Perinatal Experiences Research Articles

Perinatal care experiences among racially and ethnically diverse mothers whose infants required a NICU stay.

ObjectiveTo learn how diverse mothers whose babies required a neonatal intensive care unit (NICU) stay evaluate their obstetric and neonatal care.Study DesignWe conducted three focus groups stratified by race/ethnicity (Black, Latina, White, and Asian women, n=20) who delivered infants at <32 weeks gestation or <1500 grams with a NICU stay. We asked women to assess perinatal care and applied classic qualitative analysis techniques to identify themes and make comparisons across groups.ResultsPredominant themes were similar across groups, including thoroughness and consistency of clinician communication, provider attentiveness, and barriers to closeness with infants. Care experiences were largely positive, but some suggested poorer communication and responsiveness toward Black and Latina mothers.ConclusionFeeling consulted and included in infant care is critical for mothers of high-risk neonates. Further in-depth research is needed to remediate differences in hospital culture and quality that contribute to disparities in neonatal care and outcomes.

Community perspectives on the racial disparity in perinatal outcomes

Objective The United States’ infant and maternal mortality rates are significantly higher among non-Hispanic Black women and infants than women and infants of other races, independent of educational attainment or socioeconomic status. The purpose of this research was to understand conditions that lead to these disparities and propose practices for addressing them through community perspectives. Method Researchers conducted six focus groups with African American women who had been pregnant previously (n = 27) and performed inductive thematic analysis looking at the interaction between race and health. Results Major themes included barriers to quality healthcare and support. Women perceived that healthcare professionals provided substandard care based on implicit biases and felt that asking questions of providers led to loss of autonomy. Conclusions and relevance: The perceived quality of a woman’s perinatal experience is affected by women’s relationships with their healthcare providers, their social support, and their sense of autonomy in decision-making. To improve the relationships between African American women and their providers, participants expressed that racism and implicit bias must be recognized and addressed. While this should be addressed in individual interactions, this study also suggests the role of policy change and system-level modifications that should be considered to effectively decrease the racial disparity in perinatal outcomes.

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care.

Women of color are at increased risk for poor birth outcomes, often driven by upstream social determinants and socially structured systems. Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. This study aims to describe and thematically analyze the recommendations to improve pregnancy and birth care made by women of color with lived experience of perinatal health care. Twenty-two women of color living in the San Francisco Bay Area and receiving support services from a community-based nonprofit organization participated in semistructured interviews about their experiences receiving health care during pregnancy and birth. Interviews were audio-recorded and transcribed, and transcripts were analyzed using thematic analysis to highlight recommendations for improving perinatal care experiences. Participants shared experiences and provided recommendations for improving care at the individual health care provider level, including spending quality time, relationship building and making meaningful connections, individualized person-centered care, and partnership in decision making. At the health systems level, recommendations included continuity of care, racial concordance with providers, supportive health care system structures to meet the needs of women of color, and implicit bias trainings and education to reduce judgment, stereotyping, and discrimination. Participants in this study shared practical ways that health care providers and systems can improve pregnancy and birth care experiences for women of color. In addition to the actions needed to address the recommendations, health care providers and systems need to listen more closely to women of color as experts on their experiences in order to create effective change. Community-centered research, driven by and for women of color, is essential to improve health disparities during pregnancy and birth.

Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

IssueFear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions. AimTo conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them. MethodsA meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis. FindingsOne overarching theme “Ownership of Childbirth” and three analytical themes “Facing the fear”, “Feeling empowered”, “Managing the fear with a sense of security” were generated through the synthesis. There were no studies outside of Scandinavia located. DiscussionThis meta-synthesis provides a new way to describe the process of moving from fear to “Ownership of childbirth”. The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff. ConclusionThese findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.

PC-FACS: COVID-19

PC-FACS (FastArticleCriticalSummaries forClinicians inPalliativeCare) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pcfacs@aahpm.org.

