SRIP 2016 Keynote Lecture
Psychological welfare in third party assisted conception
Olga van den Akker BSc PhD AFBPsS C.Psychol
Professor of Health Psychology
Middlesex University, London, UK
Hundreds of thousands of babies are born across the world each year via assisted conception techniques, many of these with a genetic link only to one of the parents, and some with no genetic and no gestational link. Assisted conception treatments are in huge demand for social (usually single men, older women, same sex couples) and medical reasons (usually heterosexual infertile couples). Despite the opportunities and demand, inequality in access to these services is evident at home and abroad. With the increasing international commercialisation of gamete, embryo and surrogate services, further amplification of inequalities of family building possibilities develop.
Many third party assisted reproductive healthcare services, also mimic as closely as possible traditional conception, but the resultant conceptions, pregnancies and babies (who become children then adults) are non-traditional, despite frequent attempts by the parent(s) to deny difference. Evidence will be presented that some donors, surrogates and recipients of third party assisted reproduction demonstrate cognitive conflict or dissonance about their use of third party conception to build families. Similarly, some offspring who know they were conceived in non-traditional ways report identity conflict and require knowledge about their origins. These conflicts are not sufficiently addressed in research, policy and practice. Human rights and psychosocial welfare issues in building families using third party assisted conception, in addition to allowing for equality in access, also demand accuracy of birth and genetic information. This raises numerous psychological, social and ethical questions. It is not in the interest of the child to be misinformed about their genetic or gestational origins. Policies and practices do not always reflect the specific, lifetime and shifting needs of the populations they serve, including future generations resulting from these innovations. Psychosocial research can do much to contribute to the evidence and to debates.
SRIP 2016 SRIP Lecture
Mental health problems in pregnancy: New evidence on detection and treatment
Louise M Howard BSc MSc MPhil PhD MRCP MRCPsych
Professor in Women’s Mental Health
Head of the Section of Women’s Mental Health at the Health Service and Population Research Department, Institute of Psychiatry, King’s College London, UK
There has been limited evidence on how to identify and treat mental health problems across the diagnostic spectrum at antenatal booking and through pregnancy. This lecture presents new data from a programme of research on identification and treatment of perinatal mental health problems. The effectiveness of the Whooley questions compared with the Edinburgh Postnatal Depression Scale and a gold standard diagnostic interview will be presented from an enrichment sample of “Whooley positive” and “Whooley negative” women recruited at antenatal booking. Data on the prevalence of disorders across the diagnostic spectrum at antenatal booking will also be presented. Preliminary results of a qualitative study on the experience of perinatal mental health services (from primary care to specialist care) will be discussed and implications for practice and future research highlighted.
Disclosure:
This abstract summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number: RP-PG-1210-12002). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health
SRIP 2016 Doctoral Prize
Women’s experience of coping with termination of pregnancy for fetal abnormality: Coping strategies, perinatal grief and posttraumatic growth
Authors:
Lafarge, Caroline*; Mitchell, Kathryn; Fox, Pauline
Corresponding author:
*Caroline Lafarge, Postdoctoral researcher, University of West London, UK. Email: [email protected]
Background: Termination of pregnancy for fetal abnormality (TFA) can have negative psychological consequences for women. However, little is known about the way women cope with TFA, their potential for posttraumatic growth (PTG) post-TFA or health professionals’ understanding of women’s coping with this event.
Aim and Objectives: The research aimed to: explore women’s coping strategies when dealing with TFA; examine the relationship between coping and psychological outcomes (perinatal grief and PTG); and investigate health professionals’ perceptions of women’s coping.
Method: Using a mixed methodology, four studies were conducted. Fieldwork with women was carried out online, with participants recruited from a support organisation. Fieldwork with health professionals was conducted face-to-face, with participants recruited from three hospitals in England.
Results: Despite using mainly ‘adaptive’ coping strategies (e.g. support or acceptance) women’s grief levels were high and PTG levels moderate. ‘Acceptance’ and ‘positive reframing’ predicted lower grief levels and ‘positive reframing’ predicted PTG. Health professionals had a valid understanding of women’s short-term coping strategies but limited insights into their long-term coping processes. This points to a deficit in aftercare, an issue raised by women participants.
Interpretation: Some women struggle to adjust to TFA and only a moderate proportion reported deriving any benefit from their experience. This emphasises the traumatic nature of TFA which, coupled with a perceived deficit in aftercare, calls for the development of a psychological intervention to support women post-TFA. Given the relevance of ‘positive reframing’ and ‘acceptance’ to TFA, an intervention based on Cognitive Behavioural techniques may be beneficial.
Conclusions: The research informs practice and policy making, with a view to optimise the care women receive when undergoing TFA.
SRIP 2016 Masters Prize
The Experiences of Fathers When Their Partners are Admitted With Their Infants to a Psychiatric Mother and Baby Unit
Authors:
Reid, Holly*; Wieck, Angelika; Matrunola, Andrew; Wittkowski, Anja
Corresponding author:
*Holly Reid, Research Assistant, University of Manchester, UK. Email: [email protected]
Background: In the United Kingdom, mothers with severe postnatal mental illness may be admitted with their infant to a psychiatric mother and baby unit (MBU). Partners of these women play an important role in their recovery and within the family unit. These fathers may show reduced wellbeing themselves, however their support needs have not been investigated.
Aim and Objectives: The qualitative investigation aimed to determine how fathers experience the MBU during their partners’ admission and how they felt supported.
Method: A purposive sample of fathers was recruited from a MBU during their partners’ admission. Interviews addressed topics, such as their role as a partner, a father, their own health and support they had received. The data were submitted to an inductive thematic analysis and a number of techniques were employed to increase rigour and methodological quality.
Results: A sample of 17 fathers was recruited. Four themes were developed: 1) “double whammy”, 2) understanding the admission and illness, 3) support for fathers, and 4) personal stressors and coping. Fathers’ experiences of each theme were positioned on an emotional-practical continuum.
Interpretation: We identified that fathers face an emotional struggle when coping simultaneously with the arrival of a baby and their partner’s illness. Fathers sought support from many sources including the MBU but their knowledge of psychiatric services and mental illness was limited. Fathers felt a distressing uncertainty about how his partner was progressing and when she would return home with their baby.
Conclusions: The provision of an information pack and regular one-to-one meetings between fathers and MBU staff are recommended to facilitate the father’s understanding of their partner’s illness and assess the father’s wellbeing.
SRIP 2016 Masters Runner-Up Prize
Making sense of childbirth choices; exploring the decision to freebirth in the UK. An interpretative phenomenological study
Authors:
Feeley, Claire
Corresponding author:
Claire Feeley, University of Central Lancashire, UK, Email: [email protected]
Background:
Freebirthing is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision.
Aim and Objectives:
To explore the decision making experience of women who chose to freebirth in a UK context.
Method:
An interpretive phenomenological approach was adopted. Advertisements were posted on freebirth websites, and ten women participated in the study by completing a narrative (n = 9) and/or taking part in an in-depth interview (n = 10). Data analysis was carried out using interpretative methods.
Results/Interpretation:
Three main themes emerged from the data: ‘contextualising herstory’; ‘diverging paths of decision making’ and ‘the converging path of decision making’. Most women made this choice due to a previous birth experience; traumatic or deeply positive.
Conclusions:
This study highlights women valued becoming their own expert about their birth experience. They did not want authoritarian care approaches to be enforced upon them, which had caused birth trauma, disillusionment with maternity services. For some, the decision stemmed from an ideological perspective.
ORAL PRESENTATIONS
Perinatal mental health: A qualitative study exploring women’s perception of mental health during pregnancy in Accra, Ghana
Authors: Agyekum, Buruwaa
Corresponding author: Buruwaa Agyekum, Student, University of Ghana, Ghana. Email: [email protected]
Background: Mental health problems are a key determinant of maternal and child mortality and morbidity, but are not currently recognized in existing initiatives to promote maternal health (Mares, Newman & Warren, 2011).This leaves mental health a neglected pillar of maternal health care, resulting in poor health outcomes along the continuum of care.
Aim and Objectives: The main aim was to investigate pregnant women’s perceptions of perinatal mental health in Accra. The specific objectives were to explore women’s experiences of mental illness during the perinatal period, identify the risk and protective factors associated with perinatal mental illness and to investigate perinatal women’s experiences of the health care system.
Method: It was a qualitative study to which participants were recruited via purposive sampling. Participants meeting the inclusion criteria (18 years and above and 8 -9 months into pregnancy) and consenting, were interviewed. Interviews followed a semi-structured interview guide to explore participants’ experiences and perceptions. Data was audio-recorded, transcribed verbatim and analyzed using Interpretive Phenomenological Approach.
Results: There were 30 participants between ages 19-40 years. The main themes encapsulating participants’ perception and experience of perinatal metal health related to lack of awareness of perinatal mental illness and spiritual attributions for symptoms of perinatal mental illness. Other themes included vulnerability and coping factors as well as systemic challenges within health care delivery for pregnant women.
Interpretation: Participants’ seeming lack of information about perinatal mental health could be a result of the stigma attached to issues of mental illness in Ghana as well as a consequence of gender role stereotypic beliefs.
Conclusions: The findings suggest the need for the adoption of appropriate interventions including education about perinatal mental health, culturally sensitive psychosocial screening, and the implementation of appropriate referral pathways for pregnant women to enable them have access to holistic care during the perinatal period.
References: Mares, S, Newman, L. & Warren, B. (2011) Clinical Skills in Infant Mental Health: The First Three Years. (2nd ed.) Camberwell, Vic.: ACER Press.
Attachment and dyadic coping: A comparison between healthy and distressed couples during the transition to parenthood
Authors: Alves, Stephanie; Fonseca, Ana; Canavarro, Maria Cristina; & Pereira, Marco
Corresponding author: Stephanie Alves, PhD student (Clinical Psychology), Faculdade de Psicologia e Ciências da Educação da Universidade de Coimbra, Rua do Colégio Novo, 3000-315 Coimbra, Portugal. E-mail: [email protected]
Background: Transition to parenthood can be a potentially stressful event, with several challenges for couples coping together. Attachment theory can be an important framework to study the dynamics of couples’ relationship during transition to parenthood [1]. Therefore, it is important to investigate whether attachment representations, activated under stress-inducing conditions, may be associated with couples’ engagement in dyadic coping (DC) strategies.
Aim and Objectives: The aims of this study were to examine: (a) attachment-related anxiety and avoidance and DC similarities/differences among healthy vs. distressed couples (at least one partner experiencing clinical symptoms of depression); (b) the associations between attachment and DC; and (c) whether these associations differ between healthy and distressed couples.
Method: 199 couples during the second trimester of pregnancy completed the Edinburgh Postnatal Depression Scale, the Experience in Close Relationships - Relationship Structures (partner domain), and the Dyadic Coping Inventory.
Results: Men reported significantly more attachment-related avoidance and less DC enacted by oneself than women. Healthy couples (n=142) reported lower scores on attachment-related anxiety and avoidance as well as more positive DC enacted by the partner and by oneself, and joint DC, compared to distressed couples (n=57). Attachment-related avoidance was negatively associated with all forms of DC (enacted by oneself, by the partner, and joint DC), independently of couple’s type.
Interpretation: This study highlights the lower engagement in DC strategies among distressed couples during the transition to parenthood. Regardless of couples’ experience of depressive symptoms, more positive representations of the others seem to play an important role in promoting the use of adaptive DC strategies.
Conclusions: Distressed couples may particularly benefit from DC-enhancing interventions. Through more efficient partner and couple-oriented behaviors, couple’s emotional adjustment, as well as other couples’ skills, may be improved [2].
References:
[1] Pietromonaco, P. R., Uchino, B., & Dunkel Schetter, C. (2013). Close relationship processes and health: Implications of attachment theory for health and disease. Health Psychology, 32, 499-513. doi:10.1037/a0029349.
[2] Bodenmann, G. (2008). Dyadic coping and the significance of this concept for prevention and therapy. Zeitschrift fur Gesundheitspsychologie, 16, 108-111. doi:10.1026/0943-8149.16.3.108
The City Birth Trauma Scale (CITY BiTS) measure of postpartum PTSD
Authors: Ayers, S; Thornton, A; Wright, D.B.
Corresponding author: Professor Susan Ayers, City University London. School of Health Sciences, Northampton Square, London, EC1V 0HB, UK. Email: [email protected] Background: Reviews show PTSD after childbirth affects 3% of women overall and 15% of women in high risk groups. However, postpartum PTSD remains largely unrecognised and is not routinely screened for. One barrier to screening is that there is no validated questionnaire that measures postpartum PTSD in accordance with revised DSM-5 diagnostic criteria.
Aim and Objectives: To develop a questionnaire measure of PTSD after childbirth according to DSM-5 criteria.
Method: A 31-item questionnaire was developed on the basis of DSM-5 criteria and reviewed by perinatal researchers (n=9) and postpartum women (n=8). The questionnaire was then completed online by 950 women who had given birth in the previous 12 months.
Results: Analysis of individual subscales showed that symptom subscales of intrusions, avoidance, negative cognitions, and hyperarousal were coherent. Subscales had good internal reliability and were positively correlated with each other. Factor analysis of the total scale identified two factors of (1) intrusions and avoidance and (2) hyperarousal and anhedonia. Items from the new DSM-5 subscale of negative cognitions loaded on different factors, and two items did not load on any factor.
Interpretation: The City Birth Trauma Scale (City BiTS) provides a valid and reliable measure of PTSD following events related to pregnancy, birth or immediately postpartum.
Conclusions: Further research is needed on the relevance of the new DSM-5 symptoms of negative cognitions.
How do age and internal resources contribute to mental health of women entering fertility treatment?
Authors: Ben Shlomo, Shirley*; Taubman – Ben-Ari, Orit; Skvirski, Vera
Corresponding author: School of Social Work, Bar Ilan University, Israel. Email: [email protected]
Background: Medical research indicates that once a woman has reached her mid-30s, physiological processes in the female body lead to a decrease in fertility and ovarian function and a rise in the length of time required to conceive. While fertility treatment may help in overcoming the physiological problems, it typically entails a difficult and lengthy process which is, by nature, stressful.
Aim and Objectives: To examine (a) age-groups (above or below 35) difference in the mental health of women entering fertility treatment; (b) whether the association between age and mental health is, mediated by internal resources (hope, two aspects of self-consciousness: reflection, rumination).
Method: 137 women at the start of fertility treatment completed a series of self-report questionnaires.
Results: Younger women reported higher distress and rumination than older women. Higher hope was associated with greater well-being, while higher rumination was associated with greater distress. Hope and rumination mediated the association between age and mental health.
Interpretation: Age and internal resources play direct and indirect role in the mental health of women entering fertility treatment.
Conclusions: The findings highlight the importance of developing age-based interventions for women entering fertility treatment, aimed at strengthening their resilience to effectively cope with the demanding process ahead.
