Assessing women’s perinatal psychological health: exploring the experiences of health visitors

Objective: This study aimed to explore health visitors’ (HVs) experiences of the assessment of women with psychological distress and mental health problems across the perinatal period in clinical practice. Background: In international contexts, there is now a firm policy remit for the assessment of psychological and mental health disorder across the perinatal period. Women are in regular contact with health professionals across this time and consultations intuitively create an ideal and appropriate context in which to assess women’s psychological health. National reports and academic literature highlight that to prevent the escalation of perinatal mental illness, significant change is needed to support health professionals in detecting, discussing and dealing with mental illnesses. Methods: In a qualitative aspect of a larger mixed-method study, data were collected from two Focus Group Discussions with HVs pre and post a training session related to assessing and managing perinatal mental health problems in practice. For the purposes of this paper, the data were explicitly examined for references to recognition and assessment. Results: Four themes emerged from the data: recognising the problem; questioning and identification; so what do I do now; the importance of support to promote effective identification and assessment. Conclusion: Findings elucidate the complexities that practitioners face in assessing women’s psychological health in real world settings. HVs’ experiences highlight that the implementation of measures into practice needs to be workable and accompanied by contemporary and appropriately contextualised knowledge, adequate service provision and clear referral pathways to ensure effective assessment of women’s psychological health.     

Assessing mental health during pregnancy: An exploratory qualitative study of midwives’ perceptions

BackgroundMental health disorders are estimated to affect between 10% and 20% of women who access maternity services and can be defined as a public health issue due to the potential consequences for women, children and families. Detecting problems early in pregnancy can significantly improve outcomes for women and their families. However, mental health problems are not being consistently identified in routine midwifery practice and little is known from current literature about midwives’ practice in relation to current national guidelines or the impact models of care have on assessing maternal mental health.ObjectiveTo identify midwives’ views about barriers and facilitators to screening for mental health in pregnancy using current UK guidelines.DesignNine community midwives from a single district general hospital in the south of England were recruited to take part in focus groups. Thematic analysis was used to extract key themes from the data.FindingsThree key themes were identified from the focus groups and included system factors, social factors and trust. Barriers and facilitators to screening maternal mental health were associated with the initial ‘booking’ appointment’ and differences in models of care. Barriers to screening were defined as high workload, poor continuity, and a lack of trust between women and midwives.ConclusionsThis study highlights key barriers and facilitators associated with mental health screening during pregnancy, including issues of trust and uncertainty about women's willingness to disclose mental health conditions. Further research is required to evaluate the relationship between women and midwives in contemporary practice and the influence this may have on maternal mental health.     

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

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

Anxiety in the perinatal period: antenatal and postnatal influences and women’s experience of care

Objective: To examine the characteristics of women with antenatal or postnatal anxiety and to investigate aspects of their care that may be associated with it. Background: Positive outcomes following childbirth are associated with good physical and mental health during pregnancy and following childbirth. Although a degree of anxiety is normal in pregnancy, for some women it can become a serious problem. Methods: This study used data on 5332 women from a 2010 national maternity survey which asked about antenatal and postnatal health and well-being three months after childbirth. Women self-identified as experiencing anxiety and other problems during pregnancy and the postnatal period. Results: Antenatal anxiety was reported by 14% of women and postnatal anxiety by 5% of women. Antenatal anxiety was associated with younger age, Black and Minority Ethnic status, single parenthood, living in a disadvantaged area, having an unwanted pregnancy and long-term health problems. Of these factors, only long-term mental health problems were associated with anxiety in the postnatal period. In the logistic regression models long-term mental health problems dominated the findings. Significant differences in the perceptions of the care experienced were evident in the responses from women with anxiety both antenatally and postnatally. Conclusions: This study shows that antenatal and postnatal anxiety are influenced by health and social factors. Asking women about their current physical and psychological health and past history during pregnancy and following up on their well-being in the postnatal period is an essential element in planning and providing care to meet their needs.     

Termination of pregnancy for fetal abnormality: a meta-ethnography of women’s experiences

Due to technological advances in antenatal diagnosis of fetal abnormalities, more women face the prospect of terminating pregnancies on these grounds. Much existing research focuses on women’s psychological adaptation to this event. However, there is a lack of holistic understanding of women’s experiences. This article reports a systematic review of qualitative studies into women’s experiences of pregnancy termination for fetal abnormality. Eight databases were searched up to April 2014 for peer-reviewed studies, written in English, that reported primary or secondary data, used identifiable and interpretative qualitative methods, and offered a valuable contribution to the synthesis. Altogether, 4,281 records were screened; 14 met the inclusion criteria. The data were synthesised using meta-ethnography. Four themes were identified: a shattered world, losing and regaining control, the role of health professionals and the power of cultures. Pregnancy termination for fetal abnormality can be considered as a traumatic event that women experience as individuals, in their contact with the health professional community, and in the context of their politico-socio-legal environment. The range of emotions and experiences that pregnancy termination for fetal abnormality generates goes beyond the abortion paradigm and encompasses a bereavement model. Coordinated care pathways are needed that enable women to make their own decisions and receive supportive care.     

Surrogates’ and intended parents’ experiences of surrogacy arrangements: a systematic review

This commentary situates the recently published systematic review of empirical studies of surrogates’ and intended parents’ experiences of surrogacy by Kneebone, Beilby and Hammarberg within the context of increased international interest in legislative and regulatory reforms to surrogacy. The commentary evaluates the strengths of this systematic review, before turning to a discussion of how jurisdictions could introduce reforms aiming to facilitate domestic surrogacy arrangements, focusing on the UK and the Law Commission's recent proposals.     