Maternal pre and perinatal experiences with their full-term, preterm and very preterm newborns

BackgroundMothers’ reports about pregnancy, maternity and their experiences during the perinatal period have been associated with infants’ later quality of attachment and development. Yet, there has been little research with mothers of very preterm newborns. This study aimed to explore mothers’ experiences related to pregnancy, premature birth, relationship with the newborn, and future perspectives, and to compare them in the context of distinct infants’ at-birth-risk conditions.MethodsA semi-structured interview was conducted with women after birth, within the first 72 h of the newborn’s life. A total of 150 women participated and were divided in three groups: (1) 50 mothers of full-term newborns (Gestational Age (GA) ≥ 37 weeks; FT), (2) 50 mothers of preterm newborns (GA 32–36 weeks; PT) and (3) 50 mothers of very preterm newborns (GA < 32 weeks; VPT).ResultsMothers of full-term infants responded more often that their children were calm and that they did not expect difficulties in taking care of and providing for the baby. Mothers of preterm newborns although having planned and accepted well the pregnancy (with no mixed or ambivalent feelings about it) and while being optimistic about their competence to take care of the baby, mentioned feeling frightened because of the unexpected occurrence of a premature birth and its associated risks. Mothers of very preterm newborns reported more negative and distressful feelings while showing more difficulties in anticipating the experience of caring for their babies.ConclusionThe results indicate that Health Care Systems and Neonatal Care Policy should provide differentiated psychological support and responses to mothers, babies and families, taking into account the newborns’ GA and neonatal risk factors.

The relationship between posttraumatic stress symptoms of maternity professionals and quality of work life, cognitive status, and traumatic perinatal experiences

PurposeThe purpose of this study was to determine the relationship between posttraumatic stress symptoms of maternity nursing/midwife and their quality of work life, cognitive distortions, and traumatic perinatal experiences. MethodsA descriptive, cross-sectional survey design was used. Two hundred and sixty-six maternity nurses/midwives employed in maternity units of hospitals in a province located in the Central Anatolia Region of Turkey were included in the study. Results37.2% of the maternity nurses/midwives met the criteria for posttraumatic stress disorder (% 95 CI [31.6, 43.2]). Previous birth-related traumatic experiences, transferring to another unit, and negative cognitions about the self-increase the risk of development of posttraumatic stress disorder by 63% (F = 7.638, P < 0.001). A positive correlation was found between the outcome variable PTS total score and the following predictors: the number of years in the profession, the number of traumatizing events, quality of work life, burnout symptoms, compassion fatigue, posttraumatic cognition, negative cognition about the world, and negative cognition about the self. It was found that those maternity nurses/midwives who were not happy with their profession, who witnessed a traumatic incident, who transferred to another unit, who considered to quit the profession, who had a history of a psychological disorder, and those lacked social life were more sensitive to posttraumatic stress symptoms. ConclusionThese outcomes have significant consequences for both personal and professional well-being of the maternity nurses/midwives and the welfare of the workforce. To prepare maternity nurses/midwives for such exposures, to support maternity nurses/midwives following traumatic perinatal events, and to provide effective intervention for those with significant symptoms, organizational strategies are necessary.

Reflections of an Integrated Maternal-Child Health Medical Student Assignment.

Clinical experiences expose learners to the patient perspective, which can have a lasting impact on students' professional identity. However, in busy clinical settings where opportunities for reflection may be limited, listening to patients' stories is often neglected. We used a reflection assignment to augment a new maternal-child health integrated curriculum. Medical students completed a brief assignment from their session in the neonatal intensive care unit (NICU), which included reflective writing, between fall 2016 and summer 2017. The Depth of Reflection rubric was used to score reflections on a scale: "Knowledge and Comprehension" (Level I), "Analysis" (Level II), and "Synthesis and Evaluation" (Level III). A constant comparison method based on grounded theory elicited prenatal and postnatal themes from medical students' reflective writing. All students completed narratives (n = 166); 70% (n = 116) achieved a Depth of Reflection of Level II or III. Six overarching themes emerged: (1) Conception, Pregnancy, and Delivery Experiences; (2) Positive Support Structures; (3) Barriers and Stressors to Care; (4) Future Plans; (5) Unexpected Complications; and (6) Student Career and Professional Considerations. Reflections from a novel and brief integrated maternal-child health experience demonstrated high levels on the Depth of Reflection scale. This experience exposed students to core themes central to a family's pregnancy and perinatal experience. Professional identity formation also emerged as a theme. Reflective writing assignments in a busy NICU can facilitate exploration of medical students' knowledge of maternal-child health patient experiences.

