“Planned” and “unplanned” pregnancy: Deconstructing experiences of conception

This paper seeks to explore women's experiences of conception, and to deconstruct the dichotomy between the terms “planned” and “unplanned” pregnancy. It draws on interviews with 19 primagravidae conducted as part of a wider qualitative study of women's experiences of pregnancy and childbirth. Although the concept of pregnancy intention is widely regarded as ambiguous, and by some immeasurable, this paper draws on interview data to develop four categories of pregnancy intention. The first category (the planned pregnancy) is unambiguous and reflects the type of planned approach currently advocated by health professionals. The second category (the laissez-faire pregnancy) reflects the experiences of women who stop using contraception but adopt a more relaxed approach to pregnancy planning. The third category (the recalcitrant pregnancy) is far more ambiguous and describes the experiences of those who want to be pregnant but for whom it would not be socially acceptable to plan a pregnancy. The final category (the accidental pregnancy) is unambiguous and deals with pregnancies that could be described as unexpected, and arising due to genuine contraceptive failure. This paper concludes by highlighting the significance of pregnancy intention for health policy, health research, and for the health care providers. The importance of adopting a subjective approach to improve our understanding of women's experiences of conception is also highlighted.     

Periconceptional folic acid use among women giving birth at Queen Mary Maternity Hospital in Dunedin

BACKGROUND: The New Zealand Ministry of Health advises that all women planning a pregnancy take a folic acid supplement to reduce the risk of having a neural tube defect (NTD)-affected pregnancy. There is little information available to determine if women are following this advice. OBJECTIVE: The purpose of this study was to determine periconceptional folic acid use among women in the postnatal ward of Queen Mary Maternity Hospital in Dunedin. METHODS: A questionnaire was administered to women in the postnatal ward between 14 November and 22 December 2004. RESULTS: One hundred and six women were interviewed during the study period. Forty women (39%) used folic acid supplements before conception. Sixty-seven women (64%) planned their pregnancy. The proportion of women (P<0.001) who planned their pregnancy (53%) and used folic acid before conception was higher than those who did not (11%). The proportion of women 30 years of age (55%) who took folic acid supplements before conception was higher than women aged 17 to <25 years (10%). CONCLUSION: Despite a lack of a public health campaign in New Zealand, a high proportion of participants, especially those who planned their pregnancy, took folic acid during the periconceptional period. A comprehensive public health campaign is needed to increase folic acid use. Fortification may be required to reach those women who do not plan their pregnancies.     

Women's experiences and preferences following Caesarean birth

AIMS: To seek women's views on their planned mode of birth in a subsequent pregnancy when they had a single prior Caesarean birth in the immediately preceding pregnancy. METHODS: This study was conducted at the Women's and Children's Hospital, Adelaide. Using a hospital maintained database, women were identified based on who had given birth by primary Caesarean section between December 2002 and June 2003 to a live born infant. The women were sent a questionnaire to assess their experiences related to their Caesarean birth and their plans for mode of birth in any subsequent pregnancy. RESULTS: A total of 319 eligible women were identified from the database and sent a questionnaire, with responses obtained from 208 women (65.2%). Most women were satisfied with their birth experience with a mean satisfaction score of 6.3 (+/- 2.8). The most common response when women were asked to indicate the aspects of their birth experience that they liked was those caring for them (153 women; 48%), followed by the reassurance provided about the health of their baby (106 women; 33%) and their own health (88 women; 28%). One fifth of women (63 women; 20%) indicated that they were glad that they had experienced labour. Eighty-five women (41%) indicated that they would in future plan for a vaginal birth, 48 women (23%) would plan for Caesarean section, and 72 women (35%) were unsure. CONCLUSIONS: A proportion of women have a strong preference for mode of birth in a subsequent pregnancy, which is established within 6 months of the woman's birth experience.     

Abused pregnant women's interactions with health care providers during the childbearing year

OBJECTIVE: To explore how intimate partner abuse during pregnancy influences women's decisions about seeking care and disclosing abuse and their preferences for health care professionals' responses. DESIGN: A qualitative, grounded theory approach using dimensional analysis. Data were collected via 21 interviews. SETTING: Participants were interviewed in their homes, at their prenatal clinic, at a hospital, and at the investigator's office. PARTICIPANTS: A convenience sample of 12 English-speaking women abused during pregnancy. Five participants were recruited from two prenatal clinics in the Pacific Northwest; 7 were recruited via snowball sampling. RESULTS: The grounded theory "living two lives: women's experiences of intimate partner abuse during pregnancy" emerged from the investigation. Abused pregnant women engaged in a process of guarding and revealing their public and private lives. This process affects how women seek and attend prenatal care, their perceptions of health care providers' interventions, and abuse disclosure. CONCLUSIONS: Intimate partner abuse profoundly affects women's pregnancies and pregnancy-related decisions. Embarrassment, shame, and fear are common emotions. Pregnant, abused women want health care providers to treat them respectfully and empathetically, to recognize the conflict between their public and private lives, to support their decisions, and to be available to help them. They do not expect or want health care providers to fix their situation.     

