View Of