Preconception care & pregnancy planning: voices of African American women

PURPOSE: This study aimed to investigate the intersection of women's pregnancy planning beliefs with preconception care barriers. We assessed the meaning of "planned pregnancy" for African American women and explored its connection to preconception experiences. The role of race and economics as contextualizing women's experiences was considered. STUDY DESIGN/METHODS: African American women (n = 168) recruited from health department sites discussed the following questions: "What does the term 'planned pregnancy' mean?" "Would you describe your most recent pregnancy as planned?" Substantive themes were extracted using phenomenological methodology. RESULTS: The following themes emerged: (1) Preconception care: An unfamiliar concept; (2) Planning for pregnancy: A continuum of responses; (3) The psychology of conception: Attitudes, beliefs, and behaviors; (4) The shared nature of pregnancy: It takes two to plan; (5) Birth control: The means to the end; and (6) The context of preconception care: The big picture. CLINICAL IMPLICATIONS: Nurses who care for women in the childbearing years should understand that planning for pregnancy is not a simple cognitive process, and that race and economics play a role in women's beliefs about pregnancy. Preconception care also encompasses the contexts of family, public health, and society. Linking preconception care with all medical encounters is an important but insufficient approach. Nurses should apply their understanding of the biopsychosocial dimensions of health in support of the goals of preconception healthcare. Holistic nursing and public health perspectives should be considered to broaden the scope of preconception interventions and more effectively address social factors that influence preconception care.     

Vietnam: resolving the death of a loved one

This article is based on a study to explore the grief experience of individuals who suffered the loss of a family member in the Vietnam war. A phenomenologic approach was used to understand the grief experience of five family members of Vietnam casualties. A convenience sample of five subjects was used. Data for this study were obtained through an open-ended interview conducted by the researcher in the home of each subject. The method of analysis of the phenomenologic data was based on Giorgi's (1975) model. The researcher modified this method to identify patterns and themes in the interviews. The grief experiences of the family members emerged as prolonged early phases of the grief process. The patterns identified were prolonged early phases of denial and anger. The significant themes identified were (a) denial and a sense of unreality, (b) anger, (c) isolation, (d) sadness, (e) frustration, and (f) ambivalence. Qualitative data from a sample of five subjects cannot be generalized to the population of all family members of Vietnam casualties, but it is significant and genuine for these subjects. The data suggest that the circumstances of the death, the lack of concrete evidence, the inadequate support available, and the conflicted social environment all contributed to the prolonged early grief phases and the struggle experienced by these family members to resolve their loss.     

The lived experience of miscarriage after infertility

PURPOSE: To describe women's experiences of miscarriage after infertility treatments. Published studies in which fertile women were interviewed after miscarriage have found that the women universally look to another pregnancy as the solution to their grief. However, for women undergoing infertility treatments, the possibility of another pregnancy is not a certainty. Despite this, little is known about the unique experience of this group of women. Appropriate interventions based on evidence require research to discover these women's needs. DESIGN: Phenomenology. METHOD: Eight women who had experienced miscarriage after infertility were interviewed. Interviews were audiotaped and transcribed verbatim. Data saturation guided the sample size. Colaizzi's methods for phenomenologic analysis were used. Analyzed data were brought back to the women for fact checking and to ensure trustworthiness and reliability of the data. RESULTS: Themes included : going back to "square one," an inner struggle between hope and hopelessness for future fertility, running out of time, anger/frustration, lack of understanding by others, guilty feelings, feeling alone/numb with their grief, and gaining strength from adversity. CLINICAL IMPLICATIONS: This study provides a first glimpse of women who miscarry after infertility treatments, and demonstrates that they feel profoundly alone, and grieve intensely. They worry that they caused the miscarriage, and find it difficult to hope that they will ever become pregnant again. Several women described being hospitalized for their miscarriage on postpartum units. This was unbearable for them, and should remind all of us in healthcare that this type of unthinking treatment of women who miscarry after infertility is not acceptable.     

Understanding prenatal health care for American Indian women in a Northern Plains tribe

Early and regular prenatal care appointments are imperative for the health of both the mother and baby to help prevent complications associated with pregnancy and birth. American Indian women are especially at risk for health disparities related to pregnancy and lack of prenatal health care. Previous research has outlined a basic understanding of the reasons for lack of prenatal care for women in general; however, little is known about care received by pregnant women at Indian Health Service hospitals. Qualitative interviews were carried out with 58 women to better understand the prenatal health experiences of American Indian women from one tribe in the Northern Plains. Several themes related to American Indian women's prenatal health care experiences were noted, including communication barriers with physicians, institutional barriers such as lack of continuity of care, and sociodemographic barriers. Solutions to these barriers, such as a nurse midwife program, are discussed.     