Parent–infant psychotherapy: a systematic review of the evidence for improving parental and infant mental health

Background: Parent–infant psychotherapy (PIP) is a psychodynamic intervention with parent–infant dyads, designed to address regulatory disturbances in infancy and problems in the parent–infant relationship.

Aims: This systematic review aimed to examine whether PIP is effective in improving the parent–infant relationship or other aspects of parent or infant functioning.

Methods: A systematic review was undertaken. Electronic databases were searched for randomised controlled trials in which participants had been allocated to a PIP intervention or control group/other treatment.

Results: Eight studies were identified that provided data comparing parent–infant psychotherapy with a no-treatment control group (four studies) or comparing PIP with other kinds of treatment (four studies). Meta-analyses indicated that parents who received PIP were more likely to have an infant who was rated as being securely attached to the parent after the intervention; however, there were no significant differences in studies comparing outcomes of PIP with another model of treatment.

Conclusions: Although PIP appears to be a promising method of improving infant attachment security, there is inconclusive evidence of its benefits in terms of other outcomes, and no evidence to show that it is more effective than other interventions for parents and infants. Many studies had limitations in their design or implementation, and findings must be interpreted with caution.     

Swedish midwives’ experiences and views of amniotomy: An interview study

ObjectiveTo explore midwives’ experiences and views of amniotomy.DesignA qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12.Setting and participantsSixteen midwives working at delivery wards at three hospitals in the south of Sweden.FindingsThree categories emerged: “Promote, protect and support the physiological process of labour”, “To make the decision -to do or not to do” and “Unpredictable response”. The overall theme linking the three categories was “We become our decisions”, portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy.ConclusionsAmniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.     

Midwives’ experiences as preceptors and the development of good preceptorships in obstetric units

ObjectiveTo study midwives’ experience in their role as a preceptor and their perception on how to best support midwifery students in obstetrics units. Obstetric units are an important learning area for student midwives but knowledge on how to become a good midwife preceptor is limited.DesignThis qualitative study explores midwife preceptors’ experience of supervising midwifery students in three obstetric units in Sweden. Following ethical approval seventeen midwife preceptors were interviewed and data were analysed thematically.FindingsThematic analysis of the interviews resulted in the identification of two themes and five subthemes: (1) self-efficacy in the preceptor role which involves (a) being confident in the professional position and (b) having the support of management and colleagues and (2) supporting the student to attain self-confidence and independence which entails (a) helping the student to grow, (b) facilitating reflection in learning situations, and (c) “taking a step back”.Key conclusionGood preceptorship occurs when midwives achieve full self-efficacy, when they master the preceptor role, and when they have enhanced their abilities to help, the student reach confidence and independence.Implications for practiceHealth care organisations needs to develop and support midwifery preceptorships.     

A systematic review of concepts related to women’s empowerment in the perinatal period and their associations with perinatal depressive symptoms and premature birth

Background

The perinatal period, which we here define as pregnancy and the first year postpartum, is a time in women’s lives that involves significant physiological and psychosocial change and adjustment, including changes in their social status and decision-making power. Supporting women’s empowerment at this particular time in their lives may be an attractive opportunity to create benefits for maternal and infant health outcomes such as reductions in perinatal depressive symptoms and premature birth rates. Thus, we here systematically review and critically discuss the literature that investigates the effects of empowerment, empowerment-related concepts and empowerment interventions on reductions in perinatal depressive symptoms, preterm birth (PTB), and low birthweight (LBW).

Methods

For this systematic review, we conducted a literature search in PsychInfo, PubMed, and CINAHL without setting limits for date of publication, language, study design, or maternal age. The search resulted in 27 articles reporting on 25 independent studies including a total of 17,795 women.

Results

The majority of studies found that, for the most part, measures of empowerment and interventions supporting empowerment are associated with reduced perinatal depressive symptoms and PTB/LBW rates. However, findings are equivocal and a small portion of studies found no significant association between empowerment-related concepts and perinatal depressive symptoms and PTB or LBW.

Conclusion

This small body of work suggests, for the most part, that empowerment-related concepts may be protective for perinatal depressive symptoms and PTB/LBW. We recommend that future theory-driven and integrative work should include an assessment of different facets of empowerment, obtain direct measures of empowerment, and address the relevance of important confounders, including for example, ethnicity and socioeconomic status.

     

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

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

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

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

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

Exploring women’s sensory experiences of undergoing colposcopy and related procedures: implications for preparatory sensory information provision

Introduction: Some women experience distress during colposcopy examinations which is partly related to women’s fear, or experience, of pain during the procedure. However, little is known about women’s sensory experiences of colposcopy (other than pain) or what might impact on these experiences. The aim of this study was to explore women’s sensory experiences of colposcopy and related procedures and identify factors which influenced negative sensory experiences.

Methods: In-depth interviews were conducted with 23 women who had undergone, for the first time, a colposcopy (some with related procedures, including punch biopsies and loop excision) as part of follow-up for abnormal cervical cytology. Interviews were analysed thematically using the Framework Approach to organise the data and identify emerging higher-order themes.

Results: Women described a range of sensory experiences including pain or discomfort, cramping, stinging and cold sensations (due to the application of acetic acid to the cervix). Four key themes emerged as important aspects of the overall sensory experience: levels of pain, treatment-specific sensations, anaesthetic-specific sensations and solution-specific sensations. Factors that may influence women having a negative sensory experience were sensory expectations of the procedure(s) and lack of preparatory sensory information.

Discussion: Our study provides unique in-depth insight into women’s sensory experiences of colposcopy and related procedures and suggests women require more preparatory sensory information. The issues identified as contributing to women having a negative sensory experience may help inform the development of pre-colposcopy information which may better prepare women with abnormal cervical cytology for follow-up examinations.