Normality and collaboration: mothers' perceptions of birth centre versus hospital care

OBJECTIVE: to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth. DESIGN, SETTING AND PARTICIPANTS: an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian birth centres. Data were obtained from in-depth interviews that explored women's perceptions of their care in both the birth centre and hospital context. FINDINGS: four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions', and 'care structures'. The themes of 'beliefs about pregnancy and birth' and 'nature of the care relationship' are discussed in this paper. Beliefs about pregnancy and birth refer to the philosophical underpinnings of pregnancy and birth held by women and their carers. Nature of the care relationship identifies women's perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The women's comments suggested differences in philosophy between hospital and birth-centre settings. The philosophy and beliefs of caregivers was an important component of the care experience. Women valued the normality of the birth-centre approach and the opportunity to experience the birth of their child with collaborative support from a midwife.     

Sources of influence on intention to breastfeed among African-American women at entry to WIC.

To examine how individuals within a woman's life influence her infant feeding intention, we interviewed 441 African-American women on the breastfeeding attitudes and experiences of their friends, relatives, mother, and the baby's father. Women were interviewed at entry into prenatal care at clinics associated with one of four Baltimore WIC clinics chosen for a breastfeeding promotion project. Qualitative data were also collected among 80 women. Friends and "other" relatives were not influential. Grandmothers' opinions and experiences were important, but their influence was reduced after considering the opinion of the baby's father. The opinion of the woman's doctor was an independent predictor of infant feeding intention. Breastfeeding promotion programs should recognize the separate influence of fathers, health providers, and grandmothers in women's infant feeding decisions.     

Women's responses to nausea and vomiting in pregnancy

OBJECTIVE: To explore women's experiences of nausea and vomiting in pregnancy. DESIGN: secondary (thematic) analysis of data collected by narrative interviews for two wider studies about antenatal screening and about pregnancy for the DIPEx website (www.dipex.org). PARTICIPANTS AND SETTING: A maximum variation sample was recruited throughout the UK. Data from the 73 women interviewed have been analysed. Interviews took place between October 2003 and December 2004, mostly in the home. FINDINGS: sickness is considered a typical and almost inevitable feature of pregnancy. Against this backdrop, a new framework for understanding women's responses to nausea and vomiting in pregnancy, and the meanings they attach to it, is suggested: nausea and vomiting as something to be expected, survived, resisted, resented, and acknowledged by others. KEY CONCLUSIONS: The concepts of loss of self and biographical disruption from the field of chronic illness seem to resonate with the women's experiences, and may perhaps be extended to transient as well as chronic health conditions. People's experiences of their bodies in health as well as illness need to be more widely studied. IMPLICATIONS FOR PRACTICE: Many women would appreciate greater acknowledgement of the distress nausea and vomiting in pregnancy causes them, information about remedies and strategies other women have found helpful, and reassurance. Expressions of empathy by health-care professionals are frequently lacking and particularly desired.     

Whose choice is it anyway? Decision making,control and conception

Contemporary societies in the developed world are characterized by the expectation that women wish to and are able to control their experiences of fertility. Changes in medical technology and advances in reproductive medicine have played an important role in strengthening this expectation, together with other changes, such as the availability of free contraception. However, this article draws on data from two qualitative sociological research projects which demonstrate that women's expectations of reproductive choice and control are not always realized. Women's experiences of fertility are mediated by a dominant discourse which assumes that women both want and will achieve biological motherhood. The data indicate that women actively 'try' to achieve conception with the expectation that this is both controllable and easy. In some instances this seems to be the case, but many women soon realize that achieving conception is sometimes problematic or, indeed, impossible. This article concludes by arguing that although women may wish to control their experiences of fertility, their expectations of choice and control are frequently an illusion.     

