The postnatal support needs of mothers with an intellectual disability

Objectivethere is growing evidence that many parents with intellectual disabilities can parent successfully when given adequate support. This paper aims to explore the postnatal care experiences of mothers with an intellectual disability.Designa qualitative design was used and data were collected using a semi-structured interview format and analysed using Interpretative Phenomenological Analysis.Settingthe study took place in community settings in Scotland.Participantssix mothers with intellectual disabilities were interviewed about their experiences.Measurements and findingstwo super-ordinate themes are discussed with accompanying subthemes: challenges of providing support and how support was delivered.Key conclusionsthe mothers valued formal postnatal care, but this was secondary to informal support. How mothers perceived the support impacted on its effectiveness and building effective relationships with professionals presented challenges.Implications for practicethe study suggests the structure and quality of the wider support networks of mothers with an intellectual disability are central and should be taken account of by professionals. Providing information and advice in ways that validates the mother's role is also important, particularly as the mother's perception of how help is given can impact on the degree to which mothers engage with professionals.     

Prenatal diagnosis of a 3.2-Mb 2p16.1-p15 duplication associated with familial intellectual disability

Objective

We present prenatal diagnosis of a 2p16.1-p15 duplication associated with familial intellectual disability, and we discuss the genotype–phenotype correlation.

Prenatal diagnosis by whole exome sequencing in a family with a novel TBR1 mutation causing intellectual disability

ObjectiveTo provide prenatal diagnosis for a pregnant woman with genetic history of intellectual disability.Case reportA Chinese pedigree with intellectual disability was collected in this study. Cytogenetic analysis, chromosomal microarray analysis (CMA) and whole exome sequencing (WES) followed by Sanger validation were conducted to identify the genetic pathogenesis. A novel heterozygous deletion c.370_374delTTCCC in TBR1 gene was identified, leading to a frameshift mutation starting at Phe124 followed by a premature stop codon at position 141 (p.Phe124Valfs118). Segregation analysis identified that this novel mutation is co-segregated among the affected family members but absent in unaffected family members. Prenatal diagnosis indicated the absence of this mutation, and the family decided to continue the pregnancy after genetic counseling.ConclusionOur findings demonstrated the significance of genetic testing in the diagnosis of intellectual disability. This work also confirmed the effectiveness of WES in prenatal diagnosis.     

Psychometric Properties of the Prenatal Opioid Use Perceived Stigma Scale and Its Use in Prenatal Care

ObjectiveTo examine the psychometric properties of the Prenatal Opioid Use Perceived Stigma (POPS) scale and to assess the relationship of POPS scores to adequate prenatal care.DesignProspective cohort study.SettingMedical centers in Alabama, Ohio, and Pennsylvania (N = 4).ParticipantsWomen (N = 127) who took opioids during pregnancy and whose infants participated in the Outcomes of Babies With Opioid Exposure Study.MethodsParticipants reported their perceptions of stigma during pregnancy by responding to the eight items on the POPS scale. We evaluated the instrument’s internal consistency reliability (Cronbach’s alpha), structural validity (factor analysis), and convergent validity (relationship with measures of similar constructs). In addition, to assess construct validity, we used logistic regression to examine the relationship of POPS scores to the receipt of adequate prenatal care.ResultsThe internal consistency of the POPS scale was high (Cronbach’s α = .88), and all item-total correlations were greater than 0.50. The factor analysis confirmed that the items cluster into one factor. Participants who reported greater perceived stigma toward substance users and everyday discrimination in medical settings had higher POPS scores, which supported the convergent validity of the scale. POPS scores were significantly associated with not receiving adequate prenatal care, adjusted OR = 1.47, 95% confidence interval [1.19, 1.83], p < .001.ConclusionThe psychometric testing of the POPS scale provided initial support for the reliability and validity of the instrument. It may be a useful tool with which to assess perceived stigma among women who take opioids, a potential barrier to seeking health care during pregnancy.     

