Qualitative Interpretive Metasynthesis of Parents’ Experiences of Perinatal Loss

ObjectiveTo identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss.Data SourcesWe searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents’ experiences of perinatal loss.Study SelectionWe included research on parents’ experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature.Data ExtractionWe used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents’ perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis.Data SynthesisWe used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding–Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere.ConclusionOur findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents’ overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.     

Pregnant Women’s Knowledge of Influenza and the Use and Safety of the Influenza Vaccine During Pregnancy

IntroductionWe wished to assess pregnant women’s knowledge of influenza, vaccine safety during pregnancy and breast feeding, and the recommendations for use of the influenza vaccine in pregnancy.MethodsWe performed a cross-sectional survey of postpartum women during influenza season in 2006.ResultsPregnant women’s overall knowledge of these subjects was poor. Most women (95%) knew that influenza is highly contagious, but almost 90% incorrectly believed that pregnant women have the same risk of complications as non-pregnant women. Only one half of the women were aware of national recommendations for vaccination during pregnancy and that the vaccine is safe during pregnancy and breast feeding, and 80% incorrectly believed that the vaccine can cause birth defects. Only 20% of women had been offered the vaccine during the current pregnancy or a prior pregnancy.ConclusionsPregnant women’s knowledge about influenza vaccine recommendations and safety during pregnancy is poor. There is substantial room for improvement among prenatal care providers in both patient education and offering the vaccine.     

Women’s Experiences of the Effect of Financial Strain on Parenting and Mental Health

ObjectiveTo develop a conceptual theory to describe how financial strain affects women with young children to inform clinical care and research.DesignQualitative, grounded theory.SettingParticipants were recruited from the waiting area of a pediatric clinic and an office of the Special Supplemental Nutrition Program for Women, Infants, and Children embedded within the largest safety-net academic medical center in New England. Participants were interviewed privately at the medical center or in the community.ParticipantsTwenty-six English-speaking women, mostly single and African American/Black, with at least one child 5 years old or younger, were sampled until thematic saturation was met.MethodsWe used grounded theory methodology to conduct in-depth, semistructured interviews with participants who indicated that they experienced financial strain. We analyzed the interview data using constant comparative analysis, revised the interview guide based on emerging themes, and developed a theoretical model.ResultsFive interrelated themes emerged and were developed into a theoretical model: Financial Strain Has Specific Characteristics and Common Triggers, Financial Strain Is Exacerbated by Inadequate Assistance and Results in Tradeoffs, Financial Strain Forces Parenting Modifications, Women Experience Self-Blame, and Women Experience Mental Health Effects.ConclusionFor women with young children, financial strain results in forced tradeoffs, compromised parenting practices, and self-blame, which contribute to significant mental health problems. These findings can inform woman-centered clinical practice and advocacy interventions. Women’s health care providers should identify families experiencing financial strain, provide referrals to financial services, and join advocacy efforts to advance social policies that address the structural causes of poverty, such as increased minimum wage and paid family leave.     

Effects of Women’s Weight Changes on Adverse Outcomes in a Second Pregnancy

ObjectiveTo estimate the effects of women’s weight changes in four sequential perinatal periods across first and second pregnancies (pregravid, first gestation, interpregnancy, second gestation) on adverse maternal and neonatal outcomes in the second pregnancy while accounting for interdependencies in weight across the four periods (Aim 1) and to test the influence of the sequential path of weight changes through the four perinatal periods of risk on maternal and neonatal outcomes in the second pregnancy (Aim 2).DesignSecondary data analysis.SettingThirty-one Wisconsin hospitals.SampleWomen with 24,795 linked records from first and second births from 2006 through 2013.MethodsWe used a fully recursive system of linear and logistic regression equations to examine the relationships among weight changes in the four perinatal periods with maternal (gestational diabetes mellitus, gestational hypertension, cesarean birth) and neonatal (macrosomia, small for gestational age, large for gestational age, low birth weight, congenital anomalies, and perinatal death) adverse outcomes in the second pregnancy.ResultsPregravid weight was weakly and inconsistently associated with weight changes in subsequent periods. Each 5-kg incremental weight change in the first pregnancy, interpregnancy, and second pregnancy contributed to a 0.75- to 5-kg weight change in subsequent periods, 9% to 25% change in risk for adverse maternal outcomes, and 8% to 47% change in risk for adverse neonatal outcomes in the second pregnancy. Fluctuations in weight across pregnancies and associations with outcomes were strongest among normal-weight and overweight women.ConclusionWeight changes across two pregnancies affected maternal and neonatal outcomes in the second pregnancy in all body mass index categories; the larger weight fluctuations observed in normal and overweight women were associated with greater risk of adverse outcomes. Attention to pregnancy weight during and between pregnancies is important for targeted weight counseling to reduce risks in subsequent pregnancies.     

