‘Removed from humanity’: a qualitative analysis of attitudes toward abortion providers in anti-abortion individuals in Canada

Objective: The present study explores the content of abortion provider stigma.

Background: Abortion stigma extends beyond women who have abortions to abortion providers. Previous analyses of anti-abortion bills and rhetoric have revealed stereotypes of abortion providers as dangerous and less trustworthy than other health professionals.

Methods: We present a thematic analysis of one-on-one interviews about attitudes toward abortion providers with Canadian individuals (N = 21) holding an anti-abortion stance.

Results: We found participants held two kinds of beliefs about abortion providers: (1) providers are agentic and intentional actors and (2) providers are non-agentic victims of a larger system. While the former subtype of provider was viewed with hostility and disgust, the latter was viewed with pity, with participants suggesting that restriction of abortion would be beneficial for provider well-being.

Conclusion: We document a new component of abortion provider stigma: the belief that abortion providers are harmed by abortion and that they are to be pitied for this. This ‘abortion harms providers’ attitude parallels recent anti-abortion arguments that abortion harms women. These stigmatising attitudes both construct the provider as untrustworthy and unable to properly care for women.     

Affective temperaments during pregnancy and postpartum period: a click to hyperthymic temperament

Background: Pregnancy and postpartum periods are the main reproductive periods during which women experience mood disorders. Affective temperaments are known antecedents of mood disorders and their importance is increasing in time for early diagnosis and determining risky groups. But data about affective temperaments during perinatal period is limited.

Methods: Women during pregnancy and perinatal period and healthy controls who are not in perinatal period are included in the study. 83 pregnant women in 1st trimester, 94 pregnant women in 2nd trimester and 115 pregnant women in 3rd trimester; 32 women in 1st month postpartum and 89 women in 2nd month postpartum; and 88 healthy non-pregnant women with similar ages were evaluated regarding their temperament evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A) scores.

Results: Women in perinatal period had higher scores of hyperthymic temperaments than the control group. Women in the 2nd month of postpartum period had also higher anxious temperament scores. And women in the second trimester had the highest hyperthymic temperament scores.

Conclusion: Pregnancy and postpartum periods correlate with hyperthymic temperament characteristics in women without active psychiatric diagnosis. Future studies will help to understand if this is a mental quietness or increased risk for bipolarity.     

The impact of miscarriage and stillbirth on maternal–fetal relationships: an integrative review

Objective: To synthesise and summarise existing literature investigating whether and how psychological distress as a consequence of perinatal loss and associated coping impact upon maternal–fetal relationships subsequent to miscarriage and stillbirth.

Background: Although now widely accepted that the relationship between mother and child develops in utero, little is known about how a previous miscarriage or stillbirth impacts upon these processes in a subsequent pregnancy.

Methods: An integrative review methodology was chosen for the review.

Results: Fifteen empirical and theoretical articles were reviewed and summated into two topic areas: psychological distress following perinatal loss and the subsequent maternal–fetal relationship, and coping following perinatal loss and the subsequent maternal–fetal relationship.

Conclusions: Studies show that perinatal loss can cause psychological distress in subsequent pregnancy. It is not clear whether and how such distress impacts on maternal–fetal relationships because studies have yielded mixed findings. Mothers employ a complex self-protective mechanism to cope with this distress, and use strategies to reassure themselves and to maintain hope that the pregnancy will result in a live birth. It is not clear whether the use of this mechanism impacts upon the development of the mother–fetus relationship in subsequent pregnancy. Further research is now required to determine how these strategies are employed, the impact of these strategies on pregnancy-specific anxiety, maternal–fetal relationships and the postnatal attachment relationship. Health professionals working with parents in these circumstances should acknowledge that anxiety and associated coping behaviours are common, and support be provided when parents show signs of considerable psychological distress.     

Psychological well-being and depression from pregnancy to postpartum among primiparous and multiparous women

Background: The bulk of research on motherhood has focused on perinatal depression, largely overlooking indicators of women’s positive mental health which can likewise have pervasive consequences on family functioning.

Objective: The aim of the present study was to address this issue by exploring the impact of parity and childbirth on both women’s perinatal depression and psychological well-being.

Methods: A convenience sample of 81 women was followed during pregnancy (Time 1) and postpartum (Time 2). At both times, participants completed the Edinburgh Depression Scale and the Psychological Well-being Scales, measuring perceived autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance.

