Postpartum Contraceptive Decision-Making of Parous Teens–A Qualitative Study

Study ObjectiveApproximately 25% of teens in the United States will become pregnant before the age of 18, and within 2 years, more than 31% will have a repeat pregnancy. Acknowledging that some adolescents might seek or be ambivalent toward rapid repeat pregnancy, compared with their counterparts, not using a long-acting reversible contraception method increases a teen's risk of another pregnancy in 2 years by more than 35 times. We seek to better understand the influences and factors surrounding adolescent postpartum contraceptive decision-making following the index delivery.DesignWe completed a qualitative study via focused, semistructured interviews during an inpatient postpartum course. The interview guide was modeled after those used in other studies of adolescent contraceptive decision-making, beta tested, and developed iteratively. Interviews were completed, transcribed, coded, and analyzed with the assistance of Dedoose.SettingThe study was conducted at MetroHealth Medical Center in Cleveland, Ohio.ParticipantsParous adolescents aged 13–19ResultsWe performed 12 interviews prior to reaching theoretical saturation. Themes were identified related to the participants’ prior experiences with contraception and prior and current pregnancies. The participants’ contraceptive choices were influenced by personal relationships, varying levels of autonomy, misperceptions, and changing contraceptive needs.ConclusionsWe found that adolescents’ contraceptive decision-making was influenced by their social networks and community, including their parents and friends. Mothers played a key role as adolescents transitioned to gaining more autonomy over their reproductive decisions. Providers should consistently present adolescents with comprehensive contraceptive options as a component of preventive health care.     

Effect of Fathers’ Presence and Involvement in Newborn Care in the NICU on Mothers’ Symptoms of Postpartum Depression

ObjectiveTo determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers’ presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU.DesignObservational cohort study.SettingOpen-bay, 40-bed, tertiary level NICU in Eastern Canada.ParticipantsMothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU.MethodsParticipants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns’ bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers’ presence and involvement were the independent variables. We adjusted for covariates.ResultsThe prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers’ involvement was significantly associated with lower scores on the PDSS (adjusted β = −3.85; 95% confidence interval [CI] [−6.10, −1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted β = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted β = −0.86, 95% CI [−1.77, 0.05] and adjusted β = 10.69, 95% CI [−0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R² = 0.35.ConclusionFathers’ involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers’ involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.     

Couples’ Experiences of Maternal Postpartum Depression

ObjectiveTo understand the processes that couples navigate as they cope with maternal postpartum depression (PPD) in early parenthood.DesignQualitative, interpretive phenomenological study.SettingCommunity setting in the western United States.ParticipantsA convenience sample of 10 couples (N = 20, 10 mothers and 10 fathers) who indicated they had maternal diagnoses of PPD after the births of their first children within the last 3 years.MethodsCouples were interviewed together and then individually with the use of a semistructured interview guide. Narrative and thematic analyses were used to understand couples’ lived experiences of PPD.ResultsParticipants cocreated their experiences of maternal PPD. Three primary phases in the pattern of coping with PPD were identified: Dismissal (couples attempted to normalize their experiences and protect the mother from judgment), Acknowledgment (couples revealed their concerns, the first step in the process of seeking help), and Accommodation (process of trial and error used to find a way to meet the needs of the mother).ConclusionOur findings suggest that practitioners must support the needs of the entire family, including fathers, when mothers have a diagnosis of PPD. Fathers support mothers during this difficult experience but not without an increased burden of stress to themselves.     

What Constitutes a Good Childbirth? A Qualitative Study of Pregnant Finnish Women

The aim of this study was to describe pregnant Finnish women's perceptions of a good childbirth. Data were collected through semistructured interviews in maternity health care clinics and maternity hospitals. Data interpretation was based on content analysis. A purposive sample of 24 pregnant women aged 19 to 45, half of them expecting their first child, were interviewed. Five main issues were seen by informants as important in the course of childbirth: 1) unhurried atmosphere, 2) normality, 3) reasonable duration of labor, 4) security, and 5) control. Participants did not expect much from their birth companions, although some mentioned various tasks for them. The three main issues considered important for the role of staff were the professionals'1) personal characteristics, 2) attitudes toward the childbearing woman, and 3) way they acted. The question about the physical environment was found quite irrelevant by some women, and only a few had special wishes related to the birthing environment. None of the participants voiced opposition to obstetric interventions, but some were willing to avoid them if possible. Informed consent for interventions was seen as very important. These results suggest that health care providers are challenged to provide individualized care for every woman.     