‘Tell it Right, Start it Right’: an evaluation of training about Down syndrome for health professionals using the Kirkpatrick Model
Authors: Bryant, Louise D*; Dix, Lucy; Puri, Shiela, Ahmed, Shenaz
Corresponding author: Dr Louise Bryant, University of Leeds, LS2 9LJ, UK. Email: [email protected]
Background: Health professionals do not routinely receive training in how to manage parent care when Down syndrome (DS) is identified in pregnancy or after birth. Many parents report dissatisfaction with staff responses during this time and research demonstrates a long-lasting emotional impact of ‘poor care’. The UK Down’s syndrome Association has developed the “Tell it Right, Start it Right” training to address this problem.
Aim and Objectives: To evaluate “Tell it Right” using a validated training assessment model.
Method: The evaluation employed the first three levels of the Kirkpatrick Model of training assessment[1] and measured (1) Reaction – enjoyment, perceived value (2) Learning - knowledge or skills gained, and (3) Behaviour change related to learning. A repeated-measures online survey was administered to staff at three time points: before training, immediately afterwards and two months afterwards. Sixty-three staff registered for the training day of whom 67% completed Survey 1. Fifty-six staff attended training of whom 68% completed Survey 2; 41% of attendees subsequently completed Survey 3. The majority of respondents were midwives.Results: Knowledge of DS and parental experiences, confidence in communicating with parents and in delivering a diagnosis of DS significantly increased between Times 1 and 2 (p<0.01). Confidence in working with parents from ethnic minorities did not increase. Some qualitative evidence of behaviour change in the workplace was identified at Time 3.
Interpretation: There is a demand for ‘experience led’ training about DS among health professionals that is currently not being met. This training can improve knowledge and confidence and has the potential to improve parent care.
Conclusions: The “Tell it Right” initiative is delivered by a charity and attendance is voluntary. Training about DS must become embedded in mandatory professional education for those working in antenatal and postnatal care if widespread improvements in parent experience are to be achieved.
References:
[1] Kirkpatrick, D.L. & J.D. Kirkpatrick (2006) Evaluating Training Programs. The Four Levels. Third ed. San Francisco, CA: Berrett-Koehler Publishers, Inc.
Prenatal Representations and Their Concordance with Postnatal Relationships: A Review
Authors: Brennan, Jessica; Walsh, Judi
Corresponding author: Jessica Brennan, University of East Anglia, UK. Email: [email protected]
Background: Bowlby’s (1982) theory explaining the child-parent relationship has influenced many areas of research. While Bowlby initially described attachment as the ‘child’s tie to his or her mother,’ the theory has been expanded to include romantic, global, and parenting relationships (e.g., Fraley, Waller, & Brennan, 2000; George, Kaplan, & Main, 1996). The theory has also extended to antenatal relationships (e.g. Condon, 1993), primarily in nursing literature, exploring relations between parent’s thoughts and feelings about their foetus and later parent-child relationship quality.
Aim: To present an integrative review of the literature to date that has measured the prenatal parent-foetal relationship and additionally measured child-parent relationships after birth. This study seeks to address the question: What can the antenatal relationship tell us about the postnatal parent-child relationship?
Method: Computerized databases were searched for relevant key phrases including the words: prenatal attachment, antenatal attachment, maternal-fetal attachment, postnatal, attachment, caregiving, and bonding.
Results: The search revealed 21 articles with two distinct categories—studies which utilise traditional Bowlbian measures of attachment during pregnancy and those which are more commonly explained as antenatal attachment. One study utilised measures from both categories and found that there was not a relationship between antenatal attachment and traditional measures of attachment. Concordance rates varied across studies, mainly dependent upon the measures used.Conclusions: This review provides a cohesive picture of the literature on how antenatal representations of relationships can influence the child-parent relationship quality after birth. Research in the future should be examining both categories of attachment, in order to better understand the relationship between these two constructs. This area of research continues to be a priority in informing antenatal education and intervention as researchers and clinicians work to understand what processes during pregnancy are most important to the relationship postnatally.
References:
Bowlby, J. (1982). Attachment and loss: Vol 1 (2nd ed.). New York, NY: Basic Books.Condon, J.T. (1993) The assessment of antenatal emotional attachment: Development of a questionnaire instrument. British Journal of Medical Psychology, 66, 167-183.Fraley, R., Waller, N., & Brennan, K. (2000) An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365.George, C., Kaplan, N., & Main, M. (1996). Adult Attachment Interview. Unpublished manuscript. University of California, Berkeley.
Peer Support for Mothers with Postnatal Depression
Authors: Cust, Fiona
Corresponding author: Fiona Cust, Staffordshire University, UK. Email: [email protected]
Background: Postnatal depression (PND) is a global mental health issue and numbers are increasing each year. Recent NICE guidelines (2015) have acknowledged the importance of therapeutic interventions. This pilot study demonstrates how effective peer support can potentially be.
Aim and Objectives: To assess the effectiveness of peer support upon women diagnosed with postnatal depression - in comparison to health visitor support only.
Method: Mixed methods investigation. Quantitative analysis utilising the EPDS and qualitative analysis utilising log book recordings, face to face interviews (taped with consent, then coded and categorised) and transcribed notes from group sessions.
Results: Peer support does appear to have a positive impact upon the severity/longevity of postnatal depression.
Interpretation: Therapeutic interventions do appear to have an effect upon postnatal depression - the mothers particularly valued the acknowledgement of the worker having previously experienced PND. They described their peer support worker (PSW) as a confidante, an expert and a positive inspiration. This was in comparison to their support from the Health Visitor whom, although recognised for their own positive input, did not inspire the same feelings of confidence which were gained from the peer support worker.
Conclusions: Peer support does appear to have a positive impact upon mothers with postnatal depression. A particularly positive aspect appeared to be the shared experiences and the shaping of the intervention by the group of PSWs.
‘I just get on with it’: Fathers’ perceptions of paternal stress in the perinatal period
Authors: Darwin, Z., Galdas, P., Hinchliff, S., McGowan, L., Littlewood, E., McMillan, D., Gilbody, S., Born and Bred in Yorkshire (BaBY) team
Corresponding author: Dr Zoe Darwin, University of Leeds, LS2 9JT, UK. Email [email protected]
Background: During the perinatal period, 5-10% of fathers experience depression [1] and 5-15% experience anxiety [2]. Their children face increased risk of adverse emotional and behavioural outcomes, independent of maternal mental health [3]. Accessible and acceptable resources and services for fathers are not yet evident in practice and little is known about fathers’ preferences [4].
Aim and Objectives: To explore how mental health during the perinatal period is understood and articulated by men in first and subsequent pregnancies.
Method: Men participating in an epidemiological prospective cohort (BaBY) who met eligibility criteria (baby <12 months; previously completed mental health and wellbeing [MHWB] questionnaires) were invited to participate. Those expressing interest (n=42) were purposively sampled to ensure diversity of MHWB scores. In-depth interviews were conducted at 5-10 months postpartum with 19 men aged 25-44 years. The majority were first-time fathers, UK born and lived with their partner. Data were analysed using thematic analysis [5].Results: Men predominantly framed their discussions around ‘stress’ rather than mental health; most described role strain, and ‘feeling torn’ trying to balance work with their aspirations of being a ‘good father’ and ‘supportive partner’. Impact of stress peaked postnatally and was described with reference to exhaustion, poor concentration and irritability. Several fathers felt excluded by maternity services but questioned their entitlement to support, noting that services are pressured and ‘should’ be focused on mothers. Describing their resilience, men spoke of ‘teamwork’ with their partner but also emphasised self-reliance and the use of practical coping and distraction.
Interpretation: Although men experience psychological distress in the perinatal period they may question the legitimacy of these experiences and be reluctant to express their support needs or seek help.
Conclusions: Resources are needed that are tailored to men; these may be more accessible if framed around fatherhood, rather than mental health.
References:
[1] Paulson, J.F. & Bazemore, S.D. (2010) Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. Journal of the American Medical Association, 303(19), 1961-1969.[2] Leach, L.S., Poyser, C., Cooklin, A.R. & Giallo, R. (2016) Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. Journal of Affective Disorders, 190, 675-686.[3] Ramchandani, P., O’Connor, T.G., Evans, J., Heron, J., Murray, L. & Stein, A. (2008) The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring. Journal of Child Psychology and Psychiatry, 49, 1069-1078.[4] Rowe, H.J., Holton, S. & Fisher, J. (2013) Postpartum emotional support: a qualitative study of women’s and men’s anticipated needs and preferred sources. Australian Journal of Primary Health, 19, 46-52.[5] Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77- 101.
Reactions to the mirror self-recognition task in 20 month-old children born with a cleft lip/palate: the influence of maternal gaze to the infant’s face at 2 months of age
Authors: De Pascalis, Leonardo; Minogue, Peter; Karpf, Janne; Goodacre, Tim; Hill, Jonathan; Dalton, Louise; Vaillancourt, Kyla M.; Bicknell, Sarah; Murray, Lynne; the SPOCCL Observational Study Team; the Spires Cleft Team
Corresponding author: Leonardo De Pascalis, Post-Doctoral Research Assistant, School of Psychology & Clinical Language Sciences, University of Reading, UK. Email: [email protected]
Background: Mothers of infants born with a cleft lip/palate (CLP) gaze at their infant’s face less than mothers of typical infants, at 2 months. During school years, being born with CLP brings about decreased self-esteem, satisfaction with facial appearance, and self-concept regarding social and personal functioning, and increased rates of social withdrawal. No study has previously explored these self-image difficulties earlier in development, and their association with maternal gaze patterns during infancy.
Aim and Objectives: To investigate reactions to a mirror in children born with CLP, at 20 months (when self-recognition is first established), and their association to maternal visual focus to the infant’s face at 2 months.
Method: Mothers’ looking times (LT) to their infant’s face were measured during naturalistic mother-infant interactions at 2 months (T1), in 31 children born with CLP, and 60 typical children. Self-recognition was assessed, using the Mirror Self-Recognition Task, at 20 months (T2). Children’s reactions to the mirror (gaze, proximity, physical contact, and emotional state) were coded.Results: At T1, mothers’ LT to their infant’s face were lower, in the presence of CLP. At T2, no group difference in self-recognition was found. During the mirror task, children with CLP kept greater distance from the mirror than typical children, and displayed less positive emotion. Children with CLP also showed decreased gaze to their face, but only if their mother had shown low LT to their face at T1.
Interpretation: Signs of problematic self-image emerged in children born with CLP at 20 months. Mother’s gaze patterns to their infant’s face at 2 months were associated to how children gazed at their own face at 20 months.
Conclusions: These results point to an early origin of self-image difficulties in children with CLP. The role of early parenting warrants further study on specifically aimed forms of early support.
The prevalence of post-traumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis
Authors: Dikmen Yildiz, Pelin; Ayers, Susan; Phillips, Louise
Corresponding author: Pelin Dikmen Yildiz, Centre for Maternal and Child Health Research, City University London, Northampton Square, London, EC1R 1UW, UK. Email: [email protected]
Background: Previous reviews have provided preliminary insights into risk factors and possible prevalence of post-traumatic stress disorder (PTSD) postpartum with no attempt to examine prenatal PTSD.
Aim and Objectives: This review aimed to achieve a better understanding of the epidemiology of perinatal PTSD. The objective was to determine the prevalence rates reported in population-based and high-risk samples that use diagnostic measures of PTSD and examine the course of PTSD over time.
Method: PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure.
Results: 56 studies met inclusion criteria: 33 studies of prenatal PTSD and 26 studies of postpartum PTSD (where 3 studies provided prevalence of PTSD in pregnancy and postpartum). In normal samples the mean prevalence was 3.12% (95% CI, 2.26–4.27) for prenatal PTSD and 4.05% (95% CI, 2.78–5.46) for postpartum PTSD. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95% CI, 10.73–31.27) in pregnancy and 18.5% (95% CI, 10.55–30.41) after birth. The rate of PTSD increased over the first six months after birth regardless of sample type.
Interpretation: PTSD rates were somewhat higher immediately after birth than in pregnancy which might be due to the fact that difficult childbirth experiences can either trigger the development of a new episode of PTSD or exacerbate existing PTSD developed in or before pregnancy. Differing course of PTSD in postpartum women might be due to unique elements of the postpartum period which might delay symptom onset and/or prevent resolution.
Conclusions: PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
The Postpartum Specific Anxiety Scale: development and preliminary validation
Authors: Fallon, Victoria; Bennett, Kate Mary; Halford, Jason Christian Grovenor; Harrold, Joanne Alison
Corresponding author: Victoria Fallon, PhD Student, Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK. Email: [email protected]
Background: Perinatal symptoms of anxiety are of increasing recognition due to their high prevalence and impact. However, the interpretation of results is limited by the use of general measures of anxiety. Studies using pregnancy-specific anxiety measures have found that they may predict perinatal outcomes more effectively than general measures. However, no such measure exists to assess anxieties specific to the postpartum.
Aim and Objectives: To develop a measure (Postpartum Specific Anxiety Scale, PSAS), which accurately represents the specific anxieties faced by postpartum women.
Method: A four stage methodology was employed: 1. 51 items were generated from interviews conducted with a group of 19 postpartum women at two time-points. 2. The scale was reviewed and refined by an expert panel 3. An online pilot study (n=146) was conducted to assess comprehensibility, acceptability, and implementation issues 4. An online sample of 1282 mothers of infants up to six months old completed the PSAS alongside a battery of convergent measures. A subsample (n=262) repeated the PSAS two weeks later. Factor structure was examined, alongside other validity and reliability analyses.Results: The PSAS possessed good face and content validity and was comprehensible and acceptable to postpartum women. PSAS scores were significantly correlated with other measures indicating good convergent validity. Principal component analyses (PCA) revealed a simple four factor structure. Reliability of the overall scale and individual PSAS factors proved good to excellent. A preliminary ROC analysis also suggested that the PSAS may be a useful screening tool.
Interpretation: The psychometric evidence suggests that the PSAS is an acceptable, valid, and reliable research tool to assess anxieties which are specific to the postpartum period.
Conclusions: Next steps in the iterative validation process are considered for both research and screening purposes.
“IBD and Mums-To-Be”: The Lived Experience of Women Transitioning into Motherhood with Inflammatory Bowel Disease
Authors: Ghorayeb, Jihane*; Branney, Peter; Madill, Anna
Corresponding author: Jihane Ghorayeb, PhD Researcher, School of Psychology, University of Leeds, UK. Email: [email protected]
Background: Inflammatory Bowel Disease (IBD) affects 1 in every 250 individuals in the UK with a slightly higher female to male ratio (NHS, 2014). Furthermore, IBD’s most common onset is between the third and fourth decade of life, thus affecting women’s childbearing years (Molodecky et al., 2012). The literature on IBD is dominated by quantitative research and only a handful of articles address the subjective experience of motherhood with IBD.
Aim and Objectives: The purpose of this research is to provide understanding of the journey into motherhood with IBD.
Method: 21 women with IBD were recruited from around the UK. Semi-structured interviews lasting around 60 minutes were transcribed and analysed using Thematic Analysis (Braun & Clarke, 2006).
Results: Four themes labelled ‘burden of knowledge’, ‘weighing decision-making’, ‘blame and guilt, and ‘ambivalence towards medics’ intertwined across five stages of the transition to motherhood with IBD.
