Gender Differences and Perceptions About Childbearing Among Infertile couples

Objective: To explore gender dierences and responses of in fertile couples to childbearing issues.
Design: Data analysis from the first wave of a larger three wave prospective panel study. Face-to-face tnterviews with both husbands and wives were conducted.
Setting: Husbands and wives were interviewed separately in their homes. One was generally interviewed immediately after the other.
Participants: One hundred sixty-one infert ile couples in southeastern Michigan were interviewed in 1988.
Measures: Variables of interest included the self recognized source of the fertility problem, the tmportance of children to individuals, stress associated with infertility treatment, the number of tests and treatments received, the acceptabiltty of indicated treatments, the length of time couples expected it would take to have a child, and the ideal and expected number of children.
Results: Women experienced signijcantly more stress from tests and treatment, placed greater importance on havtng children, were more accepting of indicated treatments, and wanted more children than men did.
Conclusions: Implications for nurses working with in fertile couples are discussed, including provision of emotional support, evaluation of perceptions of success, assessment of couples' expectations, and inclusion of husbands in decision making.     

Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples.

OBJECTIVE: To compare the dynamics of fertility-problem stress experienced by wives and husbands in infertile couples with the dynamics of stress from other sources experienced by members of couples presumed to be fertile. DESIGN: Relationships of stress to four marriage factors and four aspects of life quality (subjective well-being) are examined within a causal modeling framework using data from structured interviews. SETTING: Face-to-face interviews were conducted in study participants' homes. PARTICIPANTS: Wives and husbands from 157 couples with primary infertility and from 82 presumed-fertile couples were studied. MAIN OUTCOME MEASURES: Final outcome measures were four multi-item scales assessing life quality with regard to the marriage, own self-efficacy, own health and appearance, and life as a whole. Intervening outcome scales measured four marriage factors: marital conflict, sexual self-esteem, sexual dissatisfaction, and frequency of intercourse. RESULTS AND CONCLUSIONS: Higher levels of stress, regardless of whether that stress was from attempting to solve a fertility problem or another problem, were related to reduced marital functioning and decreased life quality. For husbands, the strengths of the linkages did not depend on the source of the stress. For wives, however, the causal model suggested that fertility-problem stress had stronger negative impacts on sense of sexual identity and self-efficacy than did stress from other problems (P less than 0.05). Stress from any source had more impact on the lives of wives than of husbands, more impact on satisfaction with self and general well-being than on satisfaction with the marriage or health, and affected life quality mostly indirectly through its impacts on the marriage factors.     

Psychological well-being and coping patterns in infertile men

OBJECTIVE: To determine whether differences existed in mood and coping styles among fertile men, oligoasthenospermic men, or euspermic men whose wives were undergoing ovulation stimulation with clomiphene and IUI. DESIGN: A cross-sectional research design. SETTING: Hospital-based academic fertility clinic. PATIENT(S): 30 fertile men with currently pregnant wives, 30 euspermic and 30 oligoasthenospermic men in couples undergoing ovulation stimulation with clomiphene and IUI. INTERVENTION(S): Measures of psychological well-being and coping were administered. MAIN OUTCOME MEASURE(S): Biodemographic information, and psychometric measures of mood and coping. RESULT(S): There were no significant differences among the groups on any of the measures except the Family Inventory of Life Events (FILE), in which fertile men reported higher stress levels. FILE scores in all groups were moderate, indicating typical levels of family stress. CONCLUSION(S): Mood and coping in the three groups were similar. This study suggests that men's psychological adjustment to their own infertility and to unexplained infertility is generally healthy.     

Coping strategy in infertile couples undergoing assisted reproduction treatment

Objective

The purpose of the study was to determine whether infertility is associated with coping processes and is there a difference between infertile women and men in the use of coping strategies?