Factors Influencing Adolescent and Young Adults’ First Pelvic Examination Experiences: A Qualitative Study

Study ObjectiveTo understand the factors that influence individuals’ experiences during their first pelvic examination.Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe conducted semistructured interviews with adolescents and young adults, aged 18-24, who had received at least 1 pelvic examination. Interviews explored contextual factors of the first pelvic examination, including visit acuity and clinical setting and individuals’ experiences with the pelvic examination itself and elicited recommendations on how to improve the examination experience. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented.ResultsThirty participants completed interviews. Nineteen participants described their first pelvic examination experience as positive; 11 described this examination as a negative or neutral experience. Factors influencing the experience include the examination indication and acuity, examination location and physical space, provider features, relational and interpersonal features, and procedural aspects. Recommendations included: (1) establish rapport and educate before the examination; (2) establish practices to orient patients; (3) make no assumptions about identity; and (4) elicit continuous feedback.ConclusionIndividuals’ first pelvic examination experiences are influenced by a variety of factors. Although some factors are directly modifiable by providers, other factors that might not be modifiable are important to elicit to optimize the examination experience. These findings call for best practice guidelines and educational interventions to prepare providers to perform the first pelvic examination.     

How to Improve Adolescent Mothers’ Satisfaction with Childbirth?

Study ObjectiveThis study aimed to analyze factors related to adolescent mothers’ satisfaction with childbirth.DesignProspective and cross-sectional studyParticipantsFifty adolescent mothers with maternal age from 14 to 19 years and delivery of a single and live newborn at termSettingLow-risk maternity hospitalInterventionThe participants were invited to answer a questionnaire (North Bristol modified version of the Mackey Childbirth Satisfaction Rating Scale [mMCSRS]) with 18 items measuring childbirth satisfaction. Each item was to be rated on a 5-point Likert scale (very dissatisfied to very satisfied).Main Outcome MeasureThe main outcome measure was the total score on the questionnaire.ResultsThe median maternal age was 18 years (95% CI, 11-25), and the median maternal satisfaction score of adolescent mothers was 88 (95% CI, 83-90). There was a significant difference in the total scores on the mMCSRS regarding the following factors: “oral fluid and food intake during labor” (yes = 84.0 vs no = 78.0, P = 0.044); “professional who attended the birth” (physician = 78.0 vs midwife = 86.0, P = 0.022); “skin-to-skin contact” (yes = 83.0 vs no = 71.0, P = 0.004); and “breastfeeding at the first hour” (yes = 84.5 vs no = 75.5, P = 0.008). Multiple regression with a stepwise procedure identified the following independent factors: “gestational age” (coefficient = 2.14, P = 0.03), “oral fluid and food intake during labor” (coefficient = 5.30, P = 0.013), and “skin-to-skin contact” (coefficient = 11.2, P < 0.001).ConclusionSatisfaction with childbirth in adolescent mothers is associated with measures that can be easily implemented in the health care system. They are chiefly the provision of oral fluid and food during labor and skin-to-skin contact. Specific strategies are thus needed to increase adolescents’ satisfaction with childbirth.     

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.     

The Management of Masturbation as a Sexual Health Issue in Dar es Salaam,Tanzania: A Qualitative Study of Health Professionals’ and Medical Students’ Perspectives

BackgroundAcross Africa, there are strong cultural taboos against masturbation.AimAs part of a broader study investigating sexual health training needs of the health providers, researchers conducted a study to investigate how masturbation is addressed as a clinical issue in clinics in Dar es Salaam, Tanzania.MethodsAn exploratory qualitative study design conducted in June 2019 involving 18 focus groups among health care providers and students in the health professions (midwives, nurses, medical doctors). A total of 61 health care students and 58 health providers were interviewed. The study participants were purposively selected and the design was purposively stratified to examine findings across the 3 main health care providers and by experience (clinicians vs students). A semistructured interview guide in Kiswahili language was used. The study participants were presented a case scenario of a 14-year-old boy who was found masturbating in his room by his father, and asked how this case would be handled in a clinical setting. Data were transcribed in Kiswahili and Translated to English.OutcomesInductive-deductive thematic analysis was performed. Major themes and subthemes were identified.ResultsTwo main themes emerged: (i) knowledge about the management of masturbation and (ii) views about the effects of masturbation. Clinical interventions providers would try to include normalization of masturbation as a pubescent behavior combined with advice to stop the adolescent from masturbating, a recommendation to watch for negative effects immediately postmasturbation, and referral to a psychologist for treatment. Across providers and students, masturbation in adolescence was seen as clinically problematic, potentially leading to multiple issues in adulthood including sexual dissatisfaction with a spouse, psychological dependency, and erectile dysfunction, loss of sexual sensitivity in intercourse, premature ejaculation, and penis size reduction. Several participants mentioned they received no training about masturbation to guide their clinical practice.Clinical ImplicationsThese findings affirm the need for comprehensive sexual health training in Tanzanian universities.Strengths and LimitationsUse of stratified design by profession and experience allowed to explore if there appear to be differences between students and experienced providers. The findings cannot be generalizable to all health professional students and providers across Tanzania.ConclusionWhen designing sexual health curricula for Tanzania, it is important to include accurate information about masturbation as a normal and healthy sexual practice to address widely held myths about its effects on health, and to train providers in how to counsel when concerns and inaccurate information are brought to the clinical encounter. Mushy SE, Rosser BRS, Ross MW, et al. The Management of Masturbation as a Sexual Health Issue in Dar es Salaam, Tanzania: A Qualitative Study of Health Professionals’ and Medical Students’ Perspectives. J Sex Med 2021;18:1690–1697.     