The "Christmas Effect" and other biometeorologic influences on childbearing and the health of women

OBJECTIVE: To review the body of literature addressing biometeorologic and chronobiologic effects on conception, pregnancy, parturition, and other health conditions. DATA SOURCES: Computerized searches of MEDLINE, PUBMED, CINAHL, and the World Wide Web. STUDY SELECTION: Studies, including international research, dating from 1938 to 2001. DATA EXTRACTION: Data were extracted and information organized under the following categories: influence of leisure time and seasonality on the rate of conception and birth, the relationship of meteorologic changes and lunar cycles to childbearing, the "Christmas Effect" and its impact on other health outcomes, and nursing implications. DATA SYNTHESIS: Research from the disciplines of biometeorology and chronobiology indicates that there are patterns in the occurrence of conception, pregnancy, and onset of labor that vary in timing and amplitude in different populations and geographic regions. Consideration of these factors should be included in the analysis of birth data when planning and providing maternity care. The Christmas Effect is one of the most predominant seasonal patterns that can be seen in birth data throughout the world. CONCLUSIONS: Biometeorologic and other cyclic phenomena are underused in the United States in planning and providing maternity care. These phenomena warrant consideration when planning holistic health care.     

Does the organizational model of the maternity health clinic have an influence on women's and their partners' experiences? A service evaluation survey in Southwest Finland

ABSTRACT: BACKGROUND: In high-income countries, great disparities exist in the organizational characteristics of maternity health services. In Finland, primary maternity care is provided at communal maternity health clinics (MHC). At these MHCs there are public health nurses and general practitioners providing care. The structure of services in MHCs varies largely. MHCs are maintained independently or merged with other primary health care sectors. A widely used organizational model of services is a combined maternity and child health clinic (MHC & CHC) where the same public health nurse takes care of the family from pregnancy until the child is at school age. The aim of this study was to determine how organizational model, MHC independent or combined MHC & CHC, influence on women's and their partners' service experiences. METHODS: A comparative, cross-sectional service evaluation survey was used. Women (N = 995) and their partners (N = 789) were recruited from the MHCs in the area of Turku University Hospital. Four months postpartum, the participants were asked to evaluate the content and amount of the MHC services via a postal questionnaire. Comparisons were made between the clients of the separate MHCs and the MHCs combined to the child health clinics. RESULTS: Women who had used the combined MHC & CHCs generally evaluated services more positively than women who had used the separate MHCs. MHC's model was related to several aspects of the service which were evaluated "good" (the content of the service) or "much" (the amount of the service). Significant differences accumulated favoring the combined MHC & CHCs' model. Twelve aspects of the service were ranked more often as "good" or "much" by the parents who had used the combined MHC & CHC, only group activities regarding delivery were evaluated better by women who had used the separate MHCs. CONCLUSIONS: Based on the women's and partners' experiences an organizational model of the combined MHC & CHC where the same nurse will take care of family during pregnancy and after birth of the child was preferred. This model also provides greater amount of home visits and peer support than the separate MHC.     

Use of various contraceptive methods and time of conception in a community-based population

AIMS: To investigate the association between method of contraception and time to conception in a normal community-based population. DESIGN: Prospective, cross-sectional, survey. SETTING: Large comprehensive ambulatory women's health center. PATIENTS AND METHODS: One thousand pregnant women at their first prenatal obstetrics visit were asked to complete a self-report questionnaire. The return to fertility was analyzed by type of contraceptive method, duration of use, and other sociodemographic variables. RESULTS: Response rate was 80% (n=798). Mean age of the patients was 29.9+/-5 years. Seventy-five percent had used a contraceptive before trying to conceive: 80% oral contraceptives, 8% intrauterine device, and 7% barrier methods. Eighty-six percent conceived spontaneously. Contraceptive users had a significantly higher conception rate than nonusers in the first 3 months from their first attempt at pregnancy. Type of contraception was significantly correlated with time to conception. Pregnancy rates within 6 months of the first attempt was 60% for oral contraceptive users compared to 70 and 81% for the intrauterine device and barrier method groups, respectively. There was no correlation between time to conception and parity or duration of contraceptive use. Other factors found to be significantly related to time to conception were older age of both partners and higher body mass index. CONCLUSIONS: Contraception use before a planned pregnancy does not appear to affect ease of conception. Type of method used, although not duration of use, may influence the time required to conceive.     

Human rights and abortion laws.

Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women's wishes and women's reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women's reproductive self-determination and due to prenatal life. Human rights protect healthcare providers' claims to conscientious objection, but not at the cost of women's lives and enduring health.     

The 'Folic Acid Campaign': has the message got through? A questionnaire study.

