Abstracts of papers and posters presented at the 28th Annual Conference of the Society for Reproductive and Infant Psychology

ORAL PRESENTATIONS

Health and development of 0–3 month old newborn babies: A Randomised Cluster Control Trial [RCCT] using a novel–manual stimulus

Elvidina Nabuco Adamson‐Macedo Christopher Roland Barnes

School of Health, University of Wolverhampton, UK

Neo‐hapy is a novel manual stimulus developed after many trials demonstrating that haptic touch or active touch occurs before 4 months; a new phrase, ‘neo‐haptic touch’, was coined to describe it. This small sample and short longitudinal study (12 weeks) adopted a Randomised Cluster Control Trial (RCCT) to test the hypothesis that the mental (cognitive), motor and social (communication) development of healthy newborn babies would be facilitated by systematic ‘hands‐on exploration’ of Neo‐hapy as measured by the Bayley (III) Scales of Infant Development Screening test. Following Ethics Committees' approval, eight newborn infants (equal numbers of males and females in each group) were recruited from a single hospital in the West Midlands County; they were visited and used either Neo‐hapy or a Regular interactive object, at home twice a week for 12 weeks.

Results revealed that, compared with babies who used a Regular interactive object, those who used Neo‐hapy had higher cognitive, motor and communication development scores at weeks 6 and 12 of life; there were no significant differences on baseline measurements. A constructivist approach to perception is used to explain results which suggest that systematic community‐based programmes promote neonatal health and development.

Polish and Finnish students' views on andropause. Opinions on andropause, knowledge about its symptoms and the image of an andropausal man

Eleonora Bielawska‐Batorowicz and Katarzyna Pryczek

University of Łódź, Poland

Objectives: The andropause is gaining attention among professionals and public. Its presentation resembles in some aspects that of menopause. This study aimed to describe knowledge and opinions on andropause among Polish and Finnish students and to answer the questions: (1) whether gender and nationality differentiate opinions and the level and accuracy of knowledge, (2) how level of knowledge affects the image of andropausal men, and (3) whether opinions on andropausal men and menopausal women are related.

Material and methods: Participants were students (aged 18–27) from Łodź and Tampere. There were 62 females and 54 males in the Polish sample, and 62 females and 46 males in the Finnish sample. The questionnaires included: ‘Opinions on andropause’, ‘Andropausal symptoms’ and ‘Description of andropausal/menopausal person’. All were designed for this study and in Polish and Finnish parallel versions.

Results: Opinions on andropause and knowledge of its symptoms included false and correct elements. Neither main effect of gender or nationality nor their interaction was found when opinions were analysed. Knowledge of andropausal symptoms was significantly higher among females and among Polish participants. The image of an andropausal man included more negative than positive elements, and was related to nationality (Finns were more positive) and gender (males were more positive). Higher level of knowledge was correlated with a more negative image of a man. Images of menopausal women and andropausal men were correlated.

Conclusions: Implications of the findings include promotion activities aimed at reduction of stereotypes concerning andropause and early implementation of health‐related behaviours.

Perceptions of disability and information in prenatal testing

Hilary Grant

The Leeds institute of Health Sciences, The University of Leeds, UK

Background: When making a choice about whether or not to accept prenatal testing for genetic conditions, prospective parents need access to good quality information about the condition for which testing is offered. Although there is now a national programme for Sickle Cell testing and similar plans have been considered for Fragile X Syndrome, the literature is sparse with regard to the quality of life experienced by individuals and families affected by these conditions. The quality of information available for prospective parents may reflect this gap.

Aim: The presentation will provide data from a study that considers how these disabling conditions can manifest and affect family life and the information which may be important to give prospective parents.

Method: Two groups of people were interviewed: people who have either of the two conditions or the parents or other close relative with a caring role. The data from the interviews will be analysed using Interpretative Phenomenological Analysis. Data will also be used as input to a Q methodology study to identify diversity in people's perceptions of quality of life and Sickle Cell Disorder or Fragile X Syndrome and to identify the key similarities and differences in those perceptions.

Intended research outcome: It is considered that the findings of the study may be useful when considering information for other genetic conditions and assist policy makers in structuring interventions to support prospective parents, who face choices in the prenatal testing context.