At diagnosis (phase 1) and while planning conception (phase 2) ‘burden of knowledge’ is apparent; women are troubled by the knowledge that IBD is hereditary. Elements of blame and guilt are also depicted notably when mothers are taking medications during pregnancy and breastfeeding (phase 3). Lastly, women with IBD expressed ‘ambivalence towards their medical team’; they switched between feelings of mistrust and partnership. The last two phases ‘labour’ and ‘early years’ of motherhood cover feelings of guilt around bottle-feeding vs. breastfeeding whilst taking medication and tackled disclosing IBD to a young child.
Interpretation/Discussion: Mothers with IBD navigate across their transition through stages; each stage requiring new challenges and new ways of coping with the changes imposed by motherhood and IBD.
Conclusions: These findings will help inform mothers, mums-to-be, their partners and families as well as healthcare providers about the lived experience mothers with IBD.
References:
Braun, V., Clarke, V. (2006). Using thematic analysis in psychology, Qualitative Research in Psychology, 3, 77- 101.Molodecky, N. A. et al. (2012). Increased incidence & prevalence of IBD with time, based on systematic review. Gastroenterology, 142, 46-54 e42.National Health Service (2014). IBD. Retrieved from http://www.nhs.uk/conditions/inflammatory-bowel-disease/pages/introduction.aspx
Model care pathway in pregnancy subsequent to a traumatic birth
Authors: Greenfield, M; Jomeen, J; Glover, L.
Corresponding author: Mari Greenfield, University of Hull, UK. Email: [email protected] Julie Jomeen, University of Hull, UK. Email: [email protected] Lesley Glover, University of Hull, UK. Email: [email protected] Background: A significant number of women experience childbirth as traumatic. Little is known about the choices women make in subsequent pregnancy(s) and birth(s). Understanding the choices women make, and why, is necessary to offer appropriate support during pregnancy and birth.
Objective: To generate a model care pathway, for pregnancies subsequent to a traumatic birth.
Method: Nine pregnant UK-based women who had previously experienced a traumatic birth were recruited to a longitudinal grounded theory study, from various online pregnancy and parenting forums. Interviews were carried out at 3 timepoints during pregnancy/postnatally (27 interviews). The interviews were analysed through GTM; the emerging model care pathway is presented in this paper.Results: Women made various choices about birth at an early stage, sometimes before conceiving. They made choices throughout pregnancy with consideration as to whether this decision would affect the birth they wanted. Women invested the power to support their birth plans in different people – Obstetricians, Heads of Midwifery, Homebirth Teams, and Independent Midwives. Anticipating a lack of support, women prepared for appointments as though each would be a battle. Once each woman had met the person who she believed could support her choices, women experienced a sense of relief. If that support was denied, it was devastating. From the interviews, a theoretical model of factors that relieve anxiety, and factors that heighten anxiety has been generated. This model has been converted into a care pathway. The pathway presented is intended to have practical applications for those providing midwifery, obstetric or other birth care to women who have previously experienced a traumatic birth.
Conclusions: If women who have previously experienced a traumatic birth become pregnant again, they are focussed on avoiding a repeat experience. This pathway illustrates support that women may find helpful whilst pregnant, and conversely factors which may increase anxiety.
Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda
Authors: Hennegan, Julie*; Dolan, Catherine; Wu, Maryalice; Scott, Linda; Montgomery, Paul
Corresponding author: Julie Hennegan, Centre for Evidence-Based Intervention, University of Oxford, 32 Wellington Square, Oxford OX1 2ER, UK. Email: [email protected]
Background: Despite increasing attention to menstruation in low income contexts, studies are yet to estimate the prevalence of inadequate menstrual hygiene management (MHM) in a way consistent with the concept definition. There is a dearth of quantitative evidence testing hypothesised associations between MHM and negative outcomes.
Aim and Objectives: Describe Ugandan schoolgirls MHM practices and estimate the prevalence of inadequate MHM. Assess the relative contribution of aspects of MHM to health, education, and psychosocial outcomes.
Method: Follow-up survey data from a controlled trial of reusable sanitary pad and puberty education provision was used to describe girls’ management practices and assess outcomes. 205 menstruating girls from the eight study schools in rural Uganda were included in the study. The prevalence of MHM, consistent with the concept definition, was estimated using dimensions of; absorbent used, frequency of absorbent change, washing and drying procedures, and privacy.Results: 91% of girls failed to meet available criteria for adequate MHM, with no significant difference between those using provided reusable sanitary pads (89%), and those using existing methods, predominantly cloth (92%). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions, and concerns about odour. Many null results were also observed.
Interpretation: When considering the full definition of MHM, far more girls than previously reported do not have adequate menstrual hygiene.
Conclusions: This study was the first to assess the prevalence of MHM consistent with the concept definition. It found that the provision of reusable sanitary pads to a proportion of the sample did not affect pooled MHM. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education, and psychosocial consequences.
Development and measurement characteristics of the Birth Satisfaction Scale-Revised Indicator (BSS-RI)
Authors: Martin, Colin R.; Hollins Martin, Caroline J.; Redshaw, Maggie
Corresponding author: Professor Colin R Martin, Faculty of Society and Health, Buckinghamshire New University, Uxbridge Campus, 106 Oxford Road, Uxbridge, Middlesex, UB8 1NA, UK. Email: [email protected]
Background: Focusing on the labour and birth component of perinatal care the recently developed Birth Satisfaction Scale represents a theoretically based and psychometrically valid measure of birth satisfaction. Use of the tool in a range of international contexts has highlighted and confirmed the measurement characteristics. However, adaptation of the tool for potential use as a key performance indicator of labour and birth experience has yet to be realised despite the salience of the concept of birth satisfaction in relation to a range of clinical outcome.
Aim and Objectives: The purpose of the study was to develop simplified version that could work as a short evaluative measure and a birth satisfaction indicator using exemplar items from the 10-item Birth Satisfaction Scale-Revised (BSS-R). The study sought to determine the measurement veracity of the developed measure by evaluation of key psychometric properties.
Method: Following item selection by expert review, the Birth Satisfaction Scale-Revised Indicator (BSS-RI) was embedded within the 2014 National Maternity Survey for England. Mothers who had given birth three months earlier were randomly selected from birth registration for participation in the study by the Office for National Statistics. The BSS-RI was evaluated using a comprehensive battery of psychometric approaches including, exploratory factor analysis, confirmatory factor analysis, internal consistency, convergent, divergent and known-groups discriminant validity evaluation.
Results: Systematic psychometric review revealed the BSS-RI to two robust and theoretically cogent domains of birth satisfaction, stress experienced during childbearing and quality of care. The measurement characteristics of the BSS-RI were generally excellent across all parameters evaluated.
Interpretation: The BSS-RI offers a short, valid and reliable assessment of birth satisfaction.
Conclusions: Developed from the short-form version of the Birth Satisfaction Scale-Revised, this short instrument represents a further development of a tool that is psychometrically robust, easy to administer and which is an easily scored measure of birth satisfaction. Use of the tool as an outcome measure and key performance indicator is suggested.
Evaluation of the invariance characteristics of the Birth Satisfaction Scale-Revised: Further evidence of measurement validity
Authors: Martin, Colin R.; Vardavaki, Z.; Hollins Martin, Caroline J.
Corresponding author: Professor Colin R Martin, Faculty of Society and Health, Buckinghamshire New University, Uxbridge Campus, 106 Oxford Road, Uxbridge, Middlesex, UB8 1NA, UK. Email: [email protected]
Background: The 10-item revised version of the Birth Satisfaction Scale (BSS-R) has become increasingly used in studies Internationally, largely as a consequence of its substantive theoretical underpinnings and its established measurement qualities. However, direct comparison of the measure between different language versions have yet to be conducted despite this being a context to establish even further the opportunities for comparisons between translated versions of the instrument to be made with confidence at the measurement level.
Aim and Objectives: The study sought to directly compare the original UK-language version of the tool with a translated version in terms of fundamental measurement characteristics to determine if the two versions of the tool demonstrated measurement equivalence.
Method: Datasets from the UK version of the BSS-R and a Greek-translated version of the BSS-R were compared using a structural equation modeling measurement invariance evaluation approach. A series of increasing constrained models were used to evaluate equivalence. Participants in this secondary analysis were a convenience sample of UK (n=228) and Greek (n=162) postnatal women (n=162).Results: BSS-R model fit with pooled data was found to be excellent. A robust configural model was established and metric level invariance demonstrated between English and Greek-language versions. Partial scalar invariance of the BSS-R was also demonstrated. The two non-invariant items at the scalar level may reflect true differences between participant groups in terms of birth satisfaction giving a psychometrically facilitated insight into the impact of service delivery model and clinical factors.
Interpretation: This secondary analysis offers further evidence for the superlative measurement characteristics of the BSS-R beyond that furnished by more contemporaneous approaches to measurement evaluation.
Conclusions: This study suggests equivalence between the English-language and a Greek-translated version of the BSS-R demonstrating equivalence and thus meaningful comparisons can be made between the measures and thus, the populations under investigation.
Pregnancy while living with HIV in England: stigma and peer support
Authors: McLeish, Jenny; Redshaw, Maggie
Corresponding author: Jenny McLeish, Health Services Researcher, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK. Email: [email protected]
Background: 98% of pregnant women take up the screening test for HIV in England, and 2.5 per thousand test positive for HIV, with one in six being newly diagnosed in pregnancy. The majority of pregnant women living with HIV in England are Black African, with HIV affecting around 2-3% of pregnant women born in sub-Saharan Africa. Mentor Mother (trained mother-to-mother) peer support programmes have been developed in sub-Saharan Africa to give pregnant women living with HIV information and support and thereby to reduce mother-to-child transmission.
Aim and Objectives: To explore the experiences of women living with HIV in England who received or gave Mentor Mother volunteer peer support during pregnancy and early motherhood.
Method: A qualitative descriptive study, using semi-structured, in-depth interviews and inductive thematic analysis, carried out at England’s first Mentor Mother project as part of a larger study into perinatal peer support.
Results: 12 women living with HIV were interviewed (6 had given peer support and 6 had received support). 11 were Black African. The key themes in participants’ descriptions of their lives as pregnant women and mothers living with HIV were ‘fear and distress’, ‘stigma and isolation’, ‘loss of family’, ‘overwhelmed with other crisis issues’ and ‘the gap in maternity care’. The key themes related to volunteer peer support during and after pregnancy were ‘role modelling success’, ‘non-judgemental acceptance’, ‘reinforcing medical advice’, ‘prioritisation and problem-solving’, and ‘partnership in maternity care’.
Interpretation: Peer support from trained volunteers during and after pregnancy can have a positive impact on vulnerable mothers’ emotional wellbeing, supporting them to construct a self-accepting maternal identity, to take control of decision-making, and to have a successful transition to motherhood.
Conclusions: Mentor Mother peer support should be available to pregnant women living with HIV.
Those who do and those who don’t – Feeding decisions in the context of baby led weaning and traditional spoon-feeding
Authors: McNally, Janet; Hugh-Jones, Siobhan and Hetherington, Marion
Corresponding author: Janet McNally, University of Leeds, LS2 9JT, UK. Email: [email protected]
Background: ‘Baby Led Weaning’ (BLW) has grown in popularity recently as an alternative approach to infant weaning, and there is increasing research interest in mothers choosing this approach, and their reasons for doing so. Less attention has been paid, however, to the reasons why most mothers continue to choose traditional spoon feeding (SF) to wean their babies.
Aim and Objectives: This study aimed to understand the personal factors shaping weaning practices, whether BLW or SF. It particularly aimed to explore the context of feeding decisions and what factors mothers felt made their chosen approach right for their infant.
Method: 11 mothers of infants from 6 to 18 months participated in semi-structured interviews. Template analysis was used to identify self-reported factors influencing weaning approach. Interviews were read, transcribed in full and coded using apriori themes drawn from the research questions. Themes were modified as coding progressed to produce an initial template. This was checked against the data and revised to produce a final template for interpreting findings.
Results: Template analysis identified several common factors which shaped weaning choices for both groups including beliefs, experiences and practicalities. Differences were identified in how the two groups explained their weaning choices, with SF mothers emphasising infant characteristics and nutritional intake and BLW mothers emphasising infant autonomy and exploration.
Interpretation: Multiple factors shape choice of weaning method. Many of these are shared by SF and BLW mothers, as are many aims for weaning. Despite this, the two groups also express different beliefs about infant feeding and how their chosen approach meets both shared and differing feeding aspirations.
Conclusions: Regardless of method, mothers had similar reasons and aims for their weaning approach. However, differences in the accounts of SF and BLW mothers appear to reflect different priorities for, and different conceptualisations of, the functions of weaning.
A systematic review of interventions to improve psychological outcomes of parents of infants admitted to Neonatal Intensive Care
Authors: McNeill Jenny; Reid Esther; Lynn Fiona; O’Dowd Maureen; Smyth Suzie; Franck Linda; Alderdice Fiona
Corresponding author: Jenny McNeill, School of Nursing & Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. Email: [email protected]
Background: Appropriate support is necessary for parents of infants admitted to neonatal intensive care units (NICU) to ensure psychological outcomes are maximized.
Aim and Objectives: To identify interventions which may improve parental psychological outcomes.
Method: Databases (Medline; Embase; PsycINFO; CINAHL; Web of Science; the Cochrane Central Library; NHS EED; HEED) were searched from 1980-2016. Eligible randomised controlled trials included an intervention for parents of infants admitted to NICU, which commenced in NICU and had a primary parental psychological outcome.
Results: Nine studies were eligible for inclusion. Interventions were educational, behavioural or focused on parental relaxation. Psychological outcomes such as stress/anxiety/depression/PTSD were measured using a range of instruments at various time-points. Meta-analysis was conducted as appropriate.
Interpretation: Parental psychological outcomes could potentially be improved by the implementation of specific interventions.
Conclusions: Some interventions (n=6) demonstrated short term benefits which may help improve parental psychological outcomes; however the review was limited by variation in intervention and outcome measurement across trials.
Antenatal depression, adherence and outcomes in the UPBEAT RCT of a lifestyle intervention for obese pregnant women
Authors: Molyneaux, Emma; Poston, Lucilla; Howard, Louise M
Corresponding author: Dr Emma Molyneaux, Section of Women’s Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, PO31 David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK. Email: [email protected]
Background: Many studies have examined diet and physical activity interventions for obese pregnant women, but the effectiveness of these interventions has been limited and low adherence to intervention sessions is common. Participant characteristics, such as depression, may predict adherence and intervention outcomes, but there has been little research on this topic.
Aim and Objectives: To examine the relationships between baseline depression and intervention adherence and outcomes in a large RCT of a complex behavioural intervention for obese pregnant women.