Women's Voices Reflecting Changed Expectations for Pregnancy after Perinatal Loss

Purpose: To describe women's experiences of pregnancy after loss and their long-term effects of perinatal loss.
Design: Phenomenology.
Methods: Three focus groups were conducted in fall 1996 with a total of 21 women. These women varied in their obstetrical and loss histories. The time since their losses ranged from 34 years ago to the previous year. Data analysis was guided by Colaizzi's procedural steps.
Findings: Women's stories portrayed perinatal loss as a life-altering event. Women did not feel emotionally safe in their pregnancies after loss and were afraid that those babies too would die. Despite the differences in their obstetrical and loss histories and time since loss, similarities in their responses to pregnancy far outweighed their differences. These commonalities contained in six themes: (a) dealing with uncertainty, (b) wondering if the baby is healthy, (c) waiting to lose the baby, (d) holding back their emotions, (e) acknowledging that loss happened and that it can happen again, and (f) changing self.
Conclusions: This study indicated many common concerns and experiences among women in response to perinatal loss and subsequent pregnancies. Variations were not linked to the number or gestational age of the losses. Care providers should acknowledge women's past losses, address their concerns during a current pregnancy, and recognize the potentially life-long effect perinatal loss may have on these women.     

Women's emotions and concerns during pregnancy following perinatal loss

PURPOSE: To determine the specific emotions and concerns of women who are pregnant following a perinatal loss. STUDY DESIGN AND METHODS: Data were collected through a mailed questionnaire using an open response format. The sample consisted of 73 women on the membership mailing lists from two pregnancy-after-loss support groups. A content analysis was conducted on women's self-reports; five primary emotions and five main concerns were expressed during their pregnancies. RESULTS: "Anxious," "nervous," and "scared" were the most frequent emotions reported by these women. However, most women also included a positive emotion in their list, indicating the mixed emotions of their pregnancy experience. Eight categories of profound concerns were identified: "losing another baby," "overall health of the baby," "emotional stability of self," "impact of another loss on my future," "lack of support from others," "fear of bad news," "own impact on the baby," and "worries never end." Responses of currently pregnant women as compared with women retrospectively reporting on their last pregnancy experiences were essentially similar. CLINICAL IMPLICATIONS: Women pregnant after a previous perinatal loss are skeptical about pregnancy. Clinicians should be cognizant of the constellation of concerns and the simultaneous contrasting emotions experienced by these women in order to provide supportive prenatal care. Because the women's concerns are ongoing, responsive care should include asking about specific concerns throughout the pregnancy.     

Needs and expectations of Tamil women attending an antenatal care department at a Swiss university hospital

It has been noted that immigrant women often initiate prenatal care late in their pregnancy and thus may be inadequately prepared for their birth experience. This leads to poorer maternal outcomes and higher morbidity statistics compared to Swiss women. Tamil women of Sri Lanka represent the largest group of immigrant women being seen at the antenatal care clinic of a Swiss University Hospital. To get a deeper understanding of their needs and expectations relative to their antenatal care, a qualitative study was undertaken. Problem centred interviews were conducted with seven Tamil women before and after delivery. An interpreter was consulting. Data were analyzed using content analysis methods as described by Mayring. Four main themes emerged, demonstrating the need of the women and their resulting expectation: 1) to receive esteem--to show respect and attention; 2) to consult with somebody--to ensure communication; 3) to alleviate worries and fear--to give a sense of security and be in charge; and 4) to make up for lack of experience and knowledge--to pass on experience and knowledge. The quality of the relationships to caregivers is viewed as pivotal and seems to influence Tamil women's satisfaction and their motivation to receive prenatal care.     

The essence of women's moral perspectives in anger expression situations

This inquiry's purpose was to describe the meaning (essence) of moral perspective in adult women's experiences of anger expression. Moral perspectives have been perceived as pivotal to how one constructs and problem-solves real life dilemmas. Since some modes of anger expression have been identified as unhealthy, uncovering the meaning of moral perspectives in women's anger expression experiences could be significant to women's health. Through phenomenological interviews, 24 women, aged 21-65 (4 African-American and 20 Euro-American), reflected on an experience when they were angry and had to think about the right way to express their anger. Significant statements were extracted and thematized. Next, themes were clustered into the following essences of the experience: the realities of the self as moral, the morality of anger expression and the morality of outcomes.     