Transgender Youths’ Sexual Health and Education: A Qualitative Analysis

Study ObjectiveTo characterize transgender adolescents’ sexual behaviors, identities, and their perceived experiences with sex education.DesignSemi-structured interviews were conducted and addressed sexual experiences and perceptions of sex education received from family, school educators, and healthcare providers. Interviews were audio recorded, transcribed, and analyzed utilizing NVivo 12 software for thematic analysis.SettingChild and adolescent gender services clinic at a Midwestern university-based medical center in the United States.Participants30 transgender adolescents between the ages of 15 to 20.Interventions and Main Outcome MeasuresThemes generated during semi-structured interviews.ResultsSexual orientations were inclusive of attractions to a spectrum of gender identities. Libido was perceived to be impacted by gender-affirming hormone therapy, which was unanticipated for some adolescents. Family and school-based sex education was perceived to be relevant only for heterosexual and cisgender adolescents. Inclusive education for transgender adolescents was desired. Counseling provided by gender-affirming providers on sexual health was trusted and other healthcare providers were perceived to lack training on gender-inclusive care.ConclusionThis study demonstrated that families and school educators did not provide sex education perceived to be applicable to transgender adolescents. Similarly, healthcare providers of transgender adolescents were perceived to not provide inclusive or comprehensive medical care in comparison to physicians who routinely provide gender-affirming care. Gaps in education and healthcare could be improved with sex education outreach or training for families and school educators as well as the development and implementation of professional competencies for pediatricians on transgender adolescent healthcare.     

Secondary School Girls’ Experiences of Menstruation and Awareness of Endometriosis: A Cross-Sectional Study

Study ObjectiveTo characterize typical menstrual characteristics in a large sample of secondary school girls, as well as knowledge of typical (ie, normal) menstruation, endometriosis awareness, and educational needs. To establish whether self-reported atypical period symptoms indicate menstrual characteristics suggesting the need for further clinical review for a specialist opinion.DesignCross-sectional survey.SettingSecondary schools in West Midlands, England.ParticipantsA total of 442 girls, aged 15-19 years.Interventions and Main Outcome MeasuresThe questionnaire determined demographic characteristics, age at menarche, menstrual cycle patterns and experiences, awareness of endometriosis, and preferences for learning about it.ResultsPeriod pain was common (94%), with pain reported as moderate/severe (86%). Girls reported missing school due to their menstrual periods (23%), mainly because of pain. Most believed their period was typical (63%); however, 27% were unsure, and 30% did not know whether it was regular. Self-report of atypical periods was associated with symptoms suggesting need for clinical review and with consulting a doctor [χ²(2) = 36.272, P < .001)]. Only 8% could describe endometriosis, although 86% wanted to learn more about it.ConclusionMost secondary school girls report dysmenorrhea. Although most girls reporting atypical periods had seen a doctor, more than one-fourth did not know whether their period was typical or regular. The majority do not have knowledge of endometriosis, contrasting with adolescents’ familiarity with other common chronic conditions such as diabetes and epilepsy. We suggest menstrual health education (MHE) to improve knowledge of typical menstruation and pain treatment, aiding earlier identification of problematic period symptoms that might indicate underlying pathology.     

What is the Role of Video-Based Assessment of Laparoscopic Surgical Skill in Residency Training? A Qualitative Study of Trainee and Faculty Perspectives

ObjectivesSurgical training programs are starting to experiment with video-based assessment (VBA) of residents’ technical skills. VBA may limit the effect of interpersonal bias on assessment scores. However, before VBA is implemented widely, stakeholders’ perceptions ought to be explored, including potential benefits and challenges.MethodsUsing the qualitative methods of hermeneutical phenomenology, the authors explored both trainee and faculty educators’ perspectives on VBA using semi-structured interviews. Participants were recruited from the Department of Obstetrics and Gynecology at the University of Toronto. Data underwent thematic analysis and was validated by the investigator and theoretical triangulation.ResultsThe authors interviewed 9 physicians (5 faculty and 4 residents). Four dominant themes were identified, including advantages compared to traditional methods, the role of feedback and coaching, challenges integrating VBA, and considerations for implementation.ConclusionsSurgical trainees and faculty feel that VBA is a worthy tool to advance equity and fairness in assessment, but felt it was better as a vehicle for feedback and coaching. VBA cannot be used as a standalone assessment metric without additional evidence for its validity. If implemented, residency programs can use VBA as an adjunct to other evaluation measures to facilitate coaching, provide asynchronous feedback, and limit assessment bias.     