A comparison of Swedish and English primiparas' experiences of birth

Josephine M. Green^a, Erica Schytt^b,c, Helen A. Baston^a and Ulla Waldenström^c

^aMother & Infant Research Unit, Department of Health Sciences, University of York, UK; ^bCenter for Clinical Research Dalarna, Sweden; ^cDepartment of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden

Obstetric and midwifery practices vary considerably from country to country, and recent large‐scale studies of women's experiences have indicated an interesting range of similarities as well as differences. In the absence of a large, prospective cross‐national study using equivalent, validated data‐collections tools, data were examined from two independent survey‐based longitudinal studies, ‘KUB’ or ‘Women's experience of childbirth’ in Sweden and ‘Greater Expectations?’ in England, which had had similar aims and methodology. Our joint data sets offered us the opportunity to look for similarities and differences between the samples that might contribute to differences in women's experiences of childbirth and in mode of birth, as well as differences in psychosocial sequelae. Analyses were restricted to those giving birth for the first time. We offer this as a ‘worked example’ of the limitations of post hoc comparison and as a demonstration of what can, none the less, be learnt. Analysis revealed many commonalities as well as a number of striking differences. The most robust finding was that Swedish primiparas were significantly more likely to have an unassisted vaginal birth. The data also suggest that they used more positive terms to describe themselves in labour, but these differences between the two samples appear not to be reflected in the evaluation of childbirth overall. Regression analyses showed that the variables associated with an unassisted birth and with childbirth satisfaction were very similar in the two samples.

Involuntarily childless men: Issues surrounding the desire to be a father

Robin Hadley

University of Manchester, UK

Rationale: The rationale for this research comes from my own experience, and that of male clients in counselling, who at times have been seriously affected by the desire to be a father. Included in my own reactions have been anger, sadness, elation, depression, hurt, isolation, jealousy, denial, guilt, relief, yearning and withdrawal. Similar reactions are reported in studies in both male and female infertility. There is little research on the desire to be a father, with most studies concentrating on couples in infertility treatment. Most of this work studies the women's experience, reflecting the gendered stereotype cultural identification of childlessness to women.

Aims: This on‐going research aims to explore issues that childless men have in and around the desire to be a father. The issues examined include affects on behaviour, emotions, relationships, mental health, self perception, societal expectations, and affects of any perceived discrimination.

Methodology: Grounded Theory is being applied to the eight (at least) interviews and the latest outcomes will be discussed and explored.

Findings: The research so far indicates that a number of factors influence men's re‐action to childlessness. The earliest awareness to be a father was at age 10 and the desire then appears to peak in the mid thirties before slowly declining in the early forties, before levelling but not disappearing in later life.

Various influences from the experience of their own fathering and childhood, family/society expectations, age and relationships including partner's health indicate the pathways and unique strategies that form the participant's response to childlessness.

All the participants had suffered from depression and the drive to be a father had factored in that from little to being the major cause. The effects on the men's mental state ranged from nothing to suicidal, with the majority indicating the desire for fatherhood was a component of their distress not the source. Implications for practice will be discussed.

Does being a parent influence how a student midwife perceives childbearing and motherhood?

A. J. Hughes and D. M. Fraser

Academic Division of Midwifery, School of Human Development, University of Nottingham, UK

The study was conducted to explore the factors that influence student midwives' constructs of childbearing. To achieve this qualitative methodology using focus groups were chosen. The focus groups were conducted with two cohorts of midwifery students who were undertaking a three‐year midwifery programme. The focus groups were split into those who were parents and those who were not, to enable the influence of personal experience to be explored. The groups ranged in size with the smallest consisting of two participants and the largest twelve participants. A total of four focus groups for each cohort were conducted at different stages of the midwifery education programme. This paper will concentrate on the first stage of the research, which were the focus groups conducted within the first three months of the students starting their midwifery education. The timing was selected to avoid exposure to midwifery practice, which may affect their responses. The themes from the analysis of the data from the first focus groups of each cohort will be discussed in relation to the perceptions of pregnancy, childbirth, infant feeding and parenthood, and the influence that experience has on these issues.

A further issue of interest was what had prompted their career choice, and what their views and experience of pregnancy, childbirth and parenthood had been based on.

Maternal obesity—Tackling the issue in partnership

Karen Jewell

Cardiff and Vale NHS Trust

Obesity in pregnancy is an increasing problem linked to many complications both during pregnancy and labour. The Confidential Enquiry into Maternal Deaths in the UK in 2002 found that 35% of all the women who died were obese with a Body Mass Index over 30; of these, 26% were morbidly obese with a BMI of 35 or greater – this representation is 50% more than in the general population. Within Cardiff this figure is also rising with 7% of women having a Body Mass Index of 35 or more at the start of pregnancy. This then impacts on choice for place of birth, level of care required in pregnancy and outcomes for delivery with the need for caesarean section rising with increasing levels of obesity (Cardiff 2006).

The objective of the presentation is to describe the setting up of a support group for women who are classified as obese in pregnancy and to discuss the impact of rising obesity on maternity services and how as midwives we can promote health at a time when women are often motivated to change, altering the long‐term impact for the future generations.