Results: Significant negative correlations were observed between depression and psychological well-being dimensions. ANCOVA and mixed ANOVA analyses showed that depression levels did not differ between primiparous and multiparous women, or between pre- and postpartum assessments. By contrast, after childbirth, primiparous women reported higher values of environmental mastery and self-acceptance than multiparous women. In addition, levels of self-acceptance and personal growth increased from pregnancy to postpartum among primiparous women, while no differences were detected over time in the scores of all the psychological well-being dimensions among multiparous women.

Conclusions: This study highlighted some dimensions of positive psychological functioning that specifically contribute to women’s well-being in the transition to motherhood, and their different relevance for primiparous and multiparous mothers. Future trials are needed to integrate this information in tailored intervention for the promotion of mothers’ complete mental health.     

Development and preliminary evaluation of a group intervention targeting maternal mental health and mother–infant interactions: a combined qualitative and case series report

Objective and Background: The purpose of this study was to investigate the outcomes of an Emotional Wellbeing Group intervention developed to treat maternal depression and anxiety while concurrently supporting positive development of the mother–infant relationship.

Method: Five women diagnosed with depressive and/or anxiety disorders and their infants completed the Emotional Wellbeing Group. The participants completed pre- and post- intervention assessments which included self-report measures of mood and the motherhood experience, and a video-taped, unstructured play session between mothers and their infants.

Results: Four of the participants reported a clinically significant decrease in their symptoms of anxiety. All mothers reported more positive perceptions of their infants and their experience of motherhood, and showed enhanced maternal sensitivity and responsiveness towards their infants. Depression levels were not shown to improve consistently.

Conclusion: This study provides initial positive evidence to support future research directions and clinical efforts to develop interventions that target both the treatment of perinatal depression and anxiety and the quality of mother–infant interactions. Clinical insights for mental health professionals working with mothers and infants are presented.     

How an extended perinatal audit may improve perinatal policy

Objective: A perinatal audit has the intention of quality of care improvement based on analysis of perinatal death, with our without analysis of maternal morbidity and/or mortality. Additional analysis of cases of intrapartum asphyxia could provide more insight into ways to improve quality of perinatal care.

Methods: Analysis of cases of perinatal death and asphyxia in Jan Yperman Hospital, Ieper, Belgium, in 2012.

Results: Three perinatal deaths occurred, none were preventable. Nineteen cases of proven metabolic acidosis have been identified. Three cases are considered possibly preventable, four cases are considered preventable. In three (possibly) preventable cases, foetal monitoring was absent during the active second stage of labour. In two preventable cases, intervention following a significant ST event in the second stage of labour was delayed. In one case intervention was delayed in the first stage of labour, while in another, indicated operative delivery in the second stage was not conducted.

Conclusions: Integrating intrapartum asphyxia in the perinatal audit gives an opportunity to identify and eliminate weak points in the perinatal care chain, thereby optimizing quality of care. Lessons learned from our internal audit are the value of foetal monitoring and adequate action on significant ST events during second stage of labour.     

Universal versus risk factor-targeted early inpatient postpartum depression screening

Objective: To assess differences in two different approaches to early inpatient Edinburgh Postnatal Depression Scale (EPDS) screening (targeted risk factor screening versus universal screening).

Methods: Retrospective study of two cohorts delivering from January 2010 to June 2010. Cohort 1 included 5-weeks of consecutive deliveries. Risk factors for a positive EPDS screen were determined by multivariable logistic regression. Cohort 2 included all delivering women in the subsequent 5 months who had the most common risk factor (history of mental illness) for postpartum depression identified from Cohort 1.

Results: For Cohort 1 of universal screening (N?=?322), 11 (3.4%) had positive screens with seven (63.6%) having a history of any mental illness yielding the number needed to screen to identify one EPDS positive mother of 29. For Cohort 2 (N?=?215), there were 33 (15.3%) positive screens and the number needed to have a positive screen was 6. Without a history of mental illness, predictive models for a positive screen were poor with the number needed to screen of 80.

Conclusions: Early EPDS screening targeted for those with a history of mental illness is an efficient way to identify postpartum women with active mental health problems, but may miss up to 36.4% of potential screen positive women.     

Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort

Introduction: Pregnancy anxiety is an important psychosocial risk factor that may be more strongly associated with adverse birth outcomes than other measures of stress. Better understanding of the upstream predictors and causes of pregnancy anxiety could help to identify high-risk women for adverse maternal and infant outcomes. The objective of the present study was to measure the associations between five past pregnancy outcomes (live preterm birth (PTB), live term birth, miscarriage at <20 weeks, stillbirth at ≥20 weeks, and elective abortion) and pregnancy anxiety at three trimesters in a subsequent pregnancy.