Mothers’ experiences of the NICU and a NICU support group programme

Objective: to understand both the maternal experience of the NICU and mothers’ views of a NICU Parent Support Group. Background: mothers of babies who are born prematurely have their first experiences of parenting while their infant is in the neonatal intensive care unit (NICU). This presents multiple challenges and a range of stresses related to their role as a mother and concerns about their baby’s survival and growth. Thus, various supportive interventions have been trialled with this NICU parent population. However, the focus of this support and how it should be delivered lacks research as an evidence base for practice. Mothers’ experiences of the NICU and a professionally facilitated NICU support group at a city hospital were explored in this qualitative research study. Method: nine mothers were interviewed in 2010 while their babies were NICU inpatients. Interviews were recorded, transcribed and analysed thematically. Results: the NICU admission resulted in participant mothers facing challenges in getting to know their baby, forming their parenting role while in the NICU, and a reliance upon, but resentment toward, nursing staff. Positive feelings about their baby’s strengths were also apparent. The parent support group was an important part of managing the experience of the NICU and was reported to meet the emotional support needs of these NICU parents. Conclusion: the implications and recommendations for NICU-based emotional support are discussed. In particular, modifications to support group structures to ensure professional staff involvement and a balance between education and emotional care are reviewed.     

Identifying the Public’s Knowledge and Intention to Use Human Cloning in Greek Urban Areas

Purpose: The understanding of the publics knowledge on human cloning (HC) and its acceptability are considered important for the development of evidence-based policy making. The aim of this research study was to investigate the demographic and socioeconomic variables that affect the publics knowledge and intention to use HC in urban areas of Greece. Additionally, the possible association of religiousness with the knowledge and the intention to use HC were also investigated.Methods Individual interviews were conducted with 1020 men and women of urban areas in Greece. Stratified random sampling was performed to select the respondents. Several scientists, experts in HC, evaluated the content of the instrument initially developed. The final questionnaire was consequently the result of a pilot study.Results Almost half of the respondents (51.5%) believed that HC is a sort of in vitro fertilization and 42.9% that it has already been applied to human being. They were not aware that the cloned fetus grows in the womans uterus (41.5%) and that HC could regenerate human organs (41.7%). The acceptability of human cloning for the cure of terminal diseases and transplantation need is very high (70.7% and 58.6%, respectively). The publics intention to have recourse to cloning on the grounds of bringing back to life a loved person or because of reproductive disorders was reported as desire by 35% and 32.5%, respectively. The occupational category (scientists, self-employed, and artists), the Intention to use HC, and the number of children are highly significant predictors of valid knowledge about HC. Low rates of church attendance appeared to relate with high reported Intention to use HC, and increasing scores of valid knowledge about HC increased the publics Intention to use HC.Conclusions A number of specific demographic and socioeconomic characteristics and high scores of knowledge provide a persuasive justification in demonstrating intention toward HC. The current study suggests that these findings should receive further attention by policymakers and scientists within the Greek context.     

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.     

Mothers’ and fathers’ attachment and caregiving representations during transition to parenthood: an actor–partner approach

Objective: This study aimed to investigate the effect of one’s attachment representations on one’s and the partner’s caregiving representations.

Background: According to attachment theory, individual differences in parenting and caregiving behaviours may be a function of parents’ caregiving representations of the self as caregiver, and of others as worthy of care, which are rooted on parents’ attachment representations. Furthermore, the care-seeking and caregiving interactions that occur within the couple relationship may also shape individuals’ caregiving representations.

Methods: The sample comprised 286 cohabiting couples who were assessed during pregnancy (attachment representations) and one month post-birth (caregiving representations). Path analyses were used to examine effects among variables.

Results: Results showed that for mothers and fathers, their own more insecure attachment representations predicted their less positive caregiving representations of the self as caregiver and of others as worthy of help and more self-focused motivations for caregiving. Moreover, fathers’ attachment representations were found to predict mothers’ caregiving representations of themselves as caregivers.

Conclusions: Secure attachment representations of both members of the couple seem to be an inner resource promoting parents’ positive representations of caregiving, and should be assessed and fostered during the transition to parenthood in both members of the couple.