of women whose prenatal screening tests were suspected of fetal anomalies were analyzed and the results were interpreted. The participants were selected from four public and private maternity care clinics of Babol, Iran, from December 2021 to January 2022, using targeted convenience sampling. Data were collected from 20 women aged 24 to 41 years old, who underwent prenatal screening tests and were suspected of fetal anomalies, using semi-structured face-to-face interviews.

RESULTS

The four main themes included the "causes of worries" (with sub-themes of challenge with spouse and relatives, medical diagnosis processes, previous unpleasant experiences, physical and mental problems, financial worries, and misinformation), "anxiety-coping styles" (with cognitive emotion-oriented, behavioral emotion-oriented, and problem-oriented sub-themes), "reactions to a possible diagnosis of anomaly" (with three sub-themes, namely concealment, extreme fear and worry, and denial), and "attribution of the cause of the anomaly" (with sub-themes of consanguine marriage, evil eyes, tendency to have a baby of a particular gender, a history of anomalies in the previous child, the spouse's medical illness, unplanned pregnancy, and high maternal anxiety).

CONCLUSION

Women with suspected fetal anomalies experience a great deal of stress, the most important reason for which is the "physician's uncertainty". "Sharing worries with relatives" was the most common style of coping with worries. Establishing emotional support and empathetic communication between midwives and physicians with pregnant women suspected of fetal anomalies were important ways to reduce their worries.

Clinical trial of a birth and parenting planning program for women diagnosed with fetal anomalies: A feasibility study

AIM

We assessed the feasibility of the Birth and Parenting Planning (BPPing) program we developed to support women diagnosed with fetal anomalies.

METHODS

We conducted a feasibility study using a quasi-experimental, post-test only, non-equivalent groups design. We assessed feasibility from four aspects: (1) Demand: birth plan submitting rate (primary outcome); (2) Acceptability: woman's satisfaction of care scale (SATISFACTION) and Visual Analog Scale for care satisfaction; (3) Preliminary efficacy: women's recognition of being able to express and share her hopes scale (HOPES); and (4) Safety: obstetric/neonatal outcomes and frequency of women's referral to a psychological counselor. Fisher's exact test and Mann-Whitney U-test were used for data analysis.

RESULTS

We enrolled 62 women with fetal anomalies attending a perinatal medical center for antenatal check-ups. Of these, 51 women (median age: 34 years) received either the BPPing program (intervention group: n = 25) or the usual care (control group: n = 26). The birth plan submitting rates were 96% (intervention group, 24/25) and 7.7% (control group, 2/26). The intervention group had a significantly higher total score on HOPES at postpartum (U = 441.5, p = 0.027). Upon subgroup analysis based on parity, in the intervention group only, the multiparas had a higher score on the SATISFACTION item, "I would recommend the care I received to someone in a similar situation". There were no adverse events in either group.

CONCLUSION

The BPPing program was feasible in supporting women diagnosed with fetal anomalies in terms of demand, acceptability, preliminary efficacy, and safety.