Methods: Analyses were conducted using data from the 3D Cohort Study, a Canadian birth cohort. Data on maternal demographic characteristics and pregnancy history for each known previous pregnancy were collected via interviewer-administered questionnaires at study entry. Pregnancy anxiety for the index study pregnancy was measured prospectively by self-administered questionnaire following three prenatal study visits.

Results: Of 2366 participants in the 3D Study, 1505 had at least one previous pregnancy. In linear regression analyses with adjustment for confounding variables, prior live term birth was associated with lower pregnancy anxiety in all three trimesters, whereas prior miscarriage was significantly associated with higher pregnancy anxiety in the first trimester. Prior stillbirth was associated with greater pregnancy anxiety in the third trimester. Prior elective abortion was significantly associated with higher pregnancy anxiety scores in the first and second trimesters, with an association of similar magnitude observed in the third trimester.

Discussion: Our findings suggest that the outcomes of previous pregnancies should be incorporated, along with demographic and psychosocial characteristics, into conceptual models framing pregnancy anxiety.     

Attitudinal barriers to help-seeking and preferences for mental health support among Australian fathers

Objective: To (a) identify attitudinal barriers to help-seeking for mental health difficulties among fathers of young children; (b) explore the relationships between perceived barriers to help-seeking and mental health difficulties (i.e. depressive, anxiety, stress symptoms); (c) identify socio-demographic factors associated with barriers to help-seeking; and (d) identify fathers’ preferences for mental health support.

Background: One in 10 Australian fathers experience mental health difficulties in the early parenting period. Low rates of help-seeking and under-utilisation of health care services are key issues for the provision of mental health support to fathers at this important life stage.

Method: The sample consisted of 154 fathers of young children (aged 0–8 years) participating in an Australian online survey on parent wellbeing and parenting. The Barriers to Help-Seeking Scale assessed fathers’ attitudinal barriers to help-seeking for mental health support. Socio-demographic factors related to fathers’ employment, education, and family composition were assessed.

Results: The most common attitudinal barriers to help-seeking were: (a) the need for control and self-reliance in managing one’s own problems, (b) a tendency to downplay or minimise problems, and (c) a sense of resignation that nothing will help. A range of demographic (i.e. age, educational attainment) factors were associated with these barriers. The most common preferences for support were internet-based information resources, followed by support provided by general practitioners and maternal child health nurses.

Conclusions: These findings have important implications for health promotion, health services and clinical approaches to promoting the health and wellbeing of fathers.     

Student midwives’ awareness,knowledge, and experiences of antenatal anxiety within clinical practice

Objective: The current study aimed to explore student midwives’ awareness, knowledge, and experiences of supporting women with antenatal anxiety (ANA) within clinical practice.

Background: ANA is associated with negative outcomes for mother and baby. Midwives play a key role in the screening of antenatal mental health and care of women suffering from ANA.

Methods: This study was conducted with student midwives at one UK university in the north-west of England. Twenty-five midwifery students completed a brief online survey informed by National Institute of Health and Care Excellence (NICE) guidelines. Of these, seven volunteered to participate in semi-structured interviews exploring the survey data. The interview topic guide was designed based on the findings of the survey.

Results: Thematic analysis of the seven interviews revealed four overarching themes: Perpetuating factors, Barriers to care, Skills required in role and Suggestions for future directions. Midwives had a varied knowledge and understanding of ANA and expressed a desire to learn more about their role in supporting women with ANA.

Conclusion: Although a small study, the results highlight the need for education to be improved in order to best prepare student midwives for cases of ANA, with emphasis on integrating psychology and mental health information into teaching as well as time spent in clinical practice. Midwives are key in the screening of women for ANA and are in an ideal position to signpost for specialist care.     

Blood-based biomarkers of adverse perinatal outcomes in maternal obesity

Objective: Increasing maternal weight has been shown to predict adverse perinatal outcome, including increases in the relative risk of fetal death, stillbirth, neonatal death, perinatal death and infant death. In order to better understand the pathophysiological factors associated with obesity during pregnancy, the role of biomarkers associated with adverse outcomes in obese pregnant women is under investigation. The purpose of this review study was to examine potential biomarkers that could serve as effective screening strategies in obese pregnant women to reduce fetal and neonatal morbidity, as well as maternal morbidity.

Methods: Electronic databases (Pubmed, Embase) were searched for previously published research studies that investigated biomarkers associated with perinatal outcomes in obese pregnant women and the putative mechanisms underlying biomarker effects on pregnancy outcomes.