Embarrassment and modesty feelings during pregnancy,childbirth and follow-up care: A qualitative approach

Objective: Pregnancy and childbirth require several medical examinations which can awaken feelings of modesty in women. Although little research has been done on this specific question, previous research indicates that feelings of modesty and embarrassment could surface during medical examinations, particularly those requiring patient nudity. The aim of the present study was to explore women’s feelings of modesty and embarrassment during medical examinations during pregnancy, childbirth and postnatal care. Method: Qualitative with phenomenological approach. Data were collected by tape-recorded open-ended interviews during the early postnatal period at Paule de Viguier Hospital Maternity Unit, Toulouse (southern France). Twenty women were interviewed during their maternity stay. The interviews explored feelings of modesty during prenatal medical care, childbirth and postnatal care. Results: Results show that feelings of modesty and embarrassment are involved in women’s experience of medical care during pregnancy and childbirth. Nevertheless, all of these women accepted the necessity of medical examinations, citing that their and their baby’s health were more important than personal comfort. Conclusion: Some factors such as ensuring a professional and respectful attitude from the medical staff as well as having procedures explained could reduce feelings of modesty. This study offers an insight of an area that has, as yet, been little explored.     

Exploring Dental Care Misconceptions and Barriers in Pregnancy

Abstract: Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low‐birthweight infants. Little is known about childbearing women’s experiences in obtaining dental care. The objective of this study was to explore Florida women’s experience of barriers in obtaining dental care before and during their pregnancies. Methods: Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face‐to‐face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women’s experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject‐level content analysis, key themes were assessed about the participants’ perspectives on obtaining oral health care before and during pregnancy. Results: Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Conclusions: Misconceptions about the appropriateness of oral health care during pregnancy may affect women’s access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted. (BIRTH 37:4 December 2010)     

Qualitative,Interpretive Metasynthesis of Women’s Experiences of Intimate Partner Violence During Pregnancy

ObjectiveTo describe the perspectives of women who experienced intimate partner violence (IPV) during pregnancy through a qualitative, interpretive metasynthesis.Data SourcesWe searched 12 electronic databases to identify articles on qualitative studies pertaining to women’s experiences of IPV during pregnancy. We searched Academic Search Complete, AgeLine, CINAHL Complete, Family Studies Abstracts, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences, PsycINFO, Social Work Abstracts, Health Source–Consumer Edition, Health Source–Nursing/Academic Edition, and Humanities Full Text for articles published from 2008 through 2018.Data ExtractionWe used inclusion and exclusion criteria to identify eight reports of qualitative studies that contained direct quotations in which women described their experiences of IPV.Data SynthesisWe used a methodologic reduction to provide a theoretical context that helped us synthesize the data to five key themes: Pregnancy Escalates Abuse, Concern for Unborn Fetus, Importance of Support, My Child Saved Me, and Pregnancy Is a Catalyst for Reflection.ConclusionThe results of our synthesis illustrate the unique perspectives of women who experienced IPV during pregnancy. Understanding these experiences can help health care providers assist pregnant women through enhanced screenings and education. Health care providers can also help women identify resources for emotional and financial support as they determine the best courses of action for themselves and their children.     

Exploring the concept of continuous midwifery-led care and its dimensions in the prenatal,perinatal, and postnatal periods in Iran (Kashan)

Aimto explore the concept of continuous care and its dimensions in the prenatal, perinatal, and postnatal periods based on the experiences of midwives, gynaecologists, obstetricians, pregnant women and their husbands.Designa qualitative study that was part of a large scale action research which aimed to develop, use and test a continuous midwifery-led care model. Data collection and analysis were performed concurrently through undertaking semi-structured interviews and using the conventional content analysis approach.Settinghealthcare centres and hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran.Participants21 women following a recent pregnancy, five husbands, 18 midwives, and five physicians who had different official positions.Findingsthe participants’ experiences revealed five concepts for continuous midwifery-led care which included continuity, the process of care, education and informing, management, and professionalism. Each of these five concepts consisted of several categories.Conclusion and implication for practiceaccording to the study participants, continuous midwifery-led prenatal, perinatal, and postnatal care is a multidimensional and important concept. Given the differences in the health infrastructures of different countries as well as the unique characteristics of pregnancy, higher priorities are recommended to be given to continuous midwifery-led care and its dimensions.     