Method: The UPBEAT RCT examined the effectiveness of an intervention to improve diet and increase physical activity among obese pregnant women, with the aim of reducing risk of gestational diabetes. Antenatal depression was assessed with Edinburgh Postnatal Depression Scale (EPDS) at 15-18 weeks’ gestation and a cut-off of ≥13 was used to indicate elevated symptoms of depression. Primary outcomes for this study were adherence to intervention sessions and risk of gestational diabetes; secondary outcomes were change in diet, change in physical activity and gestational weight gain (all assessed at 27-28 weeks’ gestation). Women with fetal loss or preterm birth prior to 27-28 weeks’ gestation were excluded from the sample for these analyses. Multiple imputation was used to address missing data.
Results: These analyses included 1,526 obese pregnant women, of whom 27.9% scored ≥13 on the EPDS at baseline. There were no significant associations between antenatal depression at baseline and intervention adherence or outcomes.
Interpretation: We found no evidence that elevated symptoms of antenatal depression were associated with adherence or outcomes in this large RCT of a behaviour intervention for obese pregnant women.
Conclusions: Elevated symptoms of antenatal depression were very common among obese pregnant women recruited from largely inner-city hospitals, but there was no evidence that obese women with elevated symptoms of depression should be excluded from lifestyle interventions during pregnancy.
Fathers’ Perinatal Mental Health: An Important Yet Neglected Topic
Authors: Rominov, Holly; Giallo, Rebecca; Pilkington, Pamela; Whelan, Thomas
Corresponding author: Holly Rominov, PhD Candidate, Australian Catholic University, Melbourne, Australia. Email: [email protected]
Background: The perinatal period represents a highly significant transition for fathers, and can result in an increased vulnerability to psychological distress. Fathers’ perinatal mental health is a critical area of research, due to the potential consequences for the whole family system.
Aim and Objectives: A three-part project focusing on fathers’ mental health in the perinatal period was conducted, aimed at improving our knowledge in this area.
Method: First, the longitudinal relationships between fathers’ psychological distress and parenting self-efficacy in the postnatal period, parenting behaviour when children were aged 4-5 years, and emotional-behavioural outcomes for children aged 8-9 years were explored. Second, a systematic review of existing research detailing interventions targeting expectant and new fathers’ mental health was conducted. Finally, fathers’ perceived support needs in the perinatal period were explored through qualitative interviews.Results: Support programs targeting new fathers’ perceptions of parenting competence may be particularly important for fathers experiencing postnatal distress. Nonetheless, current evidence regarding the effectiveness of interventions is limited and studies lack methodological rigor. Fathers identify with a diverse range of experiences in the perinatal period, which translate to specific support needs.
Interpretation: The long-term consequences for children of fathers’ mood problems highlighted the need for interventions to target fathers’ mental health during the perinatal period. Future interventions need to incorporate more rigorous designs, and be informed by father voices, focusing on their specific support needs.
Conclusions: This information can inform policy, services and intervention efforts targeting the promotion of fathers’ mental health and parenting in the perinatal period.
Examining the content of women’s fears for childbirth: a meta-synthesis
Authors: Sheen, K*; Slade, P.
Corresponding author: Dr Kayleigh Sheen, Postdoctoral Research Associate, Psychological Sciences, Whelan Building, University of Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK. Email: [email protected]
Background: Fear of childbirth (FOC) is a key element of psychological distress in pregnancy, with adverse implications for women’s experiences of birth and their postpartum health. However, the construct of fear of childbirth is currently poorly defined. In the absence of a clear or clinical definition of FOC, many measures have been developed for example without domains being specifically driven by women’s concerns. Identification of these domains from the qualitative literature is required in order to fear facilitate the development of appropriate measures.
Aim and Objectives: To synthesis findings from qualitative literature reporting women’s experiences of childbirth fear.
Method: A systematic search of databases was undertaken in December 2015 using pre-defined search terms. Qualitative studies investigating fear of childbirth with women either during pregnancy or in the postpartum were retained for review. A key criterion was for studies to report on the content of women’s fears (‘what’ was feared about giving birth).Results: A total of 29 papers reporting data from 28 studies fulfilled eligibility criteria. There was a high degree of consensus between studies. Findings highlighted that women were fearful of the pain of giving birth, potential for injury, were concerned about their personal (emotional or physical) capacity to give birth, potential loss of control during labour, or a potential absence of support.
Interpretation: The contribution of findings to the development of a construct for fear of birth will be discussed.
Conclusions: Findings from this meta-synthesis constitute one element of a project that aims to develop a clear definition for the fear of childbirth construct and contribute to appropriate usable measurement tools. Identification of women experiencing high levels of fear about childbirth in their pregnancy will enable timely intervention to reduce, or effectively manage, anxiety.
Are mealtime interactions and communication cues more positive in breastfeeding infants?!
Authors:
Shloim N; Vereijken CMJL; Blundell P; Rudolf, MCJ; Feltbower RG; Mohebati L; Hetherington MM.
Corresponding author: Netalie Shloim, University of Leeds, LS2 9JT, UK. Email: [email protected]
Background: Longer duration of breastfeeding and responsive feeding has been associated with reduced risk of obesity and positive health effects. One indicator of responsive feeding is the quality of mealtime interactions. This can be influenced by the mother’s ability to identify and respond to infant cues of hunger, appetite and satiety. Objective: To explore mealtime interactions and communication cues (hunger and satiety) in the first 6 months of life in a sample of Israeli and UK mothers and infants. Aims: 1. To learn about the quality of mealtime interaction in formula and breastfeeding infants. 2. To explore feeding cues and to examine if such cues vary by mode of feeding (breastfeeding vs. formula feeding). Method: Forty one mothers and infants (age of 2-6 months) were filmed while feeding. Mealtime interactions and infant feeding cues were identified using validated coding scales (SFES and NCAST). Mixed ANOVA were conducted to compare communication cues by mode of feeding (breast vs. formula) and part of the meal (beginning, middle and end).
Results: Mealtime interactions were more positive for breastfeeding compared to formula fed infants. Breastfeeding mothers provided fewer distractions during the meal, a better feeding environment and allowed the infant to set the pace of feeding compared to formula feeding mothers.
Interpretation: Breastfeeding was associated with a more positive mealtime experience than formula feeding. More positive outcomes were identified for breastfeeding mothers and their ability to respond to disengagement cues, which can be transferred to the complementary feeding period.
Conclusions: Mealtime interactions varied between breastfeeding and formula feeding infants. These findings strengthen the conviction that feeding is not only about the food content (what) but also how mothers and infants communicate during a feed.
References:
Shloim, N., Rudolf, M. C. J., Feltbower, R. G., Mohebati, L., & Hetherington, M. (2015). Breast is best: Positive mealtime interactions in breastfeeding mothers from Israel and the United Kingdom. Health Psychology Open, 2(1), 2055102915579605.Shloim N, Vereijken CMJL, Blundell P, Hetherington MM. (2016). Looking for cues – infant hunger and satiety during milk feeding. Submitted to the journal of appetite
A meta-ethnographic synthesis of fathers’ experiences of the neonatal intensive care unit environment during hospitalization of their premature infant
Authors: Sisson, Helen; Jones, Catriona; Williams, Rhona; Lachanudis, Lisa
Corresponding author: Catriona Jones, Senior Research Fellow/Lecturer in Midwifery. Faculty of Health and Social Care, University of Hull, HU6 7RX, UK
Email: [email protected]
Background: The Neonatal Intensive Care Unit (NICU) can be an intimidating environment adding to parental distress following a preterm birth. Jamsa and Jamsa (1998) suggest that technology in NICU has a negative influence on parents’ experiences, citing wires, tubes and lights, and audible sounds, as oppressive and frightening. Other researchers have found that technology can negatively affect parental attachment. Aim and Objectives: It is well documented that the quality and level of fathers’ interactions with their infants is particularly pertinent to child behavioural development, and there is a growing interest in the needs of fathers in this context. Health professionals are being encouraged to use interactions with families as an opportunity to identify the emotional and physical needs of parents and infants (Davies & Ward, 2012). A number of studies have explored the experiences of fathers in neonatal care environments, and we identified a growing need to bring this existing body of work together with the aim of synthesizing the key messages for practice. The objective was to undertake a meta ethnographic synthesis of the existing qualitative findings about fathers’ experiences of the NICU environment.
Method: Twenty-four studies were included in this systematic review and meta ethnography. Primarily guided by Noblit and Hare (1988), the study findings were synthesized by translating initial concepts and findings from an identified key paper into data from the remaining 23 studies.
Results: Emergent themes were proximity, parental autonomy, vulnerability, communication and exclusion and isolation.
Interpretation: Our meta ethnographic synthesis highlights the intense emotional responses of fathers of preterm infants, alongside the powerful forces of the NICU environment in terms of fathers’ abilities to engage and interact with their new-born babies.
Conclusions: The needs of fathers to interact and be involved with their infant’s care is a prominent factor enhancing their experiences in the NICU. Staff in the NICU can play a key role in facilitating this interaction through encouragement and reassurance.
References:
Davies C., & Ward, W. (2012). Safeguarding children across services: messages from research. Retrieved from;
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/183231/DFERR164.pdf
Jamsa, K., & Jamsa, T. (1998). Technology in neonatal intensive care – a study on parents’ experiences. Technology and Health Care, 6(4), 225-230Noblit, G.W., & Hare, R.D. (1988). Meta-ethnography: synthesizing qualitative studies. Park, CA: Sage Publications
Do anxiety and pregnancy-stress in early pregnancy influence the progression of labour? Evidence from the Wirral Child Health and Development Study (WCHADS)
Authors:
Slade, P*; Sheen, K; Weeks, A; Wray, S; Lunt, K; Bedwell, C; Thompson, B; Hill, J; Sharp, H
Corresponding author: *Pauline Slade, Professor of Clinical Psychology and Consultant Clinical Psychologist, Clinical Psychology, Institute of Psychology, Health & Society, University of Liverpool, UK. Email: [email protected]
Background: Despite widespread belief that maternal stress causes longer labours, evidence of association between antenatal anxiety and rate of progress in labour is inconsistent. Early identification of factors predictive of prolonged birth could facilitate timely intervention with positive implications for childbirth experiences and postpartum mental health.
Aim and Objectives: To investigate associations between antenatal anxiety and pregnancy-specific stress, and labour progression as assessed by first stage of labour duration, augmentation and emergency caesarean for ‘failure to progress.’
Method: As part of a large MRC funded epidemiological study investigating predictors of child development (the Wirral Child Health and Development Study, WCHADS), pregnant primiparous women completed measures for general state anxiety (STAI) and pregnancy-specific stress (PSS) in early pregnancy. Obstetric data were extracted from birth records.
Results: Early anxiety or PSS were not directly related to labour duration or emergency caesarean section for ‘failure to progress.’ Anxiety and PSS were each associated with requirement for augmentation during labour, but these associations were rendered non-significant after the inclusion of epidural as a covariate. Epidural was associated with both longer labour and requirement for augmentation.
Interpretation: Findings point towards a psychological mechanism whereby anxiety or pregnancy-specific stress influence request for, or offer of, epidural to women, which may subsequently increase risk for prolonged labour duration or interventions.
Conclusions: Whilst assessment of anxiety or PSS at 20 weeks will not necessarily identify women more likely to experience longer labour or intervention, it may identify those more likely to require epidurals. Psychological interventions for women with high anxiety or stress could influence epidural use, potentially reducing obstetric intervention and enhancing women’s experience of labour.
SYMPOSIUM
Perinatal loss: Impact on families and staff
Introduction
Perinatal loss is often referred to as the invisible death. Parents grieve not for a past but for a lost future, and, for first-time parents, for their lost parental identity and role. Most parents are unprepared for the shocking and unanticipated loss. Research suggest that families may be deeply troubled by feelings of worthlessness, shame and isolation and that they are at risk of developing mental health problems, such as prolonged grief, anxiety, depression, or posttraumatic stress disorder. All studies presented in this symposium aim to improve our understanding of the impact a perinatal loss has on both parents and staff who support them in order to improve the quality of care for those parents.
The first presentation will focus on the role of cognitive behavioural variables in explaining symptoms of prolonged grief in mothers following stillbirth. This is important, as it may help to identify targets for assessment and treatment.
The second presentation focuses specifically on the act of holding the baby following stillbirth on both mothers’ and fathers’ mental health and wellbeing. The quantitative survey study adds to a mixed field of evidence on the topic, which has seen significant controversy in recent stillbirth care guidelines.
The third presentation is a qualitative, exploratory study of the views of healthcare professionals and support staff working with parents after stillbirth. For the welfare of both parents and staff, it is important to understand the challenges that staff face in providing good quality care.
Finally, the fourth presentation describes the process of developing guidelines for health professionals supporting parents after the loss of a baby from a multiple pregnancy, in particular when there is a loss and surviving baby.
Role of cognitive behavioural variables in prolonged grief following stillbirth
Authors:
Crispus-Jones, Helen; McKenzie-McHarg, Kirstie; Krupnik, Yael; Horsch, Antje*
Corresponding author: Dr Antje Horsch, Neonatology Service, University Hospital Lausanne, Avenue Pierre-Decker 2, CH-1011 Lausanne, Switzerland. E-mail: [email protected]
Background: Research testing the cognitive behavioural model of prolonged grief following perinatal loss is lacking. This is important, as it may help to identify targets for assessment and treatment.
Aim and Objectives: The present study sought to identify the extent to which demographic, obstetric and loss-related risk factors and cognitive behavioural variables predict prolonged grief severity up to two years following stillbirth.
Method: Mothers (N = 111) who experienced stillbirth at ≥ 24 weeks gestation within the preceding two years completed an online survey with self-report measures of grief severity, loss-related cognitions and avoidance behaviours, and additional demographic, obstetric and loss-related information.
Results: Low satisfaction with available social support, not having had a subsequent pregnancy and having held the stillborn baby were significant risk factors of grief severity, accounting for 21.4% of the variance in grief scores. Cognitive behavioural variables, namely ‘depressive avoidance strategies’, ‘negative thoughts about the self’, and ‘threatening interpretations of grief reactions’ were all significant predictors of grief severity. These three cognitive variables remained significant predictors after controlling for relevant demographic, obstetric and loss-related variables, accounting for an additional 62% of the variance.
Interpretation: Findings support the application of the cognitive behavioural model of prolonged grief to mothers bereaved by stillbirth. Results need to be interpreted with caution, as online recruitment may potentially result in higher self-reported grief scores.
Conclusions: The assessment of grief-related cognitions and avoidance behaviours may help to target interventions towards those at greatest risk of prolonged grief.
The impact of holding the baby following stillbirth on parents’ mental health and wellbeing: findings from a national survey
Authors: Redshaw, Maggie; Hennegan, Julie*; Henderson, Jane
Corresponding author: Julie Hennegan, Centre for Evidence-Based Intervention, University of Oxford, 32 Wellington Square Oxford OX1 2ER, UK. Email: [email protected]
Background: Actions surrounding a stillbirth are critical in parents’ experience and outcomes. There has been substantial controversy around policies recommending parents do, or do not, hold their baby. Past quantitative studies have found positive, negative, and null effects of the interaction for mothers, whilst none have assessed partners.
Aim and Objectives: This study compared mental health and wellbeing outcomes at three and nine months after the stillbirth between those who held or did not hold their baby, adjusting for demographic and clinical differences.
