Struggling for motherhood with an intellectual disability—A qualitative study of women's experiences in Sweden

Objectiveto gain a deeper understanding of the experiences of childbearing in women with intellectual disabililty (ID).Design/settingten women with ID, who had given birth within seven years, were interviewed twice and data were analysed with content analysis.Findingsthe overarching theme was: Struggling for motherhood with an ID. The significance of having an intellectual disability became evident when the women encountered mixed reactions from partners and relatives, who sometimes suggested an induced abortion. The women disclosed their diagnosis if they believed it was beneficial for them. Throughout the process the women also felt anxious and distressed about the custody of the child. Women experienced the pregnancy as a physical and psychological transition. It was mostly a happy and responsible life event, and the women were aware of physical signs in their bodies and contact with the unborn child. Parent education was considered important but not adequately adapted to their needs. The women described the delivery as hard and painful work, sometimes difficult to understand and they had different strategies to handle the pain and strain of labour. The child was welcomed with warmth and curiosity by the women, who cared for and breast fed the child even if the hospital environment could be confusing and continued custody not taken for granted.Conclusionswomen with ID struggle for motherhood and fear losing custody of the child. Professionals need to identify and support these women, who may not always disclose their diagnosis. Since pregnancy, delivery and the transition into motherhood can be difficult to understand, information and support should be better tailored to their needs.     

Puerperal psychosis – a qualitative study of women’s experiences

Objective: This study explored women’s experience of puerperal psychosis (PP) and their perceptions of its cause, in order to contribute to an increased understanding of PP and promote consideration of new management perspectives. Background: Out of every 1000 live births, approximately one to two women will develop PP. The numbers are relatively small, yet the consequences can be devastating. Key theoretical explanations for the aetiology of PP are genetic, biochemical and endocrine. A small and relatively tenuous evidence base considers PP from a psychological perspective, despite acknowledgement of the need for broader understanding. A stress–vulnerability model has offered a contemporary explanation of psychotic symptoms in other contexts and non-clinical populations and may offer useful insight in relation to a psychobiological model of PP. Methods: In a qualitative study, seven women who had been diagnosed with PP previously were interviewed and the data subjected to an inductive thematic analysis. Trustworthiness and rigour of the study was assured by careful monitoring of the research process and data checking. Results: Four themes were identified – The path to PP; Unspeakable thoughts and unacceptable self; ‘Snap out of it’; and Perceived causes. While women attributed their PP to the physiological changes associated with childbirth, their accounts of PP began before and during pregnancy. Women highlighted stressful pregnancies characterised by significant challenges and emotions, difficult births and unsupportive family relationships postnatally. The experience of PP was extremely distressing. Conclusion: Findings add to the debate about a more multifaceted explanation of PP and potentially offer a psychobiological model of understanding.     

Oocyte donors’ experiences of altruistic known donation: a qualitative study

Objective: The purpose of this qualitative study was to investigate the experiences of women who had donated oocytes to a known recipient. Background: Altruistic known donation between friends or family members is the predominant form of oocyte donation in Canada due to legal prohibition of donor compensation. Methods: Data were collected from a hospital-based IVF clinic located in a Canadian city. Semi-structured interviews were audio-taped and transcribed verbatim. Results: Fifteen donors took part in the study either face to face or by phone interview. Among them, seven were a friend, six were a sister, one was a niece of the recipient, and one donated twice, once to her sister and once to a friend. Nine donations had resulted in a live birth – from newborn to seven years at the time of interview. Of these, four were intra-familial donation and five were friend-to-friend donation. Conclusions: The findings provide little evidence of relationship difficulties between donor and recipient during or following the donation and no evidence of coercion. Other than an altruistic desire to help a recipient and a self-evaluation of her own capacity to donate, the welfare of the intended child was in the mind of most donors during the decision-making phase.     