The unconscious and consciousness of the memory: A contribution from neuroscience

By integrating data from general psychology and perinatal clinical psychology with neuroscience and psychoanalysis, the author discusses the relations between memory and consciousness, the aim being a unitary definition of the concept of unconscious. Nobody has a brain that can be the same as any other person's: the biology of memory lies in neural networks that have been constructed in the brain of that specific person by their experience. From the fetal stage, each brain progressively learns its own individual functions during its relational neuropsychic development. The author underlines how the continuous emotional biological work of the brain, together with a person's entire relational life, produces the construction of the whole functional and individual mindbrain. The whole construction is memory and this is unconscious; indeed it may be the true unconscious. From the continuous silent work of the mindbrain of a person, some forms of conscious level may emerge in his individual's subjectivity: some functioning of mindbrain makes what an individual person can consciously remember. The unconscious is only what appears in some form in an analyst's consciousness, at some specific moment in his relationship with a patient, and which the analyst translates into some form of his verbal interpretation.

Ecocentrism: Resetting Baselines for Virtue Development

From a planetary perspective, industrialized humans have become unvirtuous and holistically destructive in comparison to 99% of human genus existence. Why? This paper draws a transdisciplinary explanation. Humans are social mammals who are born particularly immature with a lengthy, decades-long maturational schedule and thus evolved an intensive nest for the young (soothing perinatal experience, responsive care, extensive breastfeeding, multiple responsive caregivers, positive social support, self-directed free play with multi-aged mates in the natural world). Neurosciences show that evolved nest components support normal development at all levels (e.g., neurobiological, social, psychological), laying the foundations for virtue. Nest components are degraded in industrialized societies. Studies and accounts of societies that provide the nest, particularly nomadic foragers, the type of society in which humanity spent 99% of its genus history, indicate a more virtuous human nature than that industrialized societies think is normal or possible. Nest-supported human nature displays Darwin’s moral sense whereas unnested individuals show dysregulation and a degraded moral sense—a species-atypical human nature. Original virtue is about flourishing—of self, human community and the more than human community—within all circles of life, based in a deep awareness of humanity’s dependence on the rest of nature to survive. The pillars of original virtue include relational attunement (engagement ethic), communal imagination, and respectful partnership with the natural world. All are apparent in human societies that provide the nest to their young, fostering connectedness throughout life. They maintain communal imagination through cultural practices that enhance ecological attachment and receptive intelligence to the natural world.

Perinatal care experiences of Muslim women in Northwestern Ontario, Canada: A qualitative study

Problem and BackgroundAlthough the number of Muslim women in Canada and northwestern Ontario (NWO) is increasing, few studies have focused on their experiences of perinatal health care. Extant research has highlighted discrimination and care that lacks respect for cultural and religious norms. These factors may limit access to health services and increase unfavorable maternal and child health outcomes. AimTo explore the perinatal health care experiences of Muslim women in NWO. MethodsA qualitative, descriptive study used purposive and snowball sampling to recruit a sample of 19 Muslim mothers. Ssemistructured interviews were conducted, audio recorded, transcribed verbatim, and analyzed thematically. FindingsThe mothers’ experiences were categorized into four themes: women’s choices and preferences of health care providers (HCPs); attitudes toward prenatal classes and education; husbands’ involvement and support in the birthing process; and challenges to optimal care. Discussion and ConclusionThe findings show that NWO Muslim women’s experiences were generally positive and their care choices and preferences were shaped by their religious beliefs and cultural practices. Factors that enhanced their experiences were HCPs’ awareness of and respect for the women’s religious and cultural beliefs and practices. However, the women lacked personal knowledge of a range of care options and services. Respecting Muslim women’s religious and cultural beliefs and practices will enhance their experience of care. Equity in access to quality services, care, and outcomes can be further enhanced if Muslim women are informed about the range of care options and services as early in their pregnancies as possible.