Method: Secondary data analysis was conducted on 468 eligible responses from a postal population survey of women with a registered stillbirth in England in 2012. Primary outcomes were self-reported depression, anxiety, PTSD symptoms and relationship difficulties. Differences in demographic, clinical and care characteristics between those who held or did not hold their infant were described and adjusted for in subsequent analysis. Subgroup comparisons tested hypothesised moderating factors.Results: Most women and partners saw (97%, 92%) and held (84%, 82%) their baby after stillbirth. There were some demographic differences with migrant status, a multiple pregnancy and fertility treatment predicting a lower rate of holding the baby. Findings suggested a protective effect of seeing the stillborn baby, but a negative impact of holding for both mothers and partners.
Interpretation: Results will be detailed carefully in presentation, as they are in contrast to qualitative study findings which describe parents’ positive feelings and satisfaction with holding their baby after stillbirth. Some evidence for proposed moderators was observed, including an effect of young gestational age and mother’s pregnancy status at outcome assessment.
Conclusions: This study supports concern about the impact of holding the infant after stillbirth and highlights the need for further quantitative research. It was the first to assess the relationship between partners’ contact with the baby and subsequent mental health.
Providing care for families who have experienced stillbirth: a qualitative, exploratory study of the views of healthcare professionals and support staff
Authors: Crawley, Rosalind; Brierley-Jones, Lyn; Gordon, Isabel; Jones, Emma; Hinshaw, Kim
Corresponding author: Dr. Rosalind Crawley, Department of Psychology, University of Sunderland, St Peter’s Campus, St. Peter’s Way, Sunderland, SR6 0DD, UK. Email: [email protected] Background: Support provided by healthcare staff is an important factor affecting the wellbeing of parents who have experienced stillbirth. Successfully supporting parents is challenging and imposes an emotional burden on healthcare staff. For the welfare of both parents and staff, it is important to understand the challenges that staff face in providing good quality care.
Aim and Objectives: To explore how a range of health professionals and other hospital staff support parents who have experienced stillbirth and their perceptions of the challenges they face.
Method: A qualitative pilot study involving six focus groups and two interviews was carried out at three hospitals in the north of England. Participants (N=60) were consultants, junior doctors, midwives, midwife sonographers and chaplains. Following transcription of the focus group discussions and interviews, thematic content analysis was used to identify major themes. Results: A major theme was concern about the lack of an evidence base to guide practice. Several tensions and uncertainties arose from this, primarily centred on whether patients have, and should have, choices about care. Examples of such choices included Caesarean section or normal delivery, and going home for 48 hours or staying in hospital before delivery. Another theme related to the importance of training versus experience in guiding practice. A desire was expressed for more feedback about what parents find beneficial. Some hospital systems were perceived as barriers to good care, for example, pressure on sonographer lists.
Interpretation: Within the tensions that emerged, competing discourses were identified between a need to protect and guide patients who were perceived as not knowing what they want, versus a discourse of freedom of choice and parents’ ability to make informed, competent decisions.
Conclusions: There is much uncertainty about how best to provide good quality care and a need for better guidance and support for staff.
Developing guidelines for health professionals who support parents who have had a loss from a multiple pregnancy
Authors: Rankin J; Hayes L; Embleton ND; Richards J; Campbell C; Crowe L
Corresponding author:
Prof. Judith Rankin, Institute of Health & Society, Baddiley Clark Building Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AE, UK. Email: [email protected]
Background: In our recent study[1] of parents and health professionals views of a bereavement from a twin pregnancy, staff reported that they lacked confidence in supporting bereaved parents in this situation. In response to this, we aimed to develop guidelines for health professionals to support parents after the loss* of a baby from a multiple pregnancy.
Aim: To describe the process of developing the guidelines and present the current guidelines.
Method: We worked iteratively with health professionals and parents to develop the guidelines, using a co-design approach. We undertook a scoping study of available resources on bereavement care and we reviewed the transcripts of interviews completed in the previous study1 to identify ‘training points’. These are factors that were important in determining whether or not parents felt well supported by health professionals at the time of their bereavement, and areas where health professionals felt they lacked confidence in supporting parents. Draft guidelines were written and circulated to health professionals, patient representatives and representatives from patient organisations. We then organised a workshop to discuss the draft guidelines and agree changes that should be made to them. The final version of the guidelines incorporated these changes.
Results: We identified a number of behaviours and actions that staff can adopt that parents find helpful around the time of a bereavement from a multiple pregnancy. These are captured by the guidelines and include: Recognising that the pregnancy is a multiple pregnancy; Acknowledging the bereavement; Providing emotional support to parents; Providing appropriate information to parents; Providing as much continuity as possible; Offering memory making; Handling cot occupancy sensitively; Preparing parents for discharge from hospital.
Conclusion: By working with health professionals, parents and representatives from parent organisations, we have developed new guidelines which will improve care for parents when a loss has occurred.
*Loss in this context refers to when a baby has died from a twin/multiple pregnancy and a baby has survived.
References
[1] Richards J et al. Health professionals’ perspectives on bereavement following loss from a twin pregnancy Journal of Perinatology, 36, 529-532. doi:10.1038/jp.2016.13
FLASH ORAL PRESENTATIONS WITH POSTER PRESENTATIONS
“Later, baby!”: Age-related attitudinal differences toward delayed childbearing
Authors: Bayly, Melanie K., Duerksen, Kari N., Sangster, Sarah L., & Lawson, Karen L.
Corresponding author: Melanie Bayly, PhD candidate, University of Saskatchewan, Canada. Email: [email protected]
Background: Delayed childbearing is an increasing trend in Canada, and has led to concerns that young women are making reproductive choices based on inaccurate beliefs or ignorance (Johnson & Tough, 2012; Milan, 2013).
Aim and Objectives: The purpose of the current research is to explore attitudes and beliefs associated with delayed childbearing within three specific age cohorts.
Method: Our sample consisted of 119 women without children, in three age groups: 22 and under (n=48), 23-29 years (n=39), and 30 and over (n=31). Participants completed an online questionnaire measuring their beliefs and attitudes toward delayed motherhood (waiting until 30 or older), and assessing their personal reproductive intentions.
Results: A series of one way ANOVAs indicated that the youngest group held less positive attitudes about delayed childbearing compared to the older groups. The youngest group was also less likely to believe delaying would be wise, safe, pleasant, and good, and more likely to believe it would be harmful and stressful. Moreover, descriptive analyses illustrated that the youngest women did not intend to delay childbearing. Women in the youngest and oldest cohorts were equally ambivalent about the potential rewards of delaying.Interpretation: Results illustrated age-related differences in women’s beliefs and attitudes toward delayed childbearing. Contrary to popular belief, younger women did not intend to delay or hold attitudes/beliefs supportive of delayed motherhood. Potential rewards of delaying may be most salient to women in their mid-to-late twenties.
Conclusions: Young women appear to be more aware of potential consequences of delayed motherhood, and may not intend to delay. Intentions to delay may instead develop over time, in response to competing life decisions/demands.
References:
Johnson, J., Tough, S., & SOGC Genetics Committee (2012). Delayed child-bearing. Journal of Obstetrics & Gynecology Canada, 34(1), 80-93. Retrieved from http://www.jogc.com/Milan, A. (2013). Fertility: Overview, 2009-2011. Report on the Demographic Situation in Canada, 91-209. Retrieved from http://www.statcan.gc.ca/pub/91-209-x/2013001/article/11784-eng.htm
Hair Cortisol Level and Perceived Stress among Physically Active Women during Pregnancy
Authors: Caparros-Gonzalez, R.A.; Romero-Gonzalez, B.*; Strivens, H.; Gonzalez-Perez, R.; Alderdice, F.; Lynn, F.; Peralta-Ramirez, M.I.
Corresponding author: Borja Romero-Gonzalez, Student, Mind, Brain and Behaviour Research Center (CIMCYC), Campus Cartuja, Granada, Spain. Email: [email protected]
Background: Hair cortisol level is a reliable and innovative biomarker to assess chronic stress among pregnant women. Practicing sport is a healthy option to improve wellbeing and reduce stress during pregnancy.
Aim and Objectives: To explore the relationship between hair cortisol levels and perceived stress on sporting habits among pregnant women
Method: A sample of 92 low-risk pregnant women, with age ranging from 25 to 39 years (M=32.67; SD=3.63), attending an antenatal appointment in Granada (Spain) with a community midwife participated in this study. Participants were divided into two groups: 41 non-physically active women and 31 physically active women assessed at the 1st trimester (M=12.56 weeks’ gestation; SD=4.03) using hair cortisol levels, the Perceived Stress Scale (PSS) and the Symptom Checklist-90-Revised (SCL-90-R).
Results: Descriptive analyses demonstrated no significant differences between groups regarding age, marital status or pregnancy method. Pregnant women who are physically active, as defined by playing at least one form of sport on a weekly basis, have lower hair cortisol levels (M=185.12; SD=117.62) and lower perceived stress (M=26.42; SD=1.32) compared to those who are not physically active, with mean hair cortisol levels of 320.18 pg cortisol/mg hair (SD=339.23) and mean PSS score of 27.33 (SD=1.76). Significant differences were found between groups regarding hair cortisol levels t=4.49; p<0.05 and PSS t=7.19; p<0.01. No significant differences were found regarding the SCl-90-R.
Interpretation: Keeping physically active and practicing a sport regularly during pregnancy may reduce stress levels by lowering cortisol levels.
Conclusions: This is the first study to assess the relation between practicing sport during pregnancy and hair cortisol levels. Promoting health-related behaviours among pregnant women can have a positive impact on stress.
Application of the long and short-form versions of the Birth Satisfaction Scale (BSS/BSS-R) in a large survey in the United States of America
Authors: Fleming, Susan; Donovan-Batson, Colleen; Burduli, Ekaterina; Barbosa-Leiker, Celestina; Hollins Martin, Caroline J.; Martin, Colin R.
Corresponding author: Professor Colin R Martin, Faculty of Society and Health, Buckinghamshire New University, Uxbridge Campus, 106 Oxford Road, Uxbridge, Middlesex, UB8 1NA, UK. Email: [email protected]
Background: The Birth Satisfaction Scale in both long (BSS) and short (BSS-R) version forms is becoming increasingly used as a theoretically anchored and psychometrically valid measure of birth satisfaction. Given the relevance and salience of birth satisfaction to clinical outcomes, data from large scale studies can usefully provide both normative population values and highlight important aspects of care delivery which impact on the experience of childbirth.
Aim and Objectives: Examine the birth satisfaction of childbearing women birthing in their home or birth centres in the United States. Investigate potential differences in birth satisfaction between these groups and those who birth in a hospital setting using the 30-item BSS and the 10-item BSS-R.
Method: An internet survey design was used for BSS/BSS-R data capture using the (QualtricsTM) system utilising a convenience sample of childbearing women (N=2229). Pertinent demographic and outcome data was also collected.
Results: Birth satisfaction was higher when women had a vaginal birth compared to those who had a Caesarean section. BSS and BSS-R full-scale and sub-scale normative scores were derived from the investigation. The measurement properties of both versions of the measure were found to be robust and consistent with previous UK and US studies.
Interpretation: Both versions of the Birth Satisfaction Scale offer a robust assessment of this key concept. Consistency between observations from the current investigation and previous UK-based studies suggest stability and transferability of the birth satisfaction concept, as assessed by the tool, between fundamentally distinct culture, health economies and service delivery models.
Conclusions: The current study offers further corroborative evidence of the manifest conceptual and measurement rigour of the Birth Satisfaction Scale.
Midwives’ experiences of providing consultations to women presenting with fear of childbirth and traumatic birth experiences: Qualitative interview study
Authors: Hirst, J; Darwin, Z; Susanti, S; McGowan, L.
Corresponding author: Dr Janet Hirst, University of Leeds, LS2 9JT, UK. Email: [email protected]
Background: In the UK, maternity services increasingly provide women opportunities to discuss concerns regarding traumatic birth and fear of childbirth with their midwives. Evidence of effectiveness in improving women’s psychological outcomes is inconsistent; yet such clinics continue to be commissioned whilst little is known about midwives’ experiences of providing such services.
Aims and objectives: This study explored experiences of midwives who provided a unique service and women who accessed it. This presentation focusses on midwives’ views and experiences about organisation of services, mechanisms which made consultations ‘work’, training needs and views regarding acceptability of delivering psychological interventions.
Method: Eight midwives were interviewed, face-to-face, using a semi-structured approach; data were analysed using thematic analysis (Braun and Clarke 2006). Ethical challenges arose regarding anonymity amongst a close and unique team as participants chose to reveal participation.
Key Findings: Key themes: Listen and Let the Woman Lead: a solution-based approach was used to direct women to resources, care-pathways and plan-births whilst striving to emulate empathy, interest and patience; Strength in Numbers: working in pairs helped to de-stress this heightened emotional work, diffuse confrontation and aide resilience by drawing on midwives expertise and collegiate reassurance; I Am Only a Midwife: scope of practise and preparation was recognised and the struggle to assess transitional psychological wellbeing was a limiting factor for the service; Broadening Horizons and Closing the Loop: realisation of the impact of childbirth on women’s lives brought about changes to personal practise.
Interpretation: Midwives worked in partnership with women drawing on skills in resilience to bridge gaps between women’s stories and quality care. Midwives recognised their strengths, yet without training in psychological assessment, i.e. defining primary problems and triggers, they were under-prepared.
Conclusion: Better preparation may be achieved by formally expanding the midwives’ role to include emotional and psychological intervention.
References:
Beck CT (2011) A metaethnography of traumatic childbirth and its aftermath: amplifying the causal loop. Qualitative Health Research, 21(3), 301-311.
Braun V & Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
Rose SC, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post-traumatic stress disorder (PTSD) (2009) Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560.
Thomson G & Downe S (2010) Changing the future to change the past: women’s experiences of a positive birth following a traumatic birth experience. Journal of Reproductive and Infant Psychology, 28(1), 102-112.
‘It’s Only Normal’: Expectant Parents’ Experience of an Intervention to Reduce Antenatal Anxiety (The ACORN Study)
Authors: Lee-Carbon, Leonie*; Shaw, Melissa; Greenfield, Geva; King, Dorothy;
Kirsten Barnicot; O’Mahen, Heather; Fearon, Pasco; Halligan, Sarah; Ramchandani, Paul
Corresponding author: Professor Paul Ramchandani, Professor in Child and Adolescent Psychiatry, Imperial College London, Central and North West London NHS Trust, UK. Email: [email protected]
Background: Maternal symptoms of anxiety are common during pregnancy and can lead to a trajectory of social-emotional difficulties for both mother and infant. Given the paucity of research on effective interventions, it is important to understand how evidence based psychological therapy can impact expectant parents’ experience of antenatal anxiety.
Aim and Objectives: The study used qualitative methodology to explore the impact of a brief cognitive behavioural therapy (CBT) based group intervention during pregnancy on first-time expectant parents’ experience of anxiety.