Cytokeratin-19 as a biomarker in urine and in serum for the diagnosis of endometriosis – a prospective study

Endometriosis compromises the quality of life of countless women worldwide and is a leading cause of disability. Clinical symptoms of endometriosis can be very heterogeneous leading to a long interval between onset of symptoms and surgical diagnosis. A noninvasive, rapid diagnostic test is urgently needed. In this prospective study, we evaluated the usefulness of Cytokeratin-19 (CK19) as a biomarker for the diagnosis of endometriosis through urine and serum ELISA. 76 reproductive-aged women undergoing laparoscopy for benign conditions were included to this study and divided into two groups by the presence (n?=?44) or absence (n?=?32) of endometriosis. There was no statistically significant correlation between the concentration of CK19 in urine (p?=?0.51) or in serum (p?=?0.77) and the diagnosis of endometriosis. Assigning the samples to the proliferative or secretory cycle stage did not sufficiently lower the p values. In this study, the promising data reported in the recent literature about CK19 serving as a sufficient biomarker for endometriosis could not be verified when tested in a larger sample size. Further studies are warranted to explore the usefulness of CK19 in the diagnosis of endometriosis.     

Should a diagnosis of endometriosis be sought in all symptomatic women?

A tool is needed to enable clinicians to determine whether women wish to seek a pathology-based explanation for chronic pelvic pain or whether they just want symptom relief. Such an approach might reduce the number of unnecessary laparoscopies without adversely affecting outcomes.     

The tangled web of reasons for the delay in diagnosis of endometriosis in women with chronic pelvic pain: will the suffering end?

Understanding the woman's experience with chronic pelvic pain and endometriosis is critical to decreasing her suffering. Further investigation must continue to determine the relation between endometriosis and pain, despite empirical treatment with GnRH agonists becoming routine in the United States.     

Midwives’ experiences of asking the Whooley questions to assess current mental health: a qualitative interpretive study

Backgound: Perinatal Mental Illness (PMI) is a key cause of maternal mortality and morbidity in the UK, with one goal of midwives to identify those at risk during pregnancy. At present, the system of preliminary identification of existing PMI in the UK involves the midwife asking pregnant women the Whooley questions at the antenatal booking interview. Aim: To explore midwives experiences of asking the Whooley questions with pregnant women. Method: A qualitative interpretive study explored midwives’ (n = 8) experiences of asking the Whooley questions in one maternity unit in England (UK). Data were gathered through semistructured interviews and analysed using Framework Analysis (FWA). Findings: Themes and subthemes identified included: (1) no clear understanding of purpose, (1a) discomfort when disclosure occurs, (2) feeling pressurised for time, (3) resultant dissatisfaction and frustration; (3a) lack of knowledge and how to refer, (3b) lack of training around PMI, (3c) relying on experience and use of intuition. Discussion: The development and evaluation of an education curriculum to prepare midwives to effectively use case-finding instruments such as the Whooley questions to identify pregnant women at risk is required.     

Why home birth? A qualitative study exploring women's decision making about place of birth in two Canadian provinces

Objective

the aim of this study was to increase our understanding of why Canadian women choose to give birth at home. Despite on-going debate regarding the safety of home birth, a small number of Canadian women choose home as a place to give birth. The factors influencing a woman's decision to plan a home birth remain poorly understood.

Design

a qualitative, grounded theory approach using semi-structured interviews.

Participants

a purposive sample of women from two Canadian provinces, who planned to give birth at home in their current pregnancy or who had planned a home birth within the last 2 years.

Findings

thematic analysis highlighted key motivating factors as well as a decision-making framework by which women chose home birth. The decision making process includes an exploration of internal motivators for wanting home birth, a phase of information gathering and taking ownership for the decision to give birth at home.

Key conclusions

the study showed that women in two geographically distinct parts of Canada approach decision making around home birth in a similar fashion and provides a framework for decision making for choosing to birth at home.

Implications for practice

improved understanding of the decision making process for choice of birth place is useful for midwives for the provision of information to their clients and for midwifery policy and practice within Canada.     