Exploring the associations between intimate partner violence victimization during pregnancy and delayed entry into prenatal care: Evidence from a population-based study in Bangladesh

ObjectiveIntimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and newborns. The aim of the study is to explore: 1) the influence of experiencing IPV during pregnancy on delayed entry into prenatal care; and 2) whether women's decision-making autonomy and the support for traditional gender roles act to mediate or moderate the relationship between IPV and delayed entry into prenatal care.Designcross-sectional survey. Multivariate logistic regression models were estimated that control for various socio-demographic and pregnancy related factors to assess whether women who experienced IPV during pregnancy were more likely to delay entry into prenatal care compared with women who had not experienced IPV. The influence of traditional gender roles acceptance and decision-making autonomy were examined both as independent variables and in interaction with IPV, to assess their role as potential mediators or moderators.SettingChandpur district, Bangladesh.Participantsthe sample comprised of 426 Bangladeshi women, aged 15–49 years. Postpartum mothers who visited vaccinations centres to receive their children's vaccinations constitute the sampling frame.Resultsalmost 70% of the women surveyed reported patterns consistent with delayed entry into prenatal care. Accounting for the influence of other covariates, women who experienced physical IPV during pregnancy were 2.61 times more likely (95% CI [1.33, 5.09]) to have delayed entry into prenatal care than their counterparts who did not report physical IPV. Neither sexual nor psychological IPV victimization during pregnancy was linked with late entry into prenatal care. Both gender role attitudes and levels of autonomy mediate the effect of IPV on prenatal care.Key conclusionsthe results suggest that the high rates of IPV in Bangladesh have effects that can compromise women's health seeking behaviour during pregnancy, putting them and their developing fetus at risk. Specifically, Bangladeshi women who experience physical IPV during pregnancy are more likely to delay or forgo prenatal care, an effect that is further magnified by cultural ideals that emphasize women's traditional roles and limit their autonomy.Implications for practicethis study reinforces the need to detect and assist women suffering IPV, not only to offer them help and support but also to increase entry into prenatal care. Healthcare professionals involved in obstetrics and midwifery need to be aware of the risk factors of IPV during pregnancy and be able to identify women who are at risk for delayed entry into prenatal care.     

Time From Pregnancy Recognition to Prenatal Care and Associated Newborn Outcomes

ObjectiveTo examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy.DesignSecondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States.SettingTwenty‐nine states.ParticipantsWomen of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births.MethodsPopulation‐based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality.ResultsThe average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p <.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p <.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p <.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p >.01).ConclusionAverage time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.     

Professional and social support enhances maternal well-being in women with intellectual disability – A Swedish interview study

Objective

to gain a deeper understanding of the experience of professional and social support during pregnancy and childbirth among women with intellectual disability (ID) in Sweden.

Design/setting

an interview study among 10 women with ID, who had given birth within seven years. Two interviews were performed with each woman and data were analysed with qualitative content analysis.

Findings

the overarching theme was: Professional and social support enhances maternal well-being in women with intellectual disability. The women described that the midwife and other caregivers contributed to their own insights and supported their mother-to-be process. They were mostly satisfied with the professional care and support during pregnancy and childbirth, based on aspects such as continuity, competence and professional experience of the midwives but also professional approach and working methods. Dissatisfaction and confusion occurred when questions were left unanswered or when the women?s special needs were not taken into consideration. Family members, friends and colleagues could also have a supporting role and, together with the health staff, contribute to the well-being of the woman.

Conclusions

if professional support and care from midwives and other caregivers is adapted to the special needs of women with ID, it contributes to new insights, enhances well-being and supports the process of becoming a mother. Midwife-led continuity of care together with continuous social support should be offered to pregnant women with ID during pregnancy and childbirth.     

Mixed-Methods Study of the Experience of Pregnancy During the COVID-19 Pandemic

ObjectiveTo understand the experiences of women who were pregnant during the initial stage of the COVID-19 pandemic, March 2020 to May 2020, and how they coped with stress.DesignA convergent mixed-methods design.SettingOnline survey that launched in April 2020.ParticipantsA total of 185 pregnant women.MethodsFor the quantitative strand, we measured adaptation to coping with stress using the Brief Resilient Coping Scale. For the qualitative strand, we asked participants to describe the experience of being pregnant during the pandemic.ResultsThe mean score on the Brief Resilient Coping Scale was 14.7, which indicated a medium-level resilient coper. Using Krippendorff’s content analysis, we identified four themes: Robbed of Enjoying the Expected Pregnancy Experiences, Anxiety and Fear in the Face of a Pandemic Pregnancy, Heightened Source of Worry With Birth on the Horizon, and Choosing Hope.ConclusionTo meet the needs of pregnant women, perinatal nurses and other maternity care providers must understand the experience of pregnancy during times of upheaval, such as the onset of a global pandemic. Health care providers and nurses can help ensure ideal outcomes for pregnant women by recognizing the loss of the expected pregnancy experience, providing support through creative social outlets, and fostering hopeful optimism.