Predictors of distress in women being treated for infertility

Many studies cite infertility as highly stressful, yet women's responses to infertility are quite variable. Lazarus and Folkman's cognitive phenomenological theory of stress, coping, and appraisal may explain this variability. Gender role identity, career role salience, and societal pressure for motherhood are variables hypothesised to affect a woman's cognitive appraisal of infertility, thus influencing distress level. Female participants (N = 119) were recruited through the NYU Fertility Clinic and Resolve, a support organisation for individuals faced with infertility. Participants completed questionnaires assessing gender characteristics, career role salience, social pressure for motherhood, cognitive appraisal, and distress. Many respondents (42%) reported clinically significant levels of distress. A path analysis assessed the effects of gender‐role identity, career role salience, social pressure for motherhood, and cognitive appraisal on distress. The model accounted for 32% of the variance in distress. Women experiencing social pressure for motherhood viewed infertility as more stressful, women identifying with more positively valued instrumental gender role traits reported less distress, and women who endorsed more negatively valued instrumental gender role traits and cognitively appraised infertility as stressful reported greater distress.     

Parents' coping in the neonatal intensive care unit: a theoretical framework

The conceptual framework that has been widely used to study the coping strategies of parents of preterm infants in neonatal intensive care units (NICU) has been the transactional model of stress and coping proposed by Lazarus and colleagues. This model supports the cognitive system as the key factor in stress transactions. The cognitive system produces an interpretation of events that leads to making sense of numerous sensations and perceptions from both external and social sources as well as from the internal physiological environment. The individual cognitive system appraises stimuli in two ways: primary appraisal and secondary appraisal. Another factor that may influence the individual's coping effort is gender difference. Mothers and fathers of preterm infants have been found to use different coping strategies to deal with the preterm birth. Other factors such as personality traits and the perceived and actual availability of social support may also influence the parents' coping effort. Implications for clinical practice by the NICU interdisciplinary team are considered.     

Depression in primary versus secondary infertility egg recipients

Women with primary infertility and their husbands were significantly more depressed than women with secondary infertility and their husbands, and the difference in levels of depression of women compared with their husbands was significantly greater for primary than for secondary infertility. Depressive symptomology for childless individuals is greater for wives than for their husbands.     

Exploring couple attributes and attitudes and marital violence in Vietnam

Using a couple-centered approach, this study focuses on the relative attributes and attitudes of spouses as predictors of marital violence. Analysis of data from Vietnam showed that 37% of married women have ever been hit by their husbands. Regression results found that husbands with lower resources or status than their wives were more likely to have abused. Results also found that the association between husbands' gender attitudes and marital violence depends on the level of equity of wives'attitudes. The decline in violence among couples in which husbands expressed gender equitable attitudes was greater when wives also expressed equitable attitudes.     

Personality,social support,coping and emotional distress after repeated spontaneous abortions

Systematic investigations on the emotional impacts of repeated spontaneous abortions have been few. We mounted a prospective study of a cohort of couples who had experienced two consecutive first trimester spontaneous abortions and for whom no clearly identifiable causes were found. The present report is based on the first part of the study and examines: (1) emotional distress reported by the miscarrying women at six months (median, range 1-12 months) after two abortions; and (2) psychosocial predictors influencing such distress. The mean score of the women on the Symptom Checklist 90-Revised--one of the most popular self-report scales for psychopathology--was 0.38, whereas that for the general population is reported to be 0.26 (the higher the score, the more psychopathology). Fourteen percent of the cohort scored above the cutoff point for mental disorders screening. Factors examined and found non-influential upon the level of emotional distress include: the maternal age; whether the last pregnancy was planned and wished for or not; and coping styles of the women after the abortions. Control by the husbands over the marital relationship and neurotic personality traits of the women increased the emotional distress, whereas the social support the women perceive decreased it. These findings suggest that martial and social support are important in determining the level of psychiatric morbidity after repeated abortions.     

An assessment of the validity of reporting by proxy to women's health questionnaire: a pilot study

OBJECTIVE: The quality of proxy reports provided by husbands regarding women's health, when the index case (the wife) cannot be interviewed, is controversial. STUDY DESIGN: Fourteen husbands and wives at menopause were interviewed separately using the same pre-constructed questionnaire. The extent of agreement between their reports was assessed. RESULTS: Higher agreement was noted for questions regarding physiognomy, number of live children, age at menopause and general health problems. Lesser agreement was observed regarding obstetric history. CONCLUSIONS: In light of these preliminary observations, the use of husbands as proxy for women's health questionnaire at midlife should be carefully considered and may be limited to questions regarding general health issues rather than reproductive health.     