Patients’ perspective on cognitive behavioural therapy after surgical treatment of endometriosis: a qualitative study

Research questionWould adding cognitive behavioural therapy (CBT) to the treatment of endometriosis improve the quality of life of patients suffering from endometriosis-associated pain? The aim of this study was to identify if patients believed CBT should be added to endometriosis treatment and which form of CBT they would prefer: face-to-face individual or group, or web-based individual, sessions.DesignBetween November 2019 and January 2020, semi-structured focus groups were conducted using an interview guide to ensure all topics were discussed. Data collection was continued until saturation was obtained. The focus groups were transcribed word for word and openly encoded. Finally, themes were formulated.ResultsAll participating women believed CBT should be offered to patients undergoing endometriosis surgery. They believed it could be an asset to improve quality of life. Participants preferred either in-person individual or group therapy. They stressed the importance of being offered a custom-made treatment plan, individually tailored to the different needs of different patients.ConclusionThis study has shown that patients with endometriosis believe that CBT should be added to the standard treatment regimen of endometriosis in either group or individual face-to-face sessions, because they expect that CBT will improve their quality of life after surgery.     

Contraceptive counselling of women seeking abortion – a qualitative interview study of health professionals’ experiences

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professional? experiences of providing contraceptive counselling to women seeking an abortion.

Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.

Results: Three clusters were identified: ‘Complex counselling’, ‘Elements of counselling’ and ‘Finding a method’. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.

Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.     

Does exist a correlation between endometriosis and thrombophilic disorders? A pilot study

Objective

At present, there is growing evidence of the existence of a genetic predisposition in both thrombophilic disorders and endometriosis. The aim of our study was to evaluate for the first time the prevalence of some thrombophilic disorders in patients with endometriosis.

Midwives’ experiences of working in an obstetric high dependency unit: A qualitative study

Objectivesto understand the challenges experienced by midwives providing obstetric high dependency care and identify the training they perceive is needed for work in an obstetric high dependency unit.Designsixteen midwives who worked in the obstetric high dependency unit participated in one of three focus groups. Focus groups lasted 60–90 minutes and were conducted in the workplace and facilitated by author (IE). Data were digitally recorded, transcribed and analysed manually by author (IE), specifically using a ‘codebook’ model to generate codes, categories and themes.Settinga purpose built, two-bed obstetric high dependency unit located in the delivery suite of a large, urban tertiary teaching hospital in New Zealand.Findingsfive themes were conceptualised: Theme 1: ‘high dependency care is not our bread and butter’; the midwives felt that working in the obstetric high dependency work did not constitute ‘normal’ midwifery work. Theme 2: ‘we are family… embracing the baby and partner in HDU’; the midwives recognised that an obstetric high dependency unit enabled the mother and infant to be cared for together, was beneficial for maternal psychosocial wellbeing, and supported mother-infant bonding and breastfeeding. Theme 3: ‘primum non nocere; First, do no harm’; the midwives voiced concern that they lacked the skills and training to provide obstetric high dependency care and considered this a potential risk to sick women in their care. Theme 4: ‘graceful swans and headless chickens’; the midwives reported feelings of stress, anxiety, fear and of being overwhelmed by the demands of obstetric high dependency care. The more experienced midwives were able to portray calmness and poise despite lots going on beneath the surface. This was in contrast to other, often less experienced midwives, who appeared confused and less organised. Theme 5: ‘please sir, can I have some more training?’; the midwives unanimously sought training in the provision of obstetric high dependency care and saw facilitation of training to be a responsibility of the hospital.Key conclusionsmidwives who are competent in obstetric high dependency care are well placed to provide holistic care to sick women within an obstetric high dependency unit. Midwives found this work challenging and identified the need for specific knowledge and skills beyond those required in the provision of care to well women. The midwives sought post-registration training in obstetric high dependency care. These findings are consistent with other studies reported in the literature.Implications for practicepost-registration training must be made available to midwives providing high dependency care to sick women to ensure they have the specialised skills and knowledge for practice. Responsibility to facilitate training rests with hospitals providing this service.