Women’s Preference of Cosmetic Results After Gynecologic Surgery

Study ObjectiveTo determine the cosmetic appeal of different incision types used in gynecologic surgery.DesignOne hundred women between the ages of 20 and 40 years were shown 4 color photographs of a female abdomen with incision sites marked for Pfannenstiel, minilaparotomy, traditional laparoscopy, and robotic-assisted laparoscopy. The women were asked to rank the photographs on cosmetic appeal alone. An additional photograph depicting single-port laparoscopy was then added, and patients were asked to again rank the photographs. Participants were also asked basic demographic information and prior surgical history.SettingOffice practice.PatientsOne hundred women between the ages of 20 and 40.InterventionParticipants.Measurements and Main ResultsMinilaparotomy was ranked as the most appealing incision among the first set of photographs by 74% of the participants, and the remaining 26% preferred traditional laparoscopy. Robotic-assisted laparoscopy was ranked as the least appealing scar type by 42%, and no patient selected it as their first choice. Sixty-four percent preferred the appearance of a single-port laparoscopic scar when that option was added. The only demographic variable that reached statistical significance was the presence of prior abdominal surgery. Patients without prior surgery ranked minilaparotomy as more cosmetically appealing.ConclusionsWhen several minimally invasive surgical approaches are possible, the patient should be counseled regarding the cosmetic results of each. Patients in this study strongly preferred the appearance of minilaparotomy and single-port incisions over full Pfannenstiel or robotic incisions.     

What Is Recommended for Healthy Women During Pregnancy? A Comparison of Seven Prenatal Clinical Practice Guideline Documents

Background: Several countries have developed clinical practice guidelines for the content of prenatal care. This study examines the consistency of recommendations in clinical practice guidelines describing routine prenatal care. Methods: The recommendations for low-risk women in seven guideline documents were examined: two from Australia, two from the United States, two from Canada, and one from Germany. The recommendations were listed into the four areas of “general health screening and health promotion during pregnancy,”“organization of care,”“clinical tests and screening,” and “education specific for pregnancy.” Results: A total of 69 recommendations were identified within the seven documents, most of which fell within the “clinical tests and screening” domain. Notable differences were identified in the number of recommendations made within the same country. Of the 69 recommendations, only four were included in all seven documents. Conclusion: Little consistency was demonstrated within or among countries in terms of the content of their prenatal care guidelines, suggesting a need to reexamine their content and the evidence on which such recommendations are based.     

Influence of Peripartum Expectations,Mode of Delivery,and Perineal Injury on Women’s Postpartum Sexuality

BackgroundSexual health has been identified as an important factor for postpartum quality of life. Although pregnancy-related changes in anatomy and metabolism return to their prepregnancy state, female sexual function may not be at the level it was before birth because of physical and psychological changes.AimThe goal of our study was to explore the influence of the mode of delivery, perineal injury, and peripartum expectations on postpartum sexual function.MethodsBetween 2013 and 2018, 522 women were enrolled in this prospective investigation. At time of recruitment during the peripartum hospitalization, patients completed a standardized questionnaire addressing expectations concerning postpartum sexuality with focus on expected influence of the mode of delivery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and Sexual Activity Questionnaire (SAQ) at time of recruitment to evaluate baseline sexual function (4 weeks before pregnancy). Follow-up assessments were conducted at 3, 6, and 12 months postpartum.OutcomesPeripartum expectations, influence of the mode of delivery, and perineal injury were analyzed for their impact on women’s sexual function within 12 months postpartum by repetitive FSFI and SAQ assessments.ResultsA total of 522 women with 263 spontaneous vaginal deliveries, 41 operative vaginal deliveries, and 218 cesarean sections were analyzed. Although the data demonstrate a significant postpartum decline in sexual function at 3 and 6 months postpartum, sexual functioning converges to baseline prepregnancy values 12 months postpartum. This observation was independent of the mode of delivery and perineal injuries with no significant between-group differences at any of the analyzed time points. Apart from breastfeeding, for which negative anticipations resulted in impaired sexuality, women’s expectations (pertaining to quantity and quality of female orgasm, partner’s sexuality, fear of altered sexuality, frequency of intercourse, the mode of delivery) do not influence female sexual function at 12 months postpartum.Clinical ImplicationsDeciphering the potential influence of patient expectations as well as pregnancy- and childbirth-related aspects on female postpartum sexuality will help in the effort to improve women’s postpartum sexual health.Strengths & LimitationsAs a strength of this study, postpartum sexuality was independently assessed with 2 different scoring systems (FSFI and SAQ). Limitations include that our follow-up is incomplete and amounts to about 2-thirds of patients who were initially recruited.ConclusionThe mode of delivery and perineal trauma do not influence women’s postpartum sexual function. With the exception of breastfeeding, peripartum expectations do not result in altered sexual functioning at 12 months postpartum.Spaich S, Link G, Alvarez SO, et al. Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women’s Postpartum Sexuality. J Sex Med 2020;17:1312–1325.     