The presenter will discuss how with limited resources within the NHS, midwives linked with a commercial slimming organisation (Slimming World) who funded a referral support group to help pregnant women modify behaviour and change their lifestyles to ultimately improve the health of both themselves and their family. The presentation will describe the referral criteria to the group of women with BMIs of 35 or over and the initial audit of findings in relation to attendance, weight loss or maintenance and initial outcomes of clinical findings and mode of birth.

Electronic support seeking among individuals affected by infertility

Sumaira H. Malik and Neil S. Coulson

Institute of Work Health and Organisations, University of Nottingham, UK

Background: Previous research suggests that there are a number of psychosocial benefits associated with participating in online support communities. However, there is comparatively little research focusing specifically on the phenomenon of online infertility support communities. The current study therefore sought to explore the experiences of people accessing online infertility support groups and in particular their perceptions of the advantages and disadvantages of participation.

Method: A total of 95 individuals recruited from the bulletin boards of several popular online support groups completed an exploratory online questionnaire containing a series of open‐ended questions. Responses to the open‐ended questions were thematically analysed.

Results: The thematic analysis revealed that the participants in this study gained a range of important benefits from accessing an online support group, which included: anonymity, reduced feelings of isolation, improved marital relationships, a wealth of information and a sense of empowerment. However, there were also a number of disadvantages identified, which included: misunderstandings among group members and difficulties coping with the success of other group members.

Conclusion: The current study reveals that online support groups can provide a valuable source of informational and emotional support to individuals experiencing various fertility problems. However, future research should seek to further examine both the benefits of participation as well as some of the potential negative effects identified in the current study. In particular, there is a need to assess the impact of online support group use over a longer period of time, using a longitudinal prospective design.

Exploring the experience of known egg donation: Implications for counselling practice

Nina Martin

Faculty of Health, Leeds Metropolitan University, UK

This paper presents the findings of a recently completed PhD study exploring the experience of known egg donation – hitherto, a largely unresearched form of gamete donation. Using a phenomenological approach, the research was conducted in two distinct phases. During Phase One, semi‐structured interviews were conducted with counsellors in UK licensed treatment centres and analysed using a version of thematic analysis. Phase Two involved a number of in‐depth interviews with individuals who had experienced known egg donation either as a donor or as a member of the recipient couple. The interviews were analysed using a voice‐centred relational approach.

The main findings of the study highlighted the importance of negotiating relationships before, during and after the donation. Key psychosocial issues identified were: the existence of pressure (both overt and covert) within the donor‐recipient relationship, defining and maintaining clear relationship boundaries, involvement of male partners of both donor and recipient, relationship changes, and a continued renegotiation of relationships in the longer term.

In this paper I will discuss the implications of these findings for counselling practice, emphasising the need for counsellors to: adopt a relationally‐focused approach within their work, promote the best interests of the families involved, work with all those involved in the donation throughout the donation process and beyond, and ensure consistency of psychosocial care.

Infants, sleeping and beyond

David Messer

Childhood Development and Learning, Centre for Education and Educational Technology, The Open University, UK

Infancy is a period of rapid development and adaptation. High on the list of parental concerns are adaptations to diurnal rhythms involving sleeping. This presentation concerns children's sleeping with a discussion of more general research issues.

Questionnaires were completed by mothers before birth, in the first week, and at 1, 3, 5, 24, 30, 36, 42 and 48 months. The initial sample consisted of 500 mothers. Information was obtained about child's sleeping (ratings of sleeping difficulties, reports about night waking, early waking, etc.). At some time points, data were also collected about maternal strategies related to sleeping and about maternal wellbeing.

Analyses indicate that there was a reasonably high probability of mothers continuing to rate their child as having sleeping difficulties at the next age point in the study, thus, there was a high continuity in sleeping. For the sample as a whole, as children became older they took less time to fall asleep and less time to go back to sleep if they woke in the night. Although information on a range of infant and maternal variables was collected, none of these were highly related to children's later sleeping; although a number of variables showed significant but low associations.

The presentation will end with a discussion of issues concerning data collection. This will draw on my work with older children to show that responses tend to be context specific rather than domain general. The implications of this for quantitative and qualitative investigations of infants and adults will be explored.

Toward primary prevention and woman‐centred approaches in pregnancy health care

Yvette D. Miller^a, Alison L. Marshall^b and Shelley Wilkinson^a

^aSchool of Psychology, The University of Queensland, Australia; ^bSchool of Public Health, Queensland University of Technology, Australia

Background: Pregnancy health behaviours and engagement with health care services are associated with maternal and infant health. This study assessed the prevalence of unhealthy behaviours during pregnancy, and knowledge and support for health behaviour change among Health Professionals (HPs) and women, in an Australian community.