Method: Participants were recruited from a larger randomized controlled feasibility trial (the ACORN Study) which explored the acceptability of a midwife-led CBT-based intervention to reduce antenatal anxiety. The ACORN study screened and recruited primiparous women scoring in the top quartile on self-reported measure of generalized anxiety symptomology, the Generalized Anxiety Disorder-7 Questionnaire. To investigate the aims of the presented study, semi-structured qualitative interviews were conducted with 14 mothers to-be and seven of their partners (N=21) who attended at least one of the three ACORN programme group therapy sessions. Interviews were recorded, then transcribed verbatim and analysed using thematic analysis.Results: Three core themes were identified depicting an overarching meta-theme: ‘gaining control in antenatal anxiety’. Each core themes represents a salient element expectant parents developed through the ACORN programme: (1) ‘normalizing anxiety’ (2) ‘a toolkit to cope’ (3) ‘building a supportive network’. Lastly, the themes portray the process of change in expectant parents’ experience of anxiety before and after attending the ACORN programme.
Interpretation: Our findings suggest that through participating in the ACORN programme, an intervention inclusive of partners drawing upon CBT principles, primiparous women perceived to better manage their anxiety.
Conclusions: Understanding the perceived impact of a brief intervention to reduce antenatal anxiety, can inform and direct future healthcare provision for anxious primiparous women.
Midwives and perinatal mental health: An integrative review
Authors: Noonan, Maria; Doody, Owen; Jomeen, Julie; Galvin, Rose
Corresponding author: Maria Noonan, Department of Nursing and Midwifery, University of Limerick, Ireland. Email: [email protected]
Background Midwives play a key role in supporting women who experience perinatal mental health issues and several studies have explored their role in this area. Through a synthesis of these studies we can increase our understanding of midwives preparation for their role and strategies available to support them in their work.
Aim and Objectives: Aim: To synthesise original research on midwives perceived role in Perinatal Mental Health. Objectives: (1) What are the experiences and perceptions of midwives supporting women who experience perinatal mental health problems? 2) What supports a midwife in this role?
Method: A systematic search of the literature included studies if they met the following criteria: original qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the identification and care of women who experience perinatal mental health problems.
A total of 3323 articles were retrieved and 22 studies were included in the review (14 quantitative, 7 qualitative and one mixed method study). Data extraction, quality assessment and thematic analysis were conducted.
Results: Two overarching themes emerged (personal and professional engagement). Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four sub themes are presented: continuous professional development (CPD), organisation of care, referral, and support.
Interpretation: Suboptimal attitudes to women who experience perinatal mental health issues may exist and education programmes are required to challenge midwives personal beliefs and attitudes to perinatal mental health problems.
Conclusions: Across the studies midwives reported a commitment to supporting women who experience perinatal mental health problems. However, a number of support structures are needed including access to CPD opportunities, referral pathways and specialist perinatal mental health advice.
MOMI: motherhood and migration: a mixed methods consideration of social support in Ireland
Authors: Peeren, Siofra*; Dempsey, Maria
Corresponding author: Siofra Peeren, Genetic Medicine, 6th Floor, St Mary’s Hospital, Oxford Road, Manchester M13 9WL, UK. Email: [email protected]
Background: Migrants’ poor health is becoming an increasingly important global public health matter as we see a steady increase in immigration in recent years. Migrant mothers show higher than average rates of a number of physical and psychological illnesses. Lack of support may be an important contributor to the worrying rates of mental and physical health problems in migrant mothers.
Aim and Objectives: Mixed methods were used in this study to examine relationships between support and stress and explore the meaning of support for Eastern European migrant mothers.
Method: Sixty participants completed an online survey. Social support, stress and acculturation were measured using the Medical Outcomes Study Social Support Scale, Perceived Stress Scale, and an adapted version of the American Rating Scale for Mexican Americans respectively. Semi-structured face-to-face interviews were conducted with a subset of participants.Results: Participants with higher total social support, higher emotional/informational support and higher tangible support reported significantly lower levels of stress. When controlling for age, emotional/informational support significantly predicted perceived stress scores. These results were enhanced through the qualitative data which described two themes of ‘self-efficacy’ and ‘connectedness’.
Interpretation: Emotional and informational support seem to be particularly important to migrant Eastern European mothers during pregnancy and motherhood. Our qualitative findings further support this and highlight how the support needs of migrant Eastern European mothers are influenced by culturally mediated values.
Conclusions: Migrant Eastern European mothers’ support needs are multifaceted and influenced by a number of complex factors. Further research is needed to illuminate potential social, cultural and situational mechanisms which can be used as a platform to design vital interventions for migrant mothers.
Women’s attitudinal, control, and normative beliefs about delayed childbearing
Authors: Sangster, Sarah L.*; Duerksen, Kari, N.; Bayly, Melanie K; Lawson, Karen, L.
Corresponding author: Sarah L Sangster, PhD Student, Department of Psychology, University of Saskatchewan, Canada. Email: [email protected]
Background: In Canada the birth rate has been decreasing for women in their 20s while increasing for women over the age of 30 (Milan, 2013).
Aim and Objectives: We aimed to elicit the control, attitudinal, and normative beliefs involved in forming intentions to delay childbearing within a theory of planned behaviour framework (TPB) (Azjen 1985)
Method: Women (N = 119, Mage = 25) answered a series of open-ended questions in an online survey to elicit their beliefs associated with delaying motherhood (cf. Ajzen, 2013). Content analyses determined the most salient beliefs within the entire sample and specific age groups (18-22, 23-29, 30+).Results: The three groups described similar beliefs overall. The influence of social norms was mentioned most frequently. While the youngest group reported their social networks would be supportive of any reproductive choices, the older groups perceived more pressure to have children (early).
Interpretation: Normative beliefs may be the most salient of the TPB constructs in reproductive planning. Younger women perceive important others as being generally supportive of personal choice, while older women sense more prescriptive social norms.
Conclusions: These results further our understanding of the decision to delay childbearing and will form the basis for a TPB questionnaire for a national sample of women in Canada.
References:
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior (pp. 11-39). Springer Berlin Heidelberg Ajzen, I. (2013). Constructing a theory of planned behavior questionnaire. Retrieved from http://people.umass.edu/aizen/pdf/tpb.measurement.pdf Milan, A. (2013). Fertility: Overview, 2009-2011. Report on the Demographic Situation in Canada, 91-209. Retrieved from http://www.statcan.gc.ca/pub/91-209-x/2013001/article/11784-eng.htm
Donor-children: their concerns and need for support
Authors: Schrijvers, Anne; Mochtar, Monique; van Rooij, Floor; Bos, Henny; Visser, Marja
Corresponding author: Anne Schrijvers, Center for Reproduction, Academic Medical Center Amsterdam, The Netherlands. Email: [email protected]
Background: Most studies on children of donor conception (DC) focus on their psychological well-being and their family relationships. Whether DC children have concerns about donor conception, what kind of concerns and whether they need support for this, is hardly known.
Aim and Objectives: Insight into concerns in relation of being a donor child, what kind of guidance and support they need, and easy accessibility.
Method: We performed in-depth interviews with 24 Dutch males and females (Mage=26.9, range 17-41) born from donor sperm within different family types.
Results: Most DC children want to know the appearance, personality, motivation of the donor and to have contact. With their half-siblings they want to exchange feelings and experiences. Furthermore they want to have access to information and support. DC children state, that when their parents would have received adequate psychosocial counselling before childbirth, they would have experienced less concerns.
Interpretation: Having contact with their donor and half-siblings is important for DC children as well as knowing where to find information and support for themselves.
Conclusions: DC children would appreciate availability of network organizations and specialist counselling if needed.
Exploring and understanding how young males in Pakistan approach information gathering in relation to puberty
Authors: Shivji, Noureen; Lymn, Joanne; Meade, Oonagh; Watts, Kim
Corresponding author:
Noureen Asif Shivji, PhD student, University of Nottingham, School of Health Sciences, University of Nottingham, UK. Email: [email protected]
Background: An adolescent’s experience of the transition through puberty can have long term impacts on their overall mental and physical health in adulthood. Whilst there is literature describing the experience of young females, the experience of young males has been largely unreported. It could be argued that understanding their experience in predominantly patriarchal cultures such as Pakistan is particularly important.
Aim and Objectives: This study aimed to explore the puberty experiences of young Pakistani males aged 18-21 years
Method: A qualitative study was conducted with 22 young Pakistani males aged 18-21 years using semi-structured interviews between September 2014 and August 2015. Interviews were transcribed verbatim and data analysed thematically.
Results: This presentation focuses on the theme of ‘information gathering’ during puberty experiences. Participants’ experiences were shaped by the socio-cultural context which considered puberty to be a ‘taboo’ subject, resulting in a lack of awareness about puberty and difficulties accessing information. Participants reported accessing ‘trustworthy’ sources. However, on closer examination, participants reported that this information was not always accurate or reliable which led them to feel confused and fearful. Participants felt that information content and methods of delivery needs to be more appropriately tailored to young people’s needs in order to improve the experience of future generations.
Interpretation: Participant’s access to accurate information about puberty were limited, largely as a result of the cultural context, leading to fear and confusion. Participants expressed concern about the lack of educational programmes relating to puberty transition phase and suggested some strategies that could have worked for them.
Conclusions: As a result of the cultural context, participants’ approaches to information gathering was characterised by curiosity, confusion and fear. The future development of health promotion programs around puberty could improve young males’ experiences and may therefore impact positively on their long-term health and well-being.
Welcome to the world: a qualitative exploration of the experiences of participants in an antenatal nurturing programme
Authors: Wadephul, Franziska; Jones, Catriona; Jomeen, Julie; Stephenson, Shirley; Harris, Dawn
Corresponding author: Franziska Wadephul, University of Hull, UK. Email: [email protected]
Background: Pregnancy has been recognised as an opportunity for interventions to enhance parental psychological well-being and the parental-baby relationship. Family Links’ Welcome to the World programme aims to improve parental bonding and communication with the baby as well as parents’ psychological well-being, relationships and support networks. This presentation explores the qualitative findings from focus groups with participants in the programme.
Aim and Objectives: The aim of this study was to explore the experiences of expectant and new parents who have attended WTTW, in terms of the programme itself and the impact of the programme on their psychological well-being, their relationships with the baby, other relationships and their perceived coping ability after birth.
Method: Six focus groups were conducted with participants in six WTTW programmes in England and Northern Ireland. Some participants had already given birth, others were still pregnant. Discussion transcripts were analysed using thematic analysis. Results: Overall, parents’ experiences of the programme were very positive. A number of themes emerged from the discussions relating to connecting and communicating with the baby, emotional and mental health needs, support and connecting with others, a safe and non-judgemental space, feeling prepared, change and growth, and including partners. There were convergences as well as divergences between participants; divergences were mostly related to differences in the way groups were run.
Interpretation: The WTTW programme appeared to help participants to communicate and interact with their baby, improve relationships and support networks, and give participants a safe space to think and talk about the transition to parenthood.
Conclusions: This study suggests that participants in the antenatal nurturing programme experience the programme as beneficial in terms of helping them communicate and interact with their baby, improving relationships, increasing their well-being and easing the transition to parenthood.
POSTER PRESENTATIONS
A systematic review of partner-inclusive interventions to prevent or treat women’s postpartum depression
Authors: Alves, Stephanie; Martins, Alexandra; Fonseca, Ana; Canavarro, Maria Cristina; & Pereira, Marco
Corresponding author:
Stephanie Alves, PhD student (Clinical Psychology), Faculdade de Psicologia e Ciências da Educação da Universidade de Coimbra, Rua do Colégio Novo, 3000-315 Coimbra, Portugal. E-mail: [email protected]
Background: Postpartum Depression (PPD) is a prevalent condition, with adverse consequences for the whole family [1]. Partner’s factors associated with development/maintenance of PPD have been widely studied [2], and may justify the partner’s inclusion in preventive and treatment approaches.
Aim and Objectives: The aim of this systematic review was to qualitatively synthesize partner-inclusive interventions designed to prevent or treat women’s PPD.
Method: The systematic search of studies published between 1967 through May 2015 identified 25 studies (13 = prevention, 12 = treatment). The following partner’s parameters were analysed: participation type, sessions’ content, mental health and attendance assessment, and effects of partners’ participation in women’s response to interventions.
Results: The partner’s total participation seems to be particularly reported in prevention studies, while a partial participation is reported particularly in treatment studies. The sessions’ contents were mostly based on psychoeducation about PPD and supportive strategies (particularly in treatment interventions), as well as on couple and parenting issues (in preventive interventions). Information about partner’s attendance and partners’ mental health were limited. Besides the positive benefits perceived by couples (e.g., better understanding of each other’s needs), the effects of partner’s participation in women’s intervention outcomes were rarely assessed.Interpretation: The benefits perceived by both partners underscore the relevance of partner’s inclusion in interventions designed to prevent/treat women’s PPD. However, the scarce information about partner’s attendance and associated effects on women’s intervention outcomes, along with some methodological limitations of the studies, made difficult to determine if partner’s participation is associated with intervention’s efficacy. Accordingly, conclusions about the scientific, clinical and economic value of including partners in PPD interventions are limited.
Conclusions: Along with the analyses of dyadic processes and interdependence surrounding PPD, more high-quality research is warranted to clarify the effects of including both partners in interventions and to better inform health policy strategies.
References:
[1] O’Hara, M. W. & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379-407. doi:10.1146/annurev-clinpsy-050212-185612[2] Pilkington, P. D, Milne, L. C., Cairns, K. E., Lewis, J., & Whelan, T. A. (2015). Modifiable partner factors associated with perinatal depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders, 178, 165-180. doi:10.1016/j.jad.2015.02.023
Exploratory Study of Indonesian Adolescents’ Reproductive Practices and their Experiences during Pregnancy
Authors: Astuti, Andari Wuri; Hirst, Janet; Bharj, Kuldip
Corresponding author: Andari Wari Astuti, University of Leeds, LS2 9JT, UK. Email: [email protected]
Background: During 2012, Indonesia had adolescent pregnancy about 48/1,000 in aged 15-19 with 0.02% occurred in adolescents aged 15 or less. Adolescents’ pregnancy is both a significant public health and social issue as it adversely affects adolescents including their children.
Aim: to explore, illuminate Indonesian adolescents’ reproductive practices and their experiences during pregnancy. The objectives are to explore the experiences of pregnant Indonesian adolescents, explore the experiences of male Indonesian adolescents with a pregnant Indonesian girlfriend and then compare and contrast their experiences.
Method: An exploratory qualitative study was undertaken. This paper presents data from a series of one-to-one in-depth interviews with 4 adolescent couples during their pregnancies. Interviews audio-recording were transcribed, and thematic analysis was employed. N-Vivo was used for data management. Research ethics approval was gained in the UK and the Indonesian Ethical Boards.Results: Four themes emerged from the study: ‘Sexual Debut and Sexual Reproductive Education’, ‘Pregnancy’, ‘Ending Adolescents’ Life’, and ‘Journey into New Life’. This presentation will focus on the ‘Pregnancy’ with sample of subthemes ‘Got Abused, being Judged and Shameful’. Quotations will be presented to illuminate these feelings.