Results: It is evident that while several biomarkers predict perinatal complications in obese pregnant women, none fulfilled the criteria to be considered clinically useful.

Conclusion: There is a critical need for reliable blood-based biomarkers associated with an increased risk of adverse perinatal outcomes in obese pregnant women.     

Prenatally diagnosed congenital portosystemic shunts

Aim: Congenital portosystemic shunts (CPSS) are rare, congenital malformations that are increasingly often discovered during the fetal period, and for which, the manifestations and evolution are poorly understood. The objective of this review is to describe the phenotype and evolution of forms diagnosed in the antenatal period.

Materials and methods: We performed a systematic review of the literature cited in Pubmed between 1982 and 2016 for CPSS cases diagnosed during the fetal period.

Results: We identified 123 cases. The median age at diagnosis was 25 GA (14–38 weeks GA). Eighty patients had 128 associated congenital anomalies. The congenital abnormalities most frequently associated with antenatal diagnosis of CPSS were congenital cardiac disease (30 cases), intrauterine growth restriction (21 cases), vascular anomalies (14 cases), and trisomy 21 (7 cases). Seventy-five complications were reported in the literature. The most frequent were antenatal hemodynamic abnormalities (27 cases), neonatal cholestasis (11 cases), and hyperammonemia (10 cases). Twenty-nine patients had no complications. The choice of treatment was conservative in 29/56 cases, interventional radiology in 15 cases and surgery in 15 cases (three of the latter after failure of embolization).

Conclusion: From this review, we propose an algorithm for the perinatal management of this congenital abnormality.     

The influence of psychological factors on postpartum weight retention 12 months post-birth

Background

During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity.

Objective

The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth.

Methods

Pregnant women (N = 176) completed questionnaires in early–mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR.

Results

Overall, models explained 26–39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR.

Conclusion

While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.     

Perinatal risk factors and mode of delivery associated with mortality in very low birth weight infants

Objective: To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting.

Methods: Medical records of 241 live-born VLBW infants (≤1500?g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated.

Results: The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750?g (p?=?0.000 and p?=?0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve?=?0.792, 95% CI: 0.719–0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality.

Conclusions: Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.     

Pregnancy planning,timing, happiness and depressive symptoms among low-income women living with and without HIV

Objective: This study assessed associations of sociodemographic factors and pregnancy intent and wantedness with pregnancy happiness and prenatal depressive symptoms and the relationship between prenatal depressive symptoms and pregnancy happiness.

Background: Depression is the leading cause of disability world-wide and more so for women. Women are most likely to experience depression in their child bearing years, including during pregnancy. Untreated prenatal depression, associated with unwanted pregnancies endangers the health and wellbeing of the mother and her child. Research on the association of prenatal depression with pregnancy happiness among women with low incomes in the U.S.A. is limited. For women living with HIV, associations among family planning factors, pregnancy feelings and prenatal depression have been understudied.

Methods: Sixty-four women living with HIV and 194 HIV-negative low-income pregnant women receiving care in a public university-based ob-gyn clinic with integrated HIV-care in Philadelphia between 2009 and 2012 participated in the study. The women completed a questionnaire on sociodemographic and pregnancy factors and the Center for Epidemiological Studies Depression Scale (CES-D). The independent associations of sociodemographic and pregnancy factors with pregnancy happiness and associations of these factors and pregnancy happiness with the CES-D were assessed using multivariable linear regressions.

Results: Women who felt the pregnancy was too soon were less happy being pregnant (p < 0.01). Prenatal depressive symptoms were inversely associated with happiness with being pregnant and completing high school (p < 0.001 for both).

Conclusion: Health care professionals need to provide reproductive counselling and mental health for prenatal depression should explore feelings about being pregnant and being a mother.     

Factors associated with father-to-infant attachment at 6 months postpartum: a community-based study in Victoria,Australia

Objective: To identify factors associated with father-to-infant attachment at 6 months postpartum.

Background: Poor father-to-infant attachment can lead to developmental problems in infants. Some studies suggest that poor paternal mental health may be negatively associated with father-to-infant attachment, but there is currently little evidence about other potential risk factors for poor father-to-infant attachment, such as aspects of the intimate partner relationship and infant characteristics.