Differences between husbands' and wives' approach to infertility affect marital communication and adjustment

Objective: To test a theoretical model of the effect on marital communication and adjustment of men’s and women’s approach to infertility.

Design: A cross-sectional research design involving interviews, questionnaires, and a marital discussion task.

Setting: Volunteers from practices of fertility specialists.

Patient(s): Forty-eight couples currently seeking infertility treatment.

Intervention(s): None.

Main Outcome Measure(s): Quality of marital communication during a marital discussion task and effect of infertility on the marriage.

Result(s): Having children was more important to wives than husbands; wives were more involved in trying to have a baby, wanted to talk with their partner more about trying to have a baby, and experienced a greater loss of self-esteem than did their husbands. To the extent that husbands saw having children as important, were involved in trying to have a baby, or wanted to talk with their wives about trying to have a baby, the quality of marital communication when discussing infertility was less negative, and in turn, wives perceived a more positive effect of infertility on their marriage.

Conclusion(s): Increases in husbands’ interest and involvement in fertility treatment may lead to positive changes in couple communication about infertility and to a more positive effect of infertility on the marriage.     

Stress vulnerability and climacteric symptoms: life events, coping behavior, and severity of symptoms

To explore a possible association between climacteric symptoms and ways of coping with stress, a comparative study was conducted among 19 menopausal women who sought treatment for climacteric symptoms (the study group) and 44 healthy menopausal women (the control group). Life stress was assessed using a life event method in which factor analysis extracted four ways that women cope with stress: avoidance-oriented coping, consultation-oriented coping, aggression-expression coping, and problem-solving coping. The study group had a higher symptom score and was more prone to avoidance-oriented coping than the control group despite experiencing the same number of undesirable life events. The severity of climacteric symptoms correlated positively with the number of undesirable life events and the degree of avoidance-oriented coping and correlated negatively with the degree of aggression- expression coping for the study group. These results suggest that vulnerability to stress contributes to worsening climacteric symptoms caused by stress.     

Maternal appraisals of risk,coping and prenatal attachment among women hospitalised with pregnancy complications

One goal of pregnancy is the development of maternal emotional attachment to the unborn baby, and this attachment has been shown to be related to later relationships and development. There are many factors which may hinder the development of prenatal attachment, including the presence of complications, hospitalisation, and anxiety. However, women's appraisals of risk may not be congruent with medical assessments of risk. The current study sought to model the relationships between risk (maternal perceptions and medical ratings), coping, psychological well‐being, and maternal–foetal attachment among 87 women hospitalised for pregnancy‐related complications. Analysis indicated that positive appraisal as a coping strategy mediates the relationship between maternal appraisals of risk and maternal–foetal attachment, and that medical ratings of risk were not predictive of maternal–foetal attachment. Awareness of the potential incongruence between patients' and health professionals' perceptions of risk is important within the clinical environment. The potential benefits of promoting positive appraisal in high‐risk pregnancy merit further research.     

Husbands' experiences of supporting their wives during childbirth in Nepal

Background

the husband’s presence at childbirth is universally accepted in industrialised nations, but the concept is still new within the cultural values and norms of Nepalese society. Understanding the cultural context surrounding the feelings and needs of Nepalese husbands will help to initiate realistic maternity education programmes.

Objective

to explore husbands’ experiences of supporting their wives during childbirth.

Method

semi-structured interviews were conducted, and the data were analysed using thematic analysis.

Setting

the Maternity and Neonatal Service Centre, a midwife-run birthing centre within a public maternity hospital in the capital of Nepal.

Participants

twelve first-time expectant Nepalese fathers who had supported their wives during childbirth were interviewed in July 2009, within seven days of the birth.

Findings

six themes were identified to explain the mixed experiences of the husbands in the labour or delivery room: (1) being positive towards attendance; (2) hesitation; (3) poor emotional reactions; (4) being able to support; (5) the need to be mentally prepared and (6) enlightenment. Husbands reflected on their experiences positively, despite profound hesitation and overwhelming emotions.