Interpretation: Adolescents experienced life transition from adolescents to be parents, they seems really hard to manage their life as young mother and father to be. Marriage was expected to “save” them from social pressure, however, it also brings subsequent difficulties and problems.
Conclusions: Indonesian adolescents with their pregnancy require specific supports for them through their pregnancy and afterwards.
Constraints and Facilitators of Agency, Autonomy, and Self-Determination in Childbirth: Protocols, Pain, and Power
Authors: Bayly, Melanie
Corresponding author: Melanie Bayly, PhD candidate, University of Saskatchewan, Canada. Email: [email protected]
Background: Agency, choice and decision making, and control have been identified as important to women’s perceptions of a “good” birth (Fair & Morrison, 2012; Namey & Lyerly, 2010; VandeVusse, 1999).
Aim and Objectives: The purpose of the current presentation is to examine constraints and facilitators of agency, autonomy, and self-determination as described in women’s childbirth narratives.
Method: Narrative interviews were conducted with first-time mothers (N=21) who had given birth within the last 18 months. Women were asked to describe their decisions, experiences, and feelings related to the birth of their child. Interviews were analysed using an inductive, thematic approach.
Results: Women described several major constraints to autonomy, agency, and self-determination during childbirth, including the structure of maternity care services and protocols, labour pain, and perceived power imbalance/lack of collaborative communication between themselves and maternity care providers. Conversely, access to preferred care providers and midwifery, birth-related knowledge and preparation, use of epidural, collaborative interactions/communication with maternity care providers, and having an advocate during labour fostered women’s sense of agency.
Interpretation: Women described a number of facilitators and constraints to agency, autonomy, and self-determination during childbirth, many of which highlight the key role of maternity care providers.
Conclusions: Results illustrate factors impacting women’s sense of agency, autonomy, and self-determination during childbirth, which may be important for maternity care providers to consider in their practice.
References:
Fair, C. D., & Morrison, T. E. (2012). The relationship between prenatal control, expectations, experienced control, and birth satisfaction among primiparous women. Midwifery, 28, 39-44. doi:10.1016/j.midw.2010.10.013Namey, E. E., & Lyerly, A. D. (2010). The meaning of “control” for childbearing women in the US. Social Science & Medicine, 71(4), 769-776. doi:10.1016/j.socscimed.2010.05.024VandeVusse, L. (1999). Decision making in analyses of women’s birth stories. Birth, 26(1), 43-52. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291523-536X
The health behaviours of pregnant Gypsy Traveller women
Authors: Bennett, Sarah
Corresponding author: Sarah Bennett, Leeds Teaching Hospitals NHS Trust, UK. Email: [email protected]
Background: Gypsy Traveller health is significantly poorer than other minority and economically disadvantaged white UK residents. Pregnancy is an ideal time to deliver health promotion; midwives are uniquely placed to improve the public health of communities.
Aim and Objectives: To examine Gypsy Traveller health behaviours during pregnancy and, what influences those health behaviours.
Method: A phenomenological study explored pregnant Gypsy Travellers health behaviours including factors influencing those health behaviours. Nine pregnant Gypsy Traveller women participated in semi-structured interviews; van Manen’s process of phenomenological reflection was adopted for analysis. Ethical approval was secured.
Results: Gypsy Traveller health behaviours in pregnancy were comparable to those found in younger women and particularly women with fewer educational qualifications; they t were more likely to smoke, eat less fruit and vegetables and drink more caffeinated drinks; Walking is the most common physical activity and Gypsy Traveller culture identified as the dominant influence on the health behaviours of pregnant women.
Interpretation: Personalised care and provision of sensitive information is needed. Initiatives such asset-based community approach would assist delivery of relevant care.
Conclusions: This study suggests how the adaptation of a model of health promotion may enable midwives to utilise the strengths of the individual and the Gypsy Traveller community in improving health outcomes for women and children.
How are you feeling?’ Recognising Postnatal Depression in Urdu and Mirpuri speaking women
Authors: Boath, Elizabeth; Henshaw, Carol; Rafiq, Nasreen; Adams, Cheryll; Iqbal, Zafar; Ahmed, Kanza
Corresponding author: Dr Elizabeth Boath, Staffordshire University, UK. Email: [email protected]
Background: Prevalence rates of postnatal depression (PND) in Black, Asian and Minority Ethnic women are estimated to be much higher than 13%. They are also less likely to be identified and treated, because screening tools are not culturally or linguistically appropriate. The ‘How are you feeling?’ picture booklets were designed to remedy this.
Aim and Objectives:
To train health visitors in using the Booklets
To explore health visitors’ and women’s views of the booklets
To screen for PND
To identify needs and gaps in training and service provision
Method: Focus groups were carried out with health visitors and semi-structured interviews with women to explore their views of the booklets. Qualitative Data was analysed using thematic framework analysis.
Results:
23 women were diagnosed using the SCID-PN. HVs had successfully identified one woman as being depressed and 22 women as not depressed using the booklets.
Nine health visitors took part in the focus groups and five women were interviewed. Overarching themes were:
Usefulness, pros and cons of the Booklets
Language barriers and interpreters
Barriers to accessing services
Interpretation: The booklets were well-received by both HVs and women for improving communication, facilitating HVs in engaging women from non-English speaking backgrounds and facilitating the identification of perinatal mental health needs.
Conclusions:
HVs should be trained in the booklet
Culturally sensitive Perinatal Public Health Campaigns need to be developed
References:
Sobowale A & Adams C (2004) How are you feeling? Supporting the emotional and social health of ethnic minority women: A Resource and Training pack. London: CPHVA.
A Review of Interventions Addressing the Parental-Fetal Relationship
Authors: Borg Cunen, Nicole; Jomeen, Julie; Borg Xuereb, Rita; Poat, Angela
Corresponding author: Nicola Borg Cunen, University of Hull, UK. Email: [email protected]
Background: Expectant parents are thought to develop varying degrees of emotional affiliation with their unborn child. Interventions supporting this relationship may be beneficial given identified links between the parental-fetal relationship and maternal health behaviour during pregnancy, as well as the parental-infant bond after birth.
Aim and Objectives: To collate, and describe the effects of interventions that have addressed the parental-fetal relationship.
Method: A search strategy was developed and relevant papers were identified from databases including Cinahl, Cochrane Library, MEDLINE, PsycINFO and Web of Science. Key search terms used included maternal/paternal-fetal attachment, prenatal bond, parental-fetal relationship and intervention. Papers eligible for inclusion were primary studies, published between 2005-2015, which focused on interventions that addressed the parental-fetal relationship. RCTs, non-RCTs, observational and non-comparative studies, before and after studies and case studies were included. Methodological quality was assessed using the ‘Quality Appraisal Checklist for Intervention Studies’ (Jackson et al., 2006; revised by NICE, 2012).
Results: Twenty-seven studies were included. Studies evaluated the effects of various strategies, including ultrasound and screening procedures, fetal awareness interventions, social and psychological support techniques, educational programmes, and relaxation tactics.
Interpretation: Results are inconsistent due to the use of diverse interventions and significant variation in methodological quality. A number of limitations, such as non-probability sampling, lack of blinding, and absent or less than adequate follow-up weaken the evidence. The inclusion of fathers in only 3 studies reflects the overall neglect of men in research regarding the prenatal relationship.
Conclusions: There is insufficient evidence to reach definitive conclusions regarding the efficacy of any of the interventions. Prior to the identification of interventions that are consistently beneficial and worthwhile, further in-depth research may be needed to allow for a true understanding of the maternal/paternal-fetal relationship.
References:
Jackson, R., Ameratunga, S., Broad, J., Connor, J., Lethaby, A., Robb, G., Wells, S., Glasziou, P. & Heneghan, C. (2006) The GATE frame: Critical appraisal with pictures. Evidence Based Nursing, 9 (3), 68-71.
National Institute for Health and Care Excellence (NICE) (2012) Methods for the development of NICE public health guidance [PMG4]. Available online: https://www.nice.org.uk/article/pmg4/resources/non-guidance- methods-for-the-development-of-nice-public-health-guidance-third- edition-pdf [Accessed: 16/03/16]
Single-mothers-by-choice: Well-being of their children and the social support network of the parent
Authors: Brewaeys, Mathilde; Bos, Henny
Corresponding author:
Mathilde Brewaeys, Research Assistant/Junior Researcher, University of Amsterdam, The Netherlands. Email: [email protected]
Background: Nowadays an increasing amount of women choose to become a parent and raise their child without a partner. Little is known about their offspring’s psychological well-being; nor about the support they receive from their social network and how this influences the well-being of the offspring.
Aim and Objectives: To assess: (1) single-mothers-by-choice and (intact) different-sex parent households on children’s well-being, parental social support and satisfaction about the support, (2) the association between children’s well-being and parental social support and whether this relation is different in both household types.
Method: Participants were 69 single-mothers-by-choice and 59 mothers in different-sex parent households (meanage children: 3.06). Mothers completed the Child Behavior Checklist 11/2-6 and the Parenting and Child Rearing Support Questionnaire.
Results: There were no significant differences on the offspring’s well-being between both household types. Single-mothers-by-choice showed significant higher levels on received social support, however, there was no significant difference on their satisfaction of this support. Only single-mothers-by-choice who were satisfied about the social support reported higher scores on the child’s well-being.
Interpretation: Children in both family types are doing well in terms of their well-being. Single-mothers-by-choice benefit more from a good social network.
Conclusions: In the counseling of women who want to become a parent and raise the child without a partner, one should emphasize the importance of having a good social supportive network.
Changes to the Maternity workforce and the effects on women’s postnatal experience
Authors: Carter, Ruth
Corresponding author:
Ruth Carter, Midwifery Lecturer, Staffordshire University, UK. Email: [email protected]
Background: In 2010 the role of the Maternity Support Worker (MSW) a health care support worker banded at 3-4 (agenda for change), was introduced into the postnatal and community areas of North Wales. The objectives associated with the introduction of this role were to improve services for women and their families, and ease the pressure of service demands on midwives, created by short staffing, and an increased birth rate, (National Leadership and Innovation Agency for Health Care, Royal College of Midwives and Skills for health 2010, Skewes 2015). The first group of MSWs in North Wales successfully completed the training programme and qualified in 2012. This research study was conducted in the postnatal in patient area of maternity care, in 2014-2015 with the aim of understanding this role and the impact of its introduction from the perspective of the MSW.
Aim and Objectives: To understand and explore the Maternity Support Worker (MSW) role and its introduction, (a new band 3-4 health care worker role within Maternity, underpinned by the “All Wales Maternity Support Worker Curriculum” 2010) from the participant’s point of view.
Method:
The study used a qualitative approach, in the form of a semi-structured self-administered questionnaire provided anonymously to participants, in order to gather information about this role and its introduction. Purposive sampling was used for the sample the inclusion criteria was- those MSWs that have successfully completed both the practical and theoretical elements of their 18-month training course “the QCF diploma in maternity and paediatric support”, and are currently employed as MSWs on a maternity ward across North Wales. The sample of MSW’s used in this research study, was not a homogeneous group. The age range was from 25 to 50 years of age; all participants were female, with 80% of the sample having worked as health care assistants on a maternity ward, mainly in the areas studied, for over 3 years prior to commencement of the 18-month training course, to become a qualified MSW. Thematic analysis was used to analysis the collected data.
Results:
The sample consisted of twenty participants. The response rate was 100%, this response rate appeared to indicate that the topic of the research study was an important one to participants, one which participants had opinions and views on. After reading and re-reading the findings on several occasions and coding the data, the main themes that emerged from the research findings were- 1. being part of a team, 2. Involvement in planning of care, 3. tasks competent in 4. health promotion activities. The results indicated that in both handover, and in the planning of care MSWs and midwifes were in the main, communicating effectively and the MSW role was being utilised to its potential as defined in the role description. Indicating that the introduction of this role was in the main received positively by the wider workforce. The findings also indicated that in many cases the MSW had grown in confidence through having successfully completed the MSW training package and working as a qualified MSW. The MSWs demonstrated a good understanding of the importance of safety measures underpinning their role.
Interpretation: This research had a relatively small sample size however rich and interesting data was obtained.
Conclusions: The participants felt the new role had improved services and eased the pressure the maternity service has been experiencing. Recommended actions from the findings would be for further research with different members of the maternity team in order to validate the results of this new study.
Women’s Experiences of Perineal trauma during childbirth
Authors: Crookall, Rebecca; Fowler, Gillian; Wood, Caroline; Slade, Pauline
Corresponding author: Rebecca Crookall, University of Liverpool, UK. Email: [email protected]
Background: Giving birth is an emotional and sometimes stressful experience for a woman. Research suggests that experiencing obstetric complications, such as an instrumental delivery or emergency caesarean section, can increase the likelihood of experiencing the event as stressful or even traumatic. Perineal lacerations (tears or a vaginal cut known as an episiotomy) are the most common obstetric complication to occur during vaginal birth; however, we do not know the full extent of how experiencing a laceration can affect a woman’s experience of birth
Aim and Objectives: To investigate the experience of childbirth in women who have sustained varying degrees of perineal trauma during vaginal birth.
Method: 202 women who had given birth to their first baby vaginally and had required suturing completed a questionnaire within 48 hours of giving birth. This included two well validated scales the (Childbirth Experience Questionnaire and Experience of Birth Scale) and a perineal pain visual analogue measure adapted from the McGill Pain Questionnaire. Socio-demographic and obstetric details were obtained from hospital medical records. Women were categorised into three groups according to their perineal status, those with 3rd and 4th degree tears, those with a 1st or 2nd degree sutured tear and those with an episiotomy. Women’s experiences of childbirth were compared between the three perineal status groups.
Results: Scores on the childbirth experience questionnaire and the experience of birth scale for 202 women will be compared across the three perineal status groups. Other obstetric and socio-demographic variables and their effects on experience of birth will also be compared.
Interpretation: Whether the degree perineal laceration impacts upon different aspects of birth experiences will be discussed.
Conclusions: Conclusions will provide information on the role of perineal tears and episiotomy on a woman’s experience of childbirth and early pain experiences and will inform care needs and provide recommendations for future research.
References:
Dencker A, Taft C, Bergqvist L, Lilja H, Berg M. (2010). Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument. BMC Pregnancy & Childbirth, 10:81Slade, P, MacPherson, SA, Hume, A, & Maresh, M (1993). Expectations, experiences and satisfaction with labour. British Journal of Clinical Psychology, 32, 469-483.
A review and meta-synthesis of the impact of traumatic childbirth on couples’ relationships
Authors: Delicate, Amy
Corresponding author: Amy Delicate, City University London, UK. Email: [email protected]
Background: There is a growing evidence that psychologically traumatic childbirth can lead to post-traumatic stress disorder (PTSD) or symptoms in women and their partners.
Aim and Objectives: The review aimed to investigate current research regarding the impact of childbirth related PTSD on couple’s relationship.