What about the men? Perinatal experiences of men of color whose partners were at risk for preterm birth, a qualitative study

BackgroundPreterm birth in the United States is associated with maternal clinical factors such as diabetes, hypertension and social factors including race, ethnicity, and socioeconomic status. In California, 8.7% of all live births are preterm, with African American and Black families experiencing the greatest burden. The impact of paternal factors on birth outcomes has been studied, but little is known about the experience of men of color (MOC). The purpose of this study was to explore the experiences of MOC who are partners to women at medical and social risk for preterm birth.MethodsThis study used a qualitative research design and focus group methods. The research was embedded within an existing study exploring experiences of women of color at risk for preterm birth conducted by the California Preterm Birth Initiative.ResultsTwelve MOC participated in the study and among them had 9 preterm children. Four themes emerged from thematic analysis of men’s experiences: (1) “Being the Rock”: Providing comfort and security; (2) “It’s a blessing all the way around”: Keeping faith during uncertainty; (3) “Tell me EVERYTHING”: Unmet needs during pregnancy and delivery; (4) “Like a guinea pig”: Frustration with the healthcare system. Participants identified many barriers to having a healthy pregnancy and birth including inadequate support for decision making, differential treatment, and discrimination.ConclusionsThis study shows novel and shared narratives regarding MOC experiences during pregnancy, birth, and postpartum periods. Healthcare providers have an essential role to acknowledge MOC, their experience of discrimination and mistrust, and to assess needs for support that can improve birth outcomes. As MOC and their families are at especially high social and medical risk for preterm birth, their voice and experience should be central in all future research on this topic.

The Field of Research and Practice in Relation to the Psychological Dimension of Pregnancy and Birth

In early Psychoanalysis was discovered that preverbal experiences during and before birth are meaningful and can influence later experience in a hidden way. Especially in Humanistic Psychology these observation were elaborated. This paper gives an overview of pre- and perinatal perspectives to different observations practical fields and fields of the humanities. It aims to demonstrate the many fields to which Prenatal Psychology can provide valuable resources. Among them, I would like to emphasize the great practical significance it holds for the field of obstetrics, the health sciences, psychotherapy and the humanities. The challenge of Prenatal Psychology is its trans-disciplinary character. It integrates different levels of quantitative and qualitative levels of observation. So far, research has been mostly conducted by individuals or in the framework of small interdisciplinary groups such as the International Society for Prenatal and Perinatal Psychology and Medicine (ISPPM) in Europe and the Association for Prenatal Psychology and Health (APPPAH) in North America. However, the great theoretical and practical significance requires increased social awareness and action.

Healing The Past By Nurturing The Future: Aqualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment.

Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.

Health &amp; Aesthetics

Otto Rank, one of the pioneers in Prenatal Psychology, has been teaching for almost 100 years now, that our life and Art are closely connected and that our health both somatic but also emotional are associated with our ability as human beings to see life as an Act of Art. And he wasn't the first of course. The majority of ancient classical philosophers in Greece and everywhere, as well as modern thinkers, speak of the value of the study of the Beautiful and the value of Aesthetics. At the same time, we have known since the era of Wundt that aesthetic pleasure is inherent in complexity. In this paper, we’ll attempt to show the connection between our Health and Fine Arts and see how Primordial Health Advancement Programs can greatly benefit from the integration of Fine Arts in their curriculum.

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents' perspectives.

A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.

Leading up to Loss: Understanding the Perinatal Grief Experience for Expectant Fathers when a Life-Limiting Fetal Diagnosis is Confirmed

Abstract The study aims to understand how men cope with the anticipated loss of their child when a life-limiting fetal diagnosis is confirmed in pregnancy. Twenty-five fathers responded to an online qualitative survey exploring their perinatal loss experiences. Data provide the reader with a glimpse of fathers’ thoughts and feelings between the time of the confirmed fetal diagnosis and the baby’s birth. Study participants chose to either engage with their pregnant partners through showing protection, emotional strength or by being productive in the areas in which they felt they could control; while others chose to avoid by not expressing their feelings with their partners, socially isolating, and turning to their work as a source of refuge. Therapeutic birth planning was shown to be a beneficial method to prepare fathers for their pending loss, involve fathers and their partners in the prenatal decision making and allow fathers to express their feelings throughout the process leading up to the loss. Study results hope to enhance the dearth of research on men’s bereavement experiences in the context of perinatal palliative care and encourage providers to acknowledge fathers’ grief in anticipation of a perinatal loss. Keywords Coping Mechanisms; Expectant Fathers; Grieving Fathers; Life-limiting Fetal Diagnosis; Perinatal Loss; Perinatal Palliative Care