Conclusions

the husbands’ experiences revealed that Nepalese husbands tend to experience overwhelming emotional feelings in the labour or delivery room if they are allowed to attend the birth without prior preparation.

Implications for practice

counselling for couples and education from the start of the pregnancy may reduce negative emotional experiences and improve satisfaction with the childbirth experience for both husbands and wives.     

Predictors and Outcomes of Postpartum Mothers' Perceptions of Readiness for Discharge after Birth

Objective: To identify predictors and outcomes of postpartum mothers' perceptions of their readiness for hospital discharge.
Design: A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables.
Setting: Midwestern tertiary perinatal center.
Participants: One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants.
Methods: Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data.
Main Outcome Measures: Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services.
Results: Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers' perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses' skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services.
Conclusion: A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth.     

Fathers' functional status during pregnancy and the early postnatal period

Objective

to determine the functional status of fathers whose wives were pregnant or in the early postnatal period.

Sample and setting

the research population comprised 3750 fathers whose wives were pregnant or in the early postnatal period, and who were registered at a primary health clinic in the province centre. The research sample comprised 275 husbands of women who were registered at these clinics and who were in at least their 28th week of a normal (not at-risk) pregnancy with a single fetus, or who were in the early postnatal period (6–8 weeks postnatal) following birth of a single baby between the 38th and 42nd week without complications. Due to fathers declining to participate in the study or unable to participate because of busy work schedules, the research was completed with 155 fathers-to-be and 93 fathers; in total, 90% of the target sample was reached. A sociodemographic survey and the Inventory of Functional Status—Fathers were used for data collection and to describe the functional abilities of fathers-to-be and fathers.

Findings

no statistically significant differences were found in functional status between the husbands of pregnant women and the husbands of women in the early postnatal period. Number of pregnancies was not significantly related to any of the seven subscales of fathers’ functional status; age of husband, length of marriage and occupation of wife were significantly related to one subscale; occupation of husband and health insurance were significantly related to two subscales; income status of husband and educational level of wife were significantly related to three subscales; and educational level of husband was significantly related to four subscales.

Conclusion

although there was no significant difference in functional status for the husbands of pregnant women and the husbands of postnatal women, sociodemographic factors were found to have an effect.     

结合计划生育服务开展性病/艾滋病预防的效果评估

目的 :评估发放宣传折页和提供咨询两种干预方法对提高育龄夫妇 STI/HIV/避孕套知识水平、改变对待 STI/AIDS病人的不良态度及增加避孕套使用意愿的效果 ,探讨结合计划生育开展 STI/HIV预防的有效方案。方法 :选取上海市 7个区 1 4个街道的 40 5对育龄夫妇 ,分为咨询干预组 (1 99对 )和折页发放组 (2 0 6对 )。基线调查后 ,咨询组进行咨询的同时提供免费避孕套并演示用法 ,折页组发放折页的同时提供免费避孕套 ,干预后一个月进行随访 ,以此评估干预效果。结果 :1 .基线无差异的两组 ,干预后咨询组夫妇 STI/AIDS/避孕套知识综合得分分别提高了 2 0 %和 2 4% ,折页组仅提高 2 %和 3% ;咨询组有93%的丈夫和 76 %的妻子消除了对 STI病人的偏见 ,73%的丈夫和 78%的妻子转变了歧视 AIDS病人或害怕与其接近的态度 ;避孕套使用意愿丈夫提高了 6 8% ,妻子提高了6 4% ;折页组对待 STI/AIDS病人的态度及避孕套使用意愿三项指标干预前后均无差别。2 .干预后得分及对待 STI/AIDS病人的态度主要与干预方式有关 ;避孕套使用意愿则受干预方式和获取方便程度的影响。结论 :1 .良好的咨询既能显著提高知识水平又能使不良态度得到明显转变 ;2 .提供有效咨询和增加可获得性是推广避孕套使用的重要因素 ;3.将咨询纳入计生门诊