Perceived impediments to prenatal care among low-income women

The study describes women's experience with prenatal care, their perceived impediments to care, and compares the impediments cited by the women with levels of care utilization. The sample consisted of 126 African American women. A structured interview and questionnaire were used. The results showed that pregnancy was unplanned in 78.6% of the women, and no one encouraged the women to obtain care in half the cases. Only 50.8% of the women made adequate utilization of prenatal care. The main impediments to care were transportation, long waiting time, having too many other problems, and fear of staff finding out about the women's use of substances. Five of the reported impediments significantly influenced the women's utilization of care. These were: substance abuse, fear of medical examination, the belief that prenatal care is not necessary, already knew of pregnancy, and no babysitter for other children.     

Parents' experiences of midwife-managed care following the loss of a baby in a previous pregnancy

AIMS OF THE STUDY: This article reports on research that explored the impact of the Special Delivery Service, a midwife-managed intervention, developed as an addition to routine care to support and educate high-risk pregnant women and their partners subsequent to the death of a baby in a previous pregnancy. BACKGROUND: Approximately 40,000 families suffer the trauma of a neonatal death* annually in the USA, while statistics for Canada and Australia give similar numbers relative to population. Since many more babies die than those accounted for in these statistics, through stillbirth, miscarriage and Sudden Infant Death Syndrome, more than the above-cited 2% of childbearing couples will face the trauma of the loss of a baby. RATIONALE: The resultant threat that this situation may pose to the health of the mother has been extensively documented in the literature. However, despite the recent growth in knowledge about the impact of perinatal loss and bereavement, few interventions are specifically designed to support Australian and Canadian women and their partners during a pregnancy following the loss of a baby. METHODOLOGY: This phenomenological study explored women's and their partners' experiences of grief and loss and the support offered to them through the Special Delivery Service programme. RESULTS & DISCUSSION: In the face of funding and organizational changes to both the Australian and Canadian health care systems that have eliminated or reduced some services, this research reinforced the need for individualized, compassionate midwifery care and the urgent need for genuinely empathic and supportive health care services for these women and their partners. It also emphasized the need for couples to be informed and supported so that gender differences in grieving do not become a divisive element in the relationship. CONCLUSIONS: The findings have implications for both nurses and midwives in their practice in countries where optimum care of this vulnerable population is not routinely available. The research supports midwife-managed models of care to ensure women and their families are appropriately supported in crisis. The findings provide insight also into the diverse grief response among couples and the difficulties experienced in a pregnancy following the loss of a baby.     

One foot in-one foot out: weathering the storm of pregnancy after perinatal loss

Pregnancies after perinatal loss are oftentimes anxiety-laden and lacking in joy. This may lead to potential negative obstetrical and parenting outcomes. The purpose of this qualitative inquiry was to gain insights into women's pregnancy after perinatal loss experiences, including major features and helpful provider responses. Thirteen women, at varying points surrounding pregnancy after perinatal loss, participated in either a focus group or interview. An overall metaphor of "One Foot In-One Foot Out" and seven themes within four contexts emerged from the data. Women found themselves living within the contexts of (a) reliving the past, (b) trying to find a balance in the present, (c) recognizing their changed reality, and (d) living with wavering expectations. Seven themes characterized their navigation of the pregnancy: (1) setting the stage, (2) weathering the storm, (3) gauging where I am, (4) honoring each baby, (5) expecting the worst, (6) supporting me where I am, and (7) realizing how I've changed. Trying to stay balanced is the major challenge in pregnancy after perinatal loss.     

Dimensions of women's long-term postabortion experience

PURPOSE: To explore and describe the long-term postabortion experience as lived by women, at least 5 years after a first-trimester-induced abortion. METHODS: This phenomenological study used semistructured interviews and constant-comparison analysis. Stories of 17 women were recorded on audio tape, transcribed verbatim, coded, and analyzed. RESULTS: Women who had induced abortions represented several ethnic groups, religions, and occupations, and were single, married, or divorced.The average number of years from abortion to interview was 18.9 (range 6-31 years). The age range at first abortion was 14 to 43, and at interview was 23 to 60 years of age. Five themes emerged within the women's stories: Making the Decision, Coping With the Memories, Gaining Perspective, Seeking Help, and Recognizing Its Worth. Most women who participated in this study were able to integrate the abortion experience into their lives, and had found meaning in the abortion experience. CLINICAL IMPLICATIONS: This study provides yet more reasons why nursing should encourage women to prevent unplanned pregnancies through fertility control.Women in this study described many life-changing experiences, both positive and negative, because of an abortion.Therefore, preabortion counseling should be sensitive and include information about possible long-term effects. Postabortion support should acknowledge spiritual issues, and include steps women can take to help heal themselves, such as grief counseling and mourning rituals when appropriate.     