Methods: Telephone interviews with pregnant (N = 444) and postnatal (N = 320) women were used to determine the prevalence of unhealthy behaviours using standard population surveillance measures. Preferred sources of advice, barriers to service use, knowledge of current health behaviour guidelines and recall of HP advice were explored through focus groups with pregnant/postnatal women (N = 42). HP's knowledge of pregnancy health behaviour guidelines and counselling practices were assessed via self‐complete survey (N = 110).

Results: Most pregnant women reported unhealthy levels of physical inactivity (63.5%) and daily intake of fruit (89%) and vegetables (96.6%). Almost a quarter (24.1%) smoked. Most (95.6%) reported fewer than recommended prenatal care visits, and 30% reported no postnatal care visits. Women valued and frequented doctors, midwives and pharmacists for trustworthy, up‐to‐date advice. However, inconsistent advice was confusing and disheartening. Younger women (<20 years) were dissatisfied with health professional care and communication. HPs demonstrated moderate to good knowledge of health behaviour guidelines, but 20–25% did not believe promoting health behaviours to pregnant women was part of their job. Less than half reported counselling pregnant clients about health behaviours.

Conclusions: These findings demonstrate gaps between current public health recommendations and health behaviours during pregnancy, and a mismatch between women's needs and current pregnancy and postnatal health care delivery.

SRIP LECTURE

Women's bodies, psychology and the politics of reproduction: is there anything new to say?

Paula Nicholson

Royal Holloway, University of London, UK

Feminist critiques in the 1980s and 1990s of the traditional model of women's reproduction appear to have had an irreversible impact on psychology's ‘take’ on women's reproductive lifespan, i.e. menstruation, pregnancy, postnatal depression and the menopause. The traditional ‘deficit’ model related to female hormones, emotion, mental health and intellect, has been challenged, particularly by the burgeoning application of alternative paradigms to explain and explore women's psychology. Women's own ‘voices’ and life stories have been fore‐grounded through the contribution of a range of qualitative approaches to research and a critical approach to understanding the meanings conveyed through the texts.

This is not the end of the story, however, and the cautious welcome given to feminist psychology, and more so qualitative research methods, has been mediated by the rise of evolutionary psychology, behavioural genetics and neuropsychology through which the phrase ‘hard wiring’ has entered conventional jargon. So where are we now? Has ‘hard science’ replaced the softer side of psychology in our pursuit of knowledge?

In this paper I shall outline the changes over the last 20 years in thinking about women's reproductive bodies and then focus upon contemporary dilemmas in the application of knowledge to research and practice in reproductive psychology.

Predictors of differences in attitudes to surrogate motherhood

Aimee E. Poote^a and O. B. A. van den Akker^b

^aWarwick Medical School, University of Warwick, Coventry, UK; ^bDepartment of Psychology, Middlesex University, London, UK

Introduction: There is ample evidence showing that problems in adaptation to and coping with infertility treatments and the resultant offspring or deciding whether to donate gametes or become a surrogate mother may be related to people's perceived normative values. This study aimed to investigate British women's attitudes to surrogacy using components of the Theory of Planned Behaviour (TPB).

Materials and methods: A questionnaire was adapted to reflect attitudes to surrogacy. The reasons for parenthood scale was also used. Local University ethical approval was obtained. The questionnaire was completed electronically by 187 women.

Results: Significant socio demographic differences were found. General Attitudes, perceived behavioural control and social norms (all P<.000, respectively, all TPB components) differed between participants possibly willing versus unwilling to consider becoming a surrogate, and positive ‘typical’ reasons for wanting to become parents themselves – in all cases the possibly willing to consider being a surrogate group scored more positively.

Conclusions: This study supported the predictive utility of components of the TPB, and differentiated adequately between groups on favourable thoughts on advertising, the consequences of being a surrogate mother and being induced to consider surrogacy. No differences in perceptions of the importance of a genetic link were obtained, although positive and typical perceptions of parenthood were also characteristic of women possibly willing to consider becoming surrogates, compared to those unwilling.