Methods: A community sample of couples with a first infant was recruited from diverse Local Government Areas. Men completed two telephone interviews, at 4 weeks and 6 months postpartum. Father-to-infant attachment was assessed using the Parental Attachment Questionnaire (PAQ). Other standardised instruments included the Edinburgh Postnatal Depression Scale (EPDS) to assess symptoms of depression and anxiety and the Intimate Bonds Measure (IBM) to assess quality of the intimate partner relationship. The outcome measure was Parental Attachment Questionnaire (PAQ) total score. Structural equation modelling was used to identify factors associated with lower PAQ scores.

Results: Total PAQ scores were provided by 270 men. Poorer quality father-to-infant attachment was significantly associated with personality traits like oversensitivity (p = 0.03), more symptoms of depression and anxiety (p = 0.02), poorer quality partner relationship (p = 0.01) and more frequent partner criticism of infant care (p = 0.01).

Conclusion: Fathers should be included in routine postnatal care. Critical behaviour by the partner is a potentially modifiable risk factor for poor father-to-infant attachment. Perinatal primary care health services programmes should focus on building parents’ skills to provide sensitive, affirming care for each other and for the infant.     

Factor analysis of the Parental Stressor Scale in parents of term and near-term surgical newborns

Objective: A confirmatory factor analysis (CFA) of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) in parents of term and near-term surgical newborns.

Background: The PSS:NICU is a common measure of the stressors experienced by parents of NICU newborns. A CFA of the PSS:NICU has not been published.

Methods: A CFA of the 26-item version of the PSS:NICU (PSS:NICU-26) was conducted using data from 216 parents of term and near-term surgical newborns. A multigroup CFA analysis was conducted to determine if the factor structure of the final PSS:NICU model was invariant across gender.

Results: CFA showed the PSS:NICU-26 model was a poor fit for the data. Exploratory factor analysis and CFAs with post hoc modifications resulted in the exclusion of 10 PSS:NICU-26 items. The resultant PSS:NICU-16 model was a good fit for the data and the factor structure was invariant across gender.

Conclusion: The PSS:NICU-16 is a reliable measure of NICU-related parental stressors with a structure that is invariant across gender. Although the study findings should be replicated, researchers should consider using the PSS:NICU-16 in studies of parents of term and near-term surgical newborns and studies where a more parsimonious model of the PSS:NICU may be preferred.     

Selective uterine fundal pressure maneuver during the second stage of the first twin delivery at near term

Objective: We examined the perinatal outcomes of twin deliveries following selective uterine fundal pressure maneuver (UFPM) during the second stage of the first twin delivery.

Methods: At our institute, if non-reassuring fetal heart rate and/or maternal exhaustion were observed during the second stage of the first twin, selective UFPM was performed following making sure of the position of the first twin’s buttocks by ultrasonography. We reviewed the obstetric records of all cases of trial of vaginal delivery of twins between 2002 and 2012.

Results: A total of 64 cases were evaluated for the statistical analyses. Of these, selective UFPM for the first twin was performed in 15 cases (24%). Although the cases requiring selective UFPM for the first twin was associated with an increased postpartum hemorrhage, there were no significant differences in neonatal outcomes between the two groups.

Conclusion: There was no evidence that the selective UFPM is unsafe for both mother and two babies during the second stage of the first twin delivery.     

Perinatal outcomes from the use of antiepileptic drugs during pregnancy: a case-control study

Objective: To evaluate the perinatal results from epileptic women using antiepileptic drugs during prenatal care.

Methods: This was a retrospective longitudinal study assessing the perinatal results of women exposed to antiepileptic drugs during pregnancy, and we compared these results with those of pregnant women who were not exposed. The development of pregnancy, gestational age at delivery, Apgar scores, biometric data, morbidity, stillbirths and neonatal mortality were analyzed. The chi-square test and Fisher’s exact test were used for the categorical variables, while Student’s t-test was used for independent numerical variables.

Results: Over a 10-year period, 12?790 singleton gestations were analyzed, among which 104 (0.8%) consisted of epileptic pregnant women. From this total, 82 evolved to childbirth and their neonatal data were compared with those of 316 newborns from non-epileptic women. The most-used antiepileptic drug was phenobarbital in 70% of the cases. There was greater neonatal mortality (p?=?0.006), occurrence of neonatal hemorrhagic disorders (p?=?0.005), and occurrence of minor congenital anomalies (p?=?0.03) among the children of women exposed to antiepileptic drugs.

Conclusion: The antenatal exposure to antiepileptic drugs is associated mainly with occurrences of hemorrhagic complications during the neonatal period; furthermore, great prevalence of newborns presenting minor congenital anomalies and elevated risk of neonatal mortality.