Not the surgery for a young person: women's experience with vaginal closure surgery for severe prolapse

INTRODUCTION: Vaginal prolapse can be debilitating, due to pelvic organ prolapse and herniation of the bladder, uterus, intestines and/or support tissues in the vaginal opening. However, there is little published information that documents women's experiences in the months and years after surgery to correct prolapse. OBJECTIVE: This phenomenologic study aimed to increase understanding of the specific experiences that patients report after vaginal closure surgery. METHOD: Participants were recruited via a mailing to surgical patients from a large urogynecologic practice. Semi-structured interviews were tape-recorded and transcribed for analysis. RESULTS: Six women participated in the study. After analyzing the results, five major themes emerged: awareness and confusion, feeling alone in silence, trusting recommendation, acceptance of changed sexuality, and still coping. CONCLUSIONS: This small study shows that vaginal closure affects an intimate body part and can impact self-image, but the women did not regret their changed sexuality. The larger issues for these women were ones of communication, information, and isolation, particularly during their followup care.     

Talking circles: Northern Plains tribes American Indian women's views of cancer as a health issue

OBJECTIVE: The purpose of this research was to understand the cultural meanings of cancer among American Indian women from Northern Plains tribes living in western South Dakota and their experiential view of breast and cervical cancer screening. DESIGN AND SAMPLE: Using an exploratory design, a purposive sample of 28 women, 35-75 years of age, were recruited into three Talking Circles. MEASUREMENT: Talking Circle and focus group methodology, combined with Affonso's Focus Groups Analytic Schema, were used to generate contextual data sets including thematic findings. RESULTS: Ten themes emerged indicating interrelationships between cultural traditions and health structures of care. The themes provided a unique perspective for conceptualizing women's experiences with breast and cervical cancer screening. CONCLUSIONS: Incorporating women's cultural experiences into screening services is necessary to address clinical and policy challenges for reducing breast and cervical cancer mortality among American Indian women. Findings from this research will be used to guide a future study investigating breast-screening patterns related to mammography adherence and development of interventions specific to American Indian women.     

The quest for ordinariness: transition experienced by midlife women living with chronic illness

AIMS: This paper reports the findings of research that aimed to elucidate the meaning of midlife women's experiences of living with chronic illness. BACKGROUND: A lack of awareness by health professionals of the context in which women must live with chronic illness often results in women feeling overwhelmed, alienated and without voice within the delivery of health care. This inquiry privileged women's voices. DESIGN: The construct of 'transition' in chronic illness experience evolved from this collaborative and participatory research with midlife women living with adult onset chronic illness. Over a 1-year timeframe, 81 women were asked to tell their stories of living with a chronic illness. These correspondence data were thematically analysed to provide storied accounts. Guided by feminist principles, women were empowered through research processes and have actively participated in the development of the transition construct. FINDINGS: The research revealed that when women are first confronted with a chronic illness they appear to move through a complex trajectory that involves an 'extraordinary' phase of turmoil and distress; however, they may then make the transition toward an 'ordinary' phase that involves incorporating chronic illness into their lives. Transitions in chronic illness experience involve movement from extraordinariness to ordinariness and sometimes back again and were found to be processes that are nonlinear, sometimes cyclical and potentially recurring throughout a woman's life. Four major constructs emerged from women's narratives: How quickly life changes; extraordinariness: confronting life with illness; The illness experience as transforming and ordinariness: reconstructing life with illness. CONCLUSION: Nurses are in a position where they may make a difference to women who live with chronic illness. Understanding illness transitions offers a framework that will enable nurses to move beyond the bio-medically orientated concepts of nursing practice, towards a holistic approach to the provision of nursing care.     

Prenatal care utilization among low-income African American women

The purpose of this study was to assess prenatal care utilization among low-income African American women, examine the relations of demographic and other selected variables to the adequacy of prenatal care utilization, and to describe the women's positive and negative experiences with prenatal care. The sample consisted of 126 African American women who had a child 1 year old or younger. A structured interview developed by the investigator was used. Adequacy of prenatal care utilization (APNCU) was calculated using Kotelchuck's index (Kotelchuck, 1994b). The findings indicated that 13% of the women did not receive any prenatal care and that only 50.8% of the women had adequate utilization of prenatal care. Women who perceived prenatal care as important utilized the services significantly more than other women, chi 2(1, N = 126) = 8.04, p = .01. Demographic variables, presence of health problems during pregnancy, and whether or not pregnancy was planned were not significantly related to APNCU. Several positive aspects of prenatal care were expressed by the women, and 24% of those who obtained care stated that there was nothing negative about it. The negative experiences mentioned by some women were clinic waiting time, waking up in the morning, transportation difficulties, having morning sickness, and disliking seeing a doctor.