Attitudes towards oocyte donation and parenthood: Structural equation modelling analyses

Satvinder Purewal and Olga van den Akker

Department of Psychology, School of Health and Social Sciences, Middlesex University, London, UK

This study assessed components of the Theory of Planned Behaviour (TPB) in oocyte donation and examined the link between women's intention to donate and their reasons for parenthood using Structural Equation Modelling (SEM). A total of 528 women completed the questionnaire; 156 were intended donors, 168 were possible donors and 204 were non‐donors. Intended donors were younger, more likely to have had a past termination, reported lower socio‐economic status and less education compared to possible donors or non‐donors. Intended donors demonstrated ambiguity towards issues of disclosure of genetic origin to the offspring; they reported more negative attitudes towards disclosure compared to non‐donors, they were also more likely to report they would be glad that perhaps their offspring might try to find them after 18 years and be happy that their genes were being passed on. In addition, intended donors were significantly more likely to report less typical reasons for wanting to have children compared to the other donor groups. SEM analyses revealed younger age (β = −.015, P<0.001), being less educated (β = −.084, P<0.001), and the theoretical components, namely: receiving social support, positive attitudes towards oocyte donation, positive attitudes towards the consequence of oocyte donation (β = .124, P<0.001) and endorsing less typical reasons for parenthood (β = −.016, P<0.001) were predictive of intention to donate. Components of the TPB all have a direct effect on intention to donate. However, SEM found that TPB components are only useful in relation to other important factors such as demographic variables and perceptions of parenthood.

Looking on the bright side of life: The role of optimism in predicting long‐term adjustment to miscarriage

Ingrid Rowlands and Christina Lee

School of Psychology, University of Queensland, Brisbane, Australia

Introduction: Psychosocial and reproductive factors have been identified as predictors of poor adjustment following miscarriage. However, the evidence is conflicting, and relatively little is known about those factors which may facilitate resilience.

Method: Three waves of data from the Younger cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were used to examine factors predicting positive mental health among 1167 women who had experienced miscarriage. Using the 5‐item Mental Health subscale (MHI‐5) of the SF‐36, we examined whether women's Mental Health trajectories differed according to sociodemographic, health‐service and psychological variables.

Results: Greater availability of social support, optimism, and satisfaction with the general practitioner was associated with higher Mental Health scores among miscarrying women at Survey 1. However, optimism was the only variable which was related to improved Mental Health scores at later surveys. Stress, negative life events, and a history of depression and anxiety predicted poor mental health. Surprisingly, previously identified variables such as age, parity and the number of miscarriages were not associated with Mental Health in this sample.

Conclusion: An optimistic outlook was identified as predicting positive long‐term adjustment following miscarriage. Mobilising social support and good general practitioner care after loss may also be important initial methods of support. Education for health professionals to ensure that adequate support is provided for women after miscarriage may be important for maintaining women's wellbeing. This analysis provides valuable information relevant for interventions aimed at maintaining the health and wellbeing of women in the long term.

What do men want? Young Australian men's fertility attitudes

Rachel Thompson and Christina Lee

School of Psychology, University of Queensland, Australia

Objective: Recent trends towards delayed childbearing and associated increases in fertility problems have increased the salience to health professionals of reproductive decision‐making. This study explored young men's fertility attitudes, which traditionally have been under‐researched and remain poorly documented.

Method: A sample of 281 childless Australian men, aged 18–25 years, who were neither married nor cohabiting, completed an online measure of reproductive aspirations and attitudes.

Results: Most participants reported aspiring to be in full time work (86.8%), to be married (93.6%) and to have children (96.1%) at the age of 40. Most commonly, participants aspired to either two (47.8%) or three (33.0%) children, with a ‘gender mix’ preferred. The young men more strongly endorsed the reasons for fatherhood (e.g. sharing knowledge, developing a special bond with a child, experiencing the fulfilment of raising a child) than they did the reasons against (e.g. financial cost, restrictions on one's freedom or the time available to spend with one's partner). However, the social and economic context of reproduction was also highly salient; participants identified having a stable relationship, a partner to share responsibility, a good financial position and sufficient maturity as the most important circumstances for embarking upon fatherhood.

Conclusions: Young Australian men's reproductive attitudes are both positive and detailed, and fatherhood appears central to their future aspirations. These findings further elucidate contemporary reproductive behaviour, suggesting that both individual and systemic factors are important fertility determinants for young men. Furthermore, this study reinforces the importance of considering both men's and women's attitudes in the study of reproductive behaviour and attitudes.

Impact of an infant massage programme on maternal mental health and attachment

N. Tierney, N. Doherty, F. Casey, B. Craig and A. Sands

The Children's Department, The Bradbury Centre, Belfast, Northern Ireland

The aim of the study was to evaluate the efficacy of an infant massage programme in promoting psychological well‐being and attachment for mothers and their infants with Congenital Heart Disease (CHD). Thirty‐one mother–infant dyads were allocated to either an intervention massage group (n = 16) or a no treatment control group (n = 15). Questionnaires to measure maternal psychological health and affectionate attachment were completed by both groups, before and after the intervention programme. The findings indicated that mothers who participated in the massage programme showed improved psychological well‐being on measures of parenting stress, anxiety and parental sense of competence. There was no significant difference in groups on measures of perception of baby vulnerability and maternal attachment. The findings have important implications in terms of early intervention for mothers and infants with CHD.