There is now clear evidence that folic acid reduces the risk of neural tube defects. In February 1996 the Health Education Authority launched a publicity campaign to inform women of the benefits of periconceptual folic acid. We have surveyed 1000 women to assess the compliance of pregnant women with the Department of Health's recommendations about taking folic acid. Of the women, 761 (76%) said they knew about the benefits of folic acid but only 433 (43%) of them took it before pregnancy. Of the 567 women who did not take folic acid before conception, 227 had not planned their pregnancy and 239 did not know about the benefits. Of the 644 women who planned their pregnancy and knew about the benefits of folic acid before conception 211 still did not take folic acid pre-pregnancy. These findings have important implications for public policy and health professionals if the incidence of neural tube defect is to be reduced further.     

Birth planning--is it beneficial to pregnant women?

The aim of this study was to investigate the experience of birth planning for pregnant women. Research in Australia and overseas has suggested that there are a number of conflicting issues with women's preparation and participation in childbirth. The researcher interviewed forty-two first time mothers in a variety of maternity settings around Victoria to ascertain the importance of birth planning in their approach to childbirth and the ways they went about making their plan and negotiating their needs with health professionals. The data from those interviews demonstrated that the means women used to negotiate their needs for childbirth with health professionals had little influence on their overall pregnancy and birth experience.     

Juggling type 1 diabetes and pregnancy in rural Australia

Objective

to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps.

Design

qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically.

Setting

The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals.

Participants

seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months.

Findings

rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants’ experiences were coloured by their limited access and interactions with expert health professionals.

Conclusion

women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals.

Implications for practice

national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.     

Women's health care: a new paradigm for the 21st century.

Oppression based on gender exists in all aspects of women's lives and transcends contemporary cultures, economic systems, and even health care services. Radical feminism provides an alternative philosophic framework of health care that is based on a women-centered viewpoint, with the experiences of women as its unifying philosophy. Midwifery is a means to apply this new philosophic approach to the health care of women. A partnership between midwifery and feminist philosophy will allow women's voices to be heard, while guiding research in women's health care in new directions, and illuminating new approaches to current health problems. The new millennium provides an opportunity to explore an alternative framework and philosophy that will change the current paradigm of women's health care.     

Materno-infantilism, feminism and maternal health policy in Brazil

In the last days of 2011, President of Brazil Dilma Rousseff issued a provisional measure (or draft law) entitled "National Surveillance and Monitoring Registration System for the Prevention of Maternal Mortality" (MP 557), as part of a new maternal health programme. It was supposed to address the pressing issue of maternal morbidity and mortality in Brazil, but instead it caused an explosive controversy because it used terms such as nascituro (unborn child) and proposed the compulsory registration of every pregnancy. After intense protests by feminist and human rights groups that this law was unconstitutional, violated women's right to privacy and threatened our already limited reproductive rights, the measure was revised in January 2012, omitting "the unborn child" but not the mandatory registration of pregnancy. Unfortunately, neither version of the draft law addresses the two main problems with maternal health in Brazil: the over-medicalisation of childbirth and its adverse effects, and the need for safe, legal abortion. The content of this measure itself reflects the conflictive nature of public policies on reproductive health in Brazil and how they are shaped by close links between different levels of government and political parties, and religious and professional sectors.     

Full circle: the evolution of preconception health promotion in America

Preconception health promotion encourages and enables a woman to actively plan pregnancy, enter pregnancy in good health with as few risk factors as possible, and be informed about her general and reproductive health before conception. Nurses have provided this holistic health care since the early 1900s. In succeeding decades, various components of and methods for promoting preconception health have been discovered and emphasized. Embracing preconception health promotion as wellness for life brings us full circle.     

"Sexual pleasure on equal terms": young women's ideal sexual situations

Objective: The aim of this study was to identify young women's ideal images of sexual situations and expectations on themselves in sexual situations. Study design: We conducted audio-taped qualitative individual interviews with 14 women aged 14 to 20 years, visiting two youth centers in Sweden. Data were analysed with constant comparative analysis, the basis of grounded theory methodology. Results: The women's ideal sexual situations in heterosexual practice were characterized by sexual pleasure on equal terms, implying that no one dominates and both partners get pleasure. There were obstacles to reaching this ideal, such as influences from social norms and demands, and experiences of the partner's "own run". An incentive to reach the ideal sexual situation was the wish to experience the well of pleasure. Conclusions: Our research further accentuates the importance of finding ways to focus on the complexity of unequal gender norms in youth heterosexuality. A better understanding of these cognitions is essential and useful among professionals working with youths' sexual health.