An Assessment of Women’s Knowledge of and Views on the Reporting of Ultrasound Soft Markers During the Routine Anatomy Ultrasound Examination

ObjectiveTo assess women’s knowledge of and views on the evaluation and reporting of ultrasound soft markers.MethodsA prospective survey of 263 women undergoing 18 to 20 week anatomy ultrasound examination at Mount Sinai Hospital, a level 3 perinatal referral centre for a multi-ethnic population of approximately 2.5 million.ResultsPrior to reading an information pamphlet provided in the context of this survey, 30% of women (79/263) reported having heard of the term soft marker and 59% of these women (47/79) had discussed soft markers with their caregiver. When asked their preferences about the reporting of ultrasound soft markers, 53% of women said that soft markers should be reported routinely, 20% said they should be reported when the caregiver thinks it necessary, and 23% preferred they be reported only when they have been discussed prior to the ultrasound examination. A minority of respondents (8%) had not participated in prenatal screening for aneuploidy. All of these women preferred that soft markers be reported only after pre-screening discussion.ConclusionThe study demonstrates that most women have little prior knowledge about routine examination for soft markers during the anatomy ultrasound examination and emphasizes the importance of expanding counselling and informed consent to include this aspect of prenatal screening.     

The Partner’s Presence in the Sex Research Lab Differentially Affects Sexual Arousal in Women and Men

IntroductionThe present study addressed the ecological validity of the individual‐focused experimental paradigm in sex research.AimThe aim of this study was to investigate the effect of partner presence vs. absence in the laboratory testing situation, and of manipulation of attentional focus, on genital and subjective sexual arousal of healthy women and men.MethodsSexually functional heterosexual men (n = 12) and women (n = 12) and their partners participated in this study. During partner presence, the partner sat opposite to the participant; self‐focused attention was experimentally manipulated by introducing, respectively, a semi‐reflecting glass pane, and a wall‐mounted camera.Main Outcome MeasuresPerceived state self‐focused attention and genital and subjective sexual arousal during presentation of audiovisual erotic film stimuli were assessed.ResultsPartner presence resulted in higher perceived self‐focus (η_p² = 0.22) and lower genital responses to erotic stimulation (η_p² = 0.21). The interaction of partner presence and increased self‐focused attention differentially affected genital arousal in female and male participants (η_p² = 0.38). The mean genital response in men was lower during private self‐focus than during non‐self‐focus with the partner present but was higher during private self‐focus with the the partner absent (η_p² = 0.23). The genital response in women to public self‐focus was lower than to private self‐focus and to non‐self‐focus with their partner present (η_p² = 0.36). With the partner absent, the genital response in women to private self‐focus was lower than to non‐self‐focus (η_p² = 0.23). Retrospective subjective arousal of women was higher with partner present (M = 3.2) than with partner absent (M = 2.9), whereas men reported higher retrospective subjective arousal with their partner absent (M = 3.5) than present (M = 3.1).ConclusionsThese findings suggest that mere presence of the partner impacts the sexual response differentially in women and men. Enhancing the ecological validity of the individual‐based laboratory paradigm for sex research warrants closer examination in future research. van Lankveld J, Hubben D, Dewitte M, Dingemans ME, den Butter C, and Grauvogl A. The partner's presence in the sex research lab differentially affects sexual arousal in women and men. J Sex Med 2014;11:697–708.     

Voices of Postpartum Women: Exploring Canadian Women's Experiences of Inpatient Postpartum Care

Objective

To explore and understand postpartum inpatient experiences in a Canadian context.

Women's Experience of Hospitalized Bed Rest During High‐Risk Pregnancy

ObjectiveTo describe the lived experience of the hospitalized pregnant woman on bed rest.DesignA qualitative, phenomenological design.SettingThree high‐risk antepartum units in the midwestern United States.ParticipantsA self‐selected, convenience sample of 11 high‐risk pregnant women.MethodPhenomenological study using thematic analysis of completed handwritten journals and/or online blogs.ResultsWomen described the battles that they fought each day for the lives of their unborn children. Using an imagery of war, three categories emerged: (a) the war within, (b) fighting each battle, and (c) bringing in reinforcements.ConclusionsWomen experience many different emotions and stressors during restricted bed rest. A nurse's understanding of this experience is essential to provide adequate care and coping strategies for women at this time.