Mental health in pregnant and postpartum women. An exploratory study on the role of maternal antenatal orientations

Johan C. H. van Bussel^a, Bernard Spitz^b and Koen Demyttenaere^a,c

^aInstitute of Family and Sexuality Sciences, Department of Public Health, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; ^bDepartment of Gynaecology and Obstetrics, University Hospital Gasthuisberg, Leuven, Belgium; ^cDepartment of Neurosciences and Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium

Introduction: Pregnancy confronts women with physical, psychological and social changes. The way these changes are experienced by women and how women cope with them, has received many professional and scientific attention. Based on her clinical practice and qualitative research, Raphael‐Leff (2005) described four different maternal orientations: the facilitator, the regulator, the reciprocator and the bipolar mother. The aim of our research is to evaluate the relation between the maternal orientations and the mental health (depressive symptomatology, anxiety and attachment) of pregnant and postpartum women.

Methods: At a routine antenatal clinical at the University Hospital, Leuven (Belgium), pregnant women between 8 and 15 gestational weeks, were invited to participate in this study. Four hundred and three women agreed to participate and completed a booklet of questionnaires in the first (T1), second (T2) and third (T3) trimester of the pregnancy, and between 8–12 weeks (T4) and 20–25 weeks (T5) postpartum. The measures included were: EPDS, HADS, PRAQ, MSAS, MAAS and MPAS (dependent variables) and NEO‐FFI, UCL, BPI, RQ and FRS (independent variables).

Results: Preliminary analyses of the data reveal a significant contribution of the maternal orientations in predicting antenatal and postpartum anxiety, depression and attachment.

Conclusion: In this study we found that, in addition to the well documented predictors of depressive symptoms, anxiety and attachment in pregnant and postpartum women (neuroticism, depressive coping), the model of maternal antenatal orientations, as defined and described by Raphael‐Leff (2005), also has a significant predictive value.

Poster presentations

The effect of hypnosis on pain relief during labor and childbirth in Iranian pregnant women

M. Abbasi and A. Barlow‐Harrison

Middlesex University, London, UK

Background: Due to some individual expectation relating to labour pain, which increases the fear and apprehension for pregnant women, it would be valuable to consider hypnosis as a non‐medical approach of creating pain relief which can motivate women for normal delivery. The aim of this study was to describe the effect of hypnosis on pain relief during labour and childbirth on women.

Methods: A qualitative approach based on the principles of phenomenology theory was used. After purposive sampling of 6 pregnant women, the hypnotiser practiced hypnosis techniques with them in hospital to prepare them for having an experience of hypnosis during labour. Researcher also trained the patients how to use self‐hypnosis and hold in trance while they are in labour. Within 24 hours after birth and in most cases after 8–10 hours, each woman was asked a series of questions. The researcher interpreted and analysed the data using Colaizzi's procedural steps.

Results: Women described their feelings about hypnosis during labor as: a sense of relief and consolation, self‐confidence, satisfaction, lack of suffering labor pain, changing the feeling of pain into one of pressure, a decrease in fear of natural childbirth, lack of tiredness and lack of anxiety. They expressed increased concentration on the uterus and cervical muscle, awareness of all the stages of labor, depending on self‐reliance and having positive thoughts. None of the participants needed medical intervention and no adverse effects were noted.

Conclusion: Women who were prepared with hypnosis used less pain medication, had lower intervention rates, and perceived their births as being very satisfactory compare to their previous experiences and would recommend using hypnosis to other women.

A qualitative study of memory and emotion during pregnancy

Liane D. Hayes

University of Chester, UK

A qualitative study was undertaken to investigate what happens to women's memory and emotions during pregnancy. The participants were six women of varying stages of pregnancy and were expecting either their first or subsequent babies. This sample was selected on the basis of maximum variation sampling. Participants took part in a semi‐structured interview comprising 23 open‐ended questions designed to explore their experiences of pregnancy, memory and emotion. Each interview was audio‐recorded, transcribed and analysed using thematic analysis, based upon the principles of grounded theory. Three main themes were identified as emerging from the data: tiredness, emotionality and preoccupation. These categories related to previous findings by the author and helped put them into a clearer context. Tiredness and preoccupation were both considered to hinder memory performance in ways akin to findings from quantitative studies. Conversely, emotionality seemed to accentuate memories, highlighting the effects of emotionally salient memories.