Psychological features of mothers who have given birth to premature infants

Psychological features of mothers who have given birth to premature babies present one of the most complex and insufficiently explored areas of modern perinatal psychology. The progressive increase of the children born before the term as well as the insufficient development of psychological care programs for mothers at the women's consultation and nursing departments of newborns dictate the urgency and necessity of this problem. Using psychological techniques, the authors comprehensively assessed the personality characteristics, motives for the pregnancy preservation, personal and situational anxiety of mothers of premature babies at Perinatal Center №.1. The assessment revealed that the mothers with premature low-birth-weight babies experienced a sharp increase in situational anxiety compared to personal anxiety, while the mothers of full-term babies with a normal weight tended to decrease the level ofsituational anxiety. In addition, the mothers of premature babiessufferfrom expressed and severe depression more often than the mothers of full-term babies(p&lt;0.05).

Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians

ProblemDespite high quality evidence supporting midwifery continuity of care, access to this model is limited in many parts of Australia and internationally. BackgroundThe models of care provided to women have a strong influence on their perinatal experience and clinical outcomes. Midwifery Continuity of Care (CoC) is arguably the most significant factor in enhancing women’s clinical outcomes during child-bearing and facilitating a positive childbirth experience. Health system change is required, yet little literature has detailed the actualisation of this in the context of upscaling midwifery CoC. Research question/aimThis study aimed to explore the perceptions and experiences of midwifery and obstetric staff during the implementation and upscaling of midwifery CoC within a regional hospital and health service in coastal Queensland, Australia. MethodsA single-site, qualitative enquiry. Obstetricians and midwives participated in semi-structured interviews or focus groups at two-time points: within 2 months of introduction of the CoC service (obstetricians n=6; midwives n=15); and 2-years after implementation (obstetricians n=5; midwives n=17). Data were analysed thematically. FindingsFour key themes and several categories were generated from the data: hopes and expectations; clinical and practice changes; organisational and structural change; and, future directions. DiscussionOrganisational culture, structural change, communication processes and collaborative relationships can be used to inform future scale-up and sustain midwifery caseload care. Specifically, communication, inter-disciplinary collegial relationships, and managerial support are crucial to the sustainability and ultimate upscaling of caseload midwifery care. ConclusionSystem change is challenging, but in order to improve access to midwifery CoC is necessary.

Образ ребенка в сознании беременных женщин

The article focuses on the issue of the future child’s image in the minds of expecting mothers. The urgency of the issue lies in the fact that the field of prenatal psychology in the Republic of Belarus has been experiencing a great need for more scientific information in this area of study. Currently available research outcomes do not provide a holistic view of the psychological problem and cannot contribute to the process of identifying pregnant women in need of psychological counselling and support. As a result, there is evidence of an increase in the number of expecting mothers who are not psychologically prepared for the change in their social role. The goal of the present research was to study the distinct features of the future child’s image as it is perceived by pregnant women during the term of their first and subsequent pregnancies. The study was conducted at the healthcare institution “Verkhnedvinskaya Central District Hospital” in the Vitebsk Region of the Republic of Belarus. In the course of research, the following methods were applied: “The structure of an individual’s image (hierarchical)” (by Valerii L. Sitnikov) and “Family life from the mother’s point of view” (an adaptation of PARI by E. Scheffer and R. Bell prepared by Tatiana V. Nescheret); mathematical and statistical methods of research results processing. The outcomes of the study enabled the authors to identify the features of the child’s image as perceived by expecting mothers during their first or subsequent pregnancies. It was determined that there are both similarities and differences in the structural components of the image in the perceptions of women who were pregnant for the first time and those who had been pregnant before; regardless of the child’s sex or the number of the mother’s pregnancies, the image was reflected through feminine qualities, and all expecting mothers regardless of the number of pregnancies over-concentrated on the child.