Method: A systematic review of the literature was conducted and records screened against inclusion criteria. Remaining papers were assessed for quality and seven qualitative papers retained for meta-synthesis. Meta-ethnography was used to identify concepts, which were then translated between papers and refined in order to create themes and interpretive conclusions.Results: All seven studies in the meta-synthesis showed that childbirth related PTSD can have a negative impact on couples’ relationships, with case studies in two papers showing it leading to relationship breakdown. Conversely, there was evidence from two studies that experiencing childbirth related PTSD could strengthen relationships. Additional relationship themes were also identified; negative emotions, lack of understanding and loss of intimacy.Interpretation: A model of the impact of childbirth related PTSD on couples’ relationships is proposed; this considers the interaction between themes identified by the meta-synthesis. This review of the qualitative literature conflicts with quantitative findings which have shown no correlation between traumatic childbirth and impact on couples’ relationships. The impact of childbirth related PTSD on couples’ relationships appears complex and more research is required to gain clarity and to assess for differences in relationship impact following traumatic and non-traumatic childbirth.
Conclusions: The meta-synthesis provides some evidence that couples’ relationships can be negatively impacted by childbirth related PTSD with various symptoms of strain being evident as well as case studies of strengthened relationships. A proposed model of the impact of childbirth related PTSD on couples’ relationships offers a potential framework for future research.
Psychosocial differences between non-pregnant, pregnant and post-natal women
Authors: Hayes, Liane; Bramwell, Ros; Mason-Whitehead, Elizabeth
Corresponding author: Liane Hayes, Department of Psychology, University of Chester, Chester, CH1 4BJ, UK. Email: [email protected]
Background: Research has identified a range of psychosocial factors that appear to have particular salience for women during pregnancy. These include demographic characteristics (Green & Baston, 2003), health information and attitudes (Marteau, 1990; Waldenström, Hildingsson, Rubertsson, & Rådestad, 2004), control (Goodman, Mackey, & Tavakoli, 2004), and support (Lundgren, Berg, & Lindmark, 2003). Research has yet to establish whether these factors retain their salience post-natally or hold similar salience outside of the pregnancy and childbirth scenario.
Aim and Objectives: To identify differences in a range of psychosocial factors between non-pregnant, pregnant and post-natal women.
Method: A sample of 120 women completed a two-stage questionnaire on demographic, health and psychological measures. Scores for each stage were examined against a comparable sample of 140 non-pregnant women.
Results: Pregnant women rated themselves significantly healthier than non-pregnant women and themselves post-natally, however they rated their health knowledge higher after childbirth and higher than non-pregnant women. Positive attitudes towards doctors and medicine were higher both post-natally than in pregnancy and in non-pregnant women. Control increased from pregnancy to post-natally but was no different at either stage to non-pregnant women. Coping styles tended to be adopted most by non-pregnant women and the least in pregnancy. Perceived social support was highest post-natally and lower in non-pregnant women than in both time points. The belief that doctors were powerful in pain control was also highest post-natally and higher at both time points than in non-pregnant women.
Interpretation: Overall, non-pregnant women typically scored lowest on the factors measured and these tended to increase in pregnancy and again post-natally.
Conclusions: The factors identified as salient in pregnancy typically increase in importance following childbirth. These factors tend to be lesser issues outside of the pregnancy and childbirth scenario.
References:
Goodman, P., Mackey, M.C. & Tavakoli, A.S. (2004). Factors related to childbirth satisfaction. Journal of Advanced Nursing, 46, 212-219.Green, J.M. & Baston, H.A. (2003). Feeling in control during labour: concepts, correlates, and consequences. Birth: Issues in Perinatal Care, 30, 235-247.Lundgren, I., Berg, M., & Lindmark, G. (2003). Is the childbirth experience improved by a birth plan? Journal of Midwifery & Women’s Health, 48(5), 322-328.Marteau, T.M. (1990). Attitudes towards doctors and medicine: the preliminary development of a new scale. Psychology and Health, 4, 351-356.Waldenström, U., Hildingsson, I., Rubertsson, C., & Rådestad, I. (2004). A negative birth experience: prevalence and risk factors in a national sample. Birth, 31, 17-27.
Systematic review and meta-analysis of strategies to increase vegetables intake in preschool children, aged 2-5 years
Authors: Nekitsing, Chandani; Hetherington, Marion; Blundell, Pam; Cockroft, Jennie
Corresponding author: Nekitsing Chandani, PhD Student, School of Psychology, University of Leeds, Leeds, LS2 9JT, UK. Email: [email protected]
Background: The majority of the population do not meet the current daily recommendations for fruit and vegetable intake. Consumption of vegetables remains especially low. Establishing healthy eating habits in childhood is important, as these have shown to persist into adulthood.
Aim and Objectives: To synthesise evidence on strategies to enhance vegetable intake in preschool children, aged 2-5 years. In particular, to report which intervention types are most successful and identify factors which could be targeted in future research.
Method: A comprehensive search strategy was carried out using databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL to identify relevant articles from 2005 onwards. Studies from which vegetable intake data could be extracted were included.
Results: 30 articles and 44 subgroups were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool aged children. These included, choice, conditioning, education, food service, modelling, reward, taste exposures, variety and visual presentation. A meta-analysis indicated that interventions which implemented a repeated taste exposure strategy had better outcomes for vegetable intake than those which did not. Moreover, vegetables which were unfamiliar or disliked increased more in terms of intake than familiar vegetables.Interpretation: Children benefit from exposure to vegetables especially if the baseline acceptance is low. This is more effective than food service or education strategies. Children will generally need between 8-10 taste exposures to significantly increase intake of unfamiliar or disliked vegetables.Conclusions: Repeated taste exposure strategies could be implemented in childcare settings and at home by parents. Health policy could specifically target use of novel and disliked vegetables in primary care settings. Further research is needed to understand the impact of these strategies on vegetable intake in picky/fussy eating children.
PROSPERO protocol registration number: CRD42016033984
Hair Cortisol Levels and Perceived Stress among Primiparous Pregnant Women: A Longitudinal Study
Authors: Romero-Gonzalez, B.*; Peralta-Ramirez, M.I.; Strivens, H.; Gonzalez-Perez, R.; Alderdice, F.; Lynn, F.; Caparros-Gonzalez, R.A.
Corresponding author: Borja Romero-Gonzalez, Student, Mind, Brain and Behaviour Research Center (CIMCYC), Campus Cartuja, Granada, Spain. Email: [email protected]
Background: Hair cortisol levels appear as an innovative chronic stress biomarker in pregnant women. This technique helps researchers understand what situations make pregnant women more vulnerable to stress.
Aim and Objectives: To assess and to compare hair cortisol levels and perceived stress among primiparous and multiparous pregnant women throughout pregnancy.
Method: A total sample of 83 low-risk pregnant women with ages ranging from 22 to 42 years (M=32.57; SD=4.25) were recruited at the first trimester of gestation (M=12.26 weeks; SD=3.61) to voluntarily participate in this study, while attending a prenatal appointment with a community midwife in Granada (Spain). Participants were divided into two groups: 50 primiparous women and 33 multiparous women, and subsequently assessed using hair cortisol levels and the Perceived Stress Scale (PSS) during the three trimesters.
Results: No significant relationships were found between participants regarding age, marital status or pregnancy method. Primiparous′ hair cortisol levels (M=557.18 pg cortisol/mg hair; SD=600.09) were significantly higher than multiparous′ (M=343.91 pg cortisol/mg hair; SD=214.63) (t=1.96; p<0.05). Moreover, primiparous′ perceived stress levels (M=27.09; SD=1.62) were significantly different than multiparous′ (M=26.45; SD=2.19) (t=2.08; p<0.01). No significant differences were found regarding the first or the second trimester.
Interpretation: Those women who are experiencing their first pregnancy have higher levels of stress (hair cortisol levels and perceived stress) when their pregnancies come to an end.
Conclusions: Primiparous women had higher levels of stress in the third trimester compared to those with previous pregnancies. Primiparous women are a vulnerable population that need to be specially evaluated to prevent adverse pregnancy outcomes.
Clips better than written information? Evaluating the effectiveness of Picture Information Clips on recruitment of participants in a pragmatic National Institute for Health Research funded Randomised Controlled Trial.
Authors: Ryan, R*; Ramchandani, P; O’Farrelly, C; Babalis, D; Iles, J.
Corresponding author: Rachael Ryan*, Research Assistant, Imperial College London: [email protected]
Background: Research in the National Health Service (NHS) is essential for the development and sustainability of services. According to National Institute for Health Research NIHR, Randomised Controlled Trials (RCT) are the best way to determine effectiveness of interventions. However, there are very few trials involving children/parents and recruitment can be challenging and costly, especially recruiting under pragmatic conditions. A key barrier is the high rates of patient refusal to participate, though it is possible that this could be reduced by improving the quality of information they. Research found the traditional Participant Information Sheet (PIS) holds more information than participants usually require in order to make an informed decision and have been widely criticised for being too long, technical and lacking in visual appeal. However, using videos to explain research to an ICT literate generation, has found to be an effective, userfriendly way of approaching participants.
Aim: To evaluate the effectiveness of Participant Information Clip PIC as a recruitment method into and NIHR RCT: Healthy Start, Happy Start.
Additional objectives:
Cost effectiveness of PIC
Time effectiveness of PIC
Proportion of second caregivers participating
Satisfaction of researchers with PIC process
Method:
Between subjects, single blind design.
Parents complete the Strength and Difficulties Questionnaire about their 12-36 month old. If score in top 20% for behavioural problems, randomized to receive either a PIC, PIC and PIS or PIS (treatment as usual TAU) to explain research.
Results:
Data collection commencing November 2016.
Interpretation:
Increased participation in PIC/PIS arm compared just PIC or PIS
PIC is more cost and time effective compared to TAU methods
Increased second caregivers in PIC arms compared to TAU
Researchers satisfied with PIC process
References:
1. Nihracuk. Why research is important. https://www.crn.nihr.ac.uk/can-help/patients-carers-public/why-research-is-important/ (accessed 10 May 2016). 2. Treweek S, Mitchell E, Pitkethly M, Cook J, Kjeldstrøm M, Taskila T, Johansen M, Sullivan F, Wilson S, Jackson C, Jones R. Strategies to improve recruitment to randomised controlled trials. Cochrane Database Syst Rev. 2010 Jan 1;4(4). 3. Antoniou EE, Draper H, Reed K, Burls A, Southwood TR, Zeegers MP. An empirical study on the preferred size of the participant information sheet in research. Journal of medical ethics. 2011 Sep 1;37(9):557-62. 4. Prescott. Statistical bulletin: Internet Access - Households and Individuals: 2015. http://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage
Dynamics of anxiety and the relationship to the child during pregnancy and after birth
Authors: Savenysheva, Svetlana; Sokolova, Maria
Corresponding author:
Savenysheva Svetlana, Associated Professor, Department of Developmental Psychology, Saint Petersburg State University, Saint-Petersburg, Russia. E-mail: [email protected]
Background: Emotional state of the women is associated with their attitude to pregnancy and the fetus, but this relationship is not linear. While the emotional state of pregnant women is actively studied at present, the relation and the dynamics of anxiety and relationship to child studied to a lesser extent in the perinatal period of child development.
Aim and Objectives: The aim of our study was to investigate relation and the dynamics of anxiety and relationship to child in the perinatal period.
Participants: I stage: 40 pregnant women living in St. Petersburg (Russia), aged 18 to 40 years, 3 trimester; II stage: the same 40 women after 2-3 months after the delivery.
Method: test on personal and situational anxiety (Spielberger, Hanin); test on pregnant woman’s attitudes (Dobryakov), projective method “Figures” (Filippova), drawing method “My family”.
Results: Analysis showed that anxious type of attitude to the fetus is most closely associated with levels of personal and situational anxiety. We also found that the women with adequate and euphoric types of attitude to the fetus are characterized by a low level of situational and personal anxiety.
The analysis of the dynamics of situational and personal anxiety did not reveal significant differences in their level before and after the birth the delivery. The level of situational and personal anxiety of women in pregnancy and after delivery closely correlated. Analysis of the relation of attitude to the child before and after birth showed that at low level of readiness to maternity, significant emotional distance with the fetus during pregnancy, we can observe a significant emotional distance with the child after birth.
Conclusions: anxiety before and after birth, are closely linked, as well as the relation to the fetus and child after birth. Anxiety during pregnancy is closely associated with the experience of pregnancy.
Funding: Research was supported by grant RHSF № 16-06-00392
Parents with donor-conceived offspring: their concerns, ability to find adequate support and daily functioning
Authors: Van Rooij, Floor; Schrijvers, Anne; Bos, Henny; Visser, Marja; Mochtar, Monique
Corresponding author: Floor Van Rooij, University of Amsterdam, The Netherlands. Email: [email protected]
Background: Previous studies showed that most parents of donor conceived children have specific concerns in relation to donor conception (DC). Knowledge about whether parents receive adequate psychosocial support if needed, is scarce.
Aim and Objectives: To investigate parents’ concerns in raising a DC child, their ability to find adequate support if needed and to investigate the associations between number concerns, inadequate support and psychological well-being, parenting stress and partner- relationship satisfaction.
Method: 209 parents in single mother, two-mother and father-mother households completed a digital quantitative survey. All families conceived a child (M age=3.38) after sperm donation in 29 Dutch clinics.
Results: On average 7.05 different types of concerns (range: 0-18) were reported. There was a lot of diversity whether parents received adequate support. Father-mother households reported significant more difficulties with finding adequate support compared to those in two-mother families. Across households, parents who reported more concerns and/or more inadequate support showed less psychological well-being, more parenting stress and were less satisfied about their partner.
Interpretation: Concerns and inadequate support negatively influenced their daily life.
Conclusions: Psychosocial support and access for parents with donor-conceived offspring need further development.
Counsellors’ practices with intended parents in donor sperm treatment
Authors: Visser, Marja; Gerrits, Trudie; van der Veen, Fulco; Mochtar, Monique
Corresponding author: Marja Visser, Center for Reproduction, Academic Medical Center Amsterdam, The Netherlands. Email: [email protected]
Background: In donor sperm treatment, counselling by qualified mental health professionals is recommended to help intended parents in coping with psychosocial implications of being parent of donor-conceived children. How counsellors actually execute their counselling practices is unknown.
Aim and Objectives: To gain insight in how counsellors actually execute their counselling practices in donor sperm treatment and on which evidence these practices are based.
Method: We performed in-depth interviews with 13 Dutch counsellors, working in one of the eight Fertility Centres offering DST.
Results: The counselling policy of fertility clinics was not underpinned by evidence, but rooted in tradition and local protocols. Counsellors had no specific education in DST counselling and acted at their own discretion regarding the content of counselling. They agreed on issues as mental stability, disclosure and future donor contact in all family types, but had different opinions about mandatory counselling and the position of the donor. All counsellors offered extended counselling after childbirth, but parents seldom returned for counselling.
Interpretation: Counselling policies of Dutch fertility clinics were not based on scientific insights and counsellors acted at their own discretion regarding the content of counselling.
Conclusions: Guidelines for evidence based psychosocial counselling and standards for clinics should be developed.