A short adjective checklist to assess perceptions of pregnancy

Julie Jomeen^a and Colin R. Martin^b

^aFaculty of Health and Social Care, University of Hull, Hull, UK; ^bSchool of Health, Nursing and Midwifery, University of the West of Scotland, Scotland, UK

Background: Women's feelings about pregnancy are becoming increasingly acknowledged as important to the mental health of the mother or mother‐to‐be and the development of the baby following birth. Consequently, an antenatal measure is highly desirable and should ideally be short while not comprising the measurement characteristics of the tool. The goal of the investigation was to develop a short assessment measure of women's perceptions of their pregnancy.

Methods: The investigation used a longitudinal design with participants (N = 146) recruited to the study during first trimester booking appointment (14 weeks) and followed prospectively to six months postnatal. The initial adjective checklist item pool used items from the 21‐item baby adjective checklist. Instrument development was accomplished using structural equation modeling. Predictive validity of the instrument was evaluated by logistic regression predicting depression caseness at the six‐month postnatal point using the Edinburgh Postnatal Depression Scale (EPDS).

Results: The optimal factorial structure was found to be bi‐dimensional representing positively (N = 4) and negatively (N = 4) valenced items. This two‐factor, eight‐item instrument produced an excellent fit to the data. Logistic regression revealed that the negative adjective sub‐scale (p<0.01) was a significant predictors of 6 month EPDS case classification.

Conclusion: The short adjective checklist (SACL) negative item sub‐scale was found to be a significant antenatal predictor of 6 month postnatal depression case classification. Given the difficulty in accurate antenatal prediction of postnatal depression, the SACL negative item sub‐scale could be a useful risk identifier. Short, easily administered, simply scored and with much predictive promise, further applied clinical research on the SACL is recommended.

Development and properties of the 10‐item Working in Healthcare Questionnaire (WHQ‐10)

Colin R. Martin^a, Maggie Redshaw^b and Julia Sonander^c

^aSchool of Health, Nursing and Midwifery, University of the West of Scotland, Scotland, UK; ^bNational Perinatal Epidemiology Unit, University of Oxford, Oxford, UK; ^cHealthcare Commission, London, UK

Background: Collaborative and supportive working is an important feature of effective multidisciplinary team working and may have a significant impact on the way that care is provided, in this instance for women during pregnancy and the perinatal period.

The goal of the current study was to develop a short and novel measure of effective and supportive team working applied to staff working in maternity services and to describe the initial psychometric properties of the tool.

Methods: The instrument was developed jointly by the Healthcare Commission and National Perinatal Epidemiology Unit as part of a staff survey that was a component of a review of maternity services in England. Final item inclusion in the measure was based on exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). Discriminate validity testing was conducted using analysis of variance with health worker group type as the independent variable.

Results: A random sample of 1701 forms was subjected to EFA using maximum‐likelihood extraction and oblimin rotation revealing two correlated factors. The item‐factor loadings suggested latent domains, compliance and influence (4 items), and support and communication (6 items), supported by a CFA on a further 1701 forms. Statistically significant differences between groups (p<0.001) on the total scale (WHQ‐10), the compliance and influence sub‐scale and the support and communication sub‐scale, were observed.

Conclusion: The WHQ‐10 is a novel instrument designed to measure the salient elements of staff collaboration and cohesion. The sub‐scales of the instrument demonstrate unique and clinically relevant sensitivity to the discipline of the practitioner and could offer a valuable tool in understanding the dynamic processes of staff interaction within the clinical environment.

How do health visitors identify, manage and refer infant mental health problems?

Lucy Murray

University of Leicester, UK

Background: There is strong evidence in favour of intervening early in the lives of children, in order to reduce mental disorder throughout the lifespan. Since Child and Adolescent Mental Health Services are not routinely directed towards under‐fives, health visitors, located in primary care services, are well placed to identify and manage mental health problems in this age group. A detailed understanding of the processes governing these practices could usefully inform developments in service provision for under‐fives and highlight areas of support or training that may be required.

Method: This study investigated health visitors' conceptualisations of IMH and sought to understand how they identified, managed and referred IMH problems on their caseload. Nine health visitors, participated in the study and their views were explored using semi structured interviews and grounded theory methodology.

Results: A theoretical account of participant conceptualisation of IMH was incorporated into a process model. The model offers a framework for understanding key activities in relation to IMH; promoting, identifying, intervening and referring. It also details contextual factors impacting on participant's conceptualisation of and interaction with IMH. The most significant finding was that participants demonstrated expertise consistent with IMH programmes described in the literature, but did not always conceptualise their work in these terms.

Conclusions: The study discusses the possible role for health visitors in designated IMH work and the range of supports and structures that may be required to facilitate this. The implication of the findings for specialist mental health practitioners, such as clinical psychologists, is also considered.

What is the impact of trial involvement on depression assessment in postnatal women?

Jean Rankin and Colin R. Martin

School of Health Nursing and Midwifery, University of the West of Scotland, Scotland, UK

Background: A fundamental assumption in the conduct of clinical trials is that the measurement of both primary and secondary outcomes of the intervention are equivalent across groups in terms of measurement characteristics. However, the impact of an intervention may impact on the measurement attributes of questionnaire‐based outcome measures. The goal of the current study was to determine if allocation to a trial could impact significantly on the measurement attributes of a commonly used instrument to assess depression postnatally.

Methods: The study used data from a prospective randomised controlled trial (RCT) investigating the effect of antenatal exercise on birth outcomes and psychological well‐ being. Postnatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at the 12–16 weeks postnatal period. Structural equation modelling approaches were used to determine the measurement invariance of the EPDS using a two‐dimensional model of the instrument with group type (exercise or control) as the criterion variable to assess model invariance.

Results: A total of 89 participants completed the trial of which 48 were in the exercise group. A confirmatory factor analysis of the two‐factor model revealed a good fit to the data. Tests were conducted for model invariance and revealed that there was evidence of variation in the factorial structure of the EPDS between groups.

Conclusion: The current study reveals that the assumption that the outcome measure is invariant between groups within an RCT is not supported in the case of the EPDS. Determination of the impact of outcome variance may be a valuable contribution to the understanding of the complex relationship between variables which influence treatment effects in trials.

‘The silence was deafening’: Women's experiences of coping with miscarriage

Ingrid Rowlands and Christina Lee

School of Psychology, University of Queensland, Brisbane, Australia

Introduction: Qualitative research related to coping with miscarriage is increasing. However, evidence which examines the coping strategies that may facilitate adjustment to miscarriage is scant. Using qualitative methods, we examined both the emotional outcomes for women after miscarriage, and the strategies identified by women as facilitating their mental health and well‐being.

Method: Nine face‐to‐face interviews were conducted with women (aged 35–42; M = 37 years) who reported experiencing a miscarriage in the last two years. Semi‐structured interviews invited the women to discuss their miscarriage experience and coping strategies. Interviews ranged from 15 to 80 mins (M = 42mins) and transcripts were analysed via thematic analysis.

Results: Women's initial reactions to miscarriage were described with powerful negative emotions – shock, bewilderment, enormous grief and loss. While some women described fearing future miscarriages, gaining a sense of mastery in subsequent pregnancies was important for maintaining their wellbeing. Further, acknowledgment and support from families and the community facilitated resilience after miscarriage. Unfortunately, many women described poor care from health professionals. Disappointment with the lack of information received, insensitive comments and lack of empathy while being treated in hospital were related to poor coping outcomes.

Conclusion: Miscarriage may be a traumatic experience for many women, however, support and acknowledgement from the community and adequate medical care appears to promote positive mental health and wellbeing. Overall, the results showed that social norms, attitudes and expectations greatly affected how women coped with miscarriage. This has important implications for support and treatment of women after miscarriage.

Does confidence in labour predict the occurrence of postnatal depression?

Wan Yim Ip^a and Colin R. Martin^b

^aFaculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, Peoples Republic of China; ^bSchool of Health Nursing and Midwifery, University of the West of Scotland, Scotland, UK

Background: Postnatal depression remains a distressing relatively poorly understood phenomenon. Little work has been conducted on the role of the woman's confidence in labour as a predictive measure. The current study sought to determine if the degree of perceived confidence in labour was a predictor of postnatal depression as determined by EPDS score and case classification.

Methods: 120 women recruited to a larger study provided complete EPDS data at the six weeks postnatal period. Confidence during labour was measured on an 11‐point Likert type scale administered in the third trimester. Prediction of EPDS score was conducted using linear regression. Prediction of EPDS case classification was conducted using logistic regression. The participants were Hong Kong Chinese and completed the Chinese version of the EPDS.

Results: Linear regression revealed confidence in labour to be a significant predictor of six‐week EPDS score (Standardised β = 0.31, t = 3.59, p<0.01). Logistic regression revealed confidence in labour to be a significant predictor of six‐week EPDS case classification (Wald = 10.46, df = 1, p<0.01).

Conclusion: The current study revealed that a general attributional trait such as level of confidence, when applied to a specific situation such as labour, has remarkable predictive value in the later presentation of postnatal depression. The findings from the current study suggest that level of confidence during labour may be a useful predictor of postnatal depression and moreover, raises the issue of the role of these type of general psychological domains in the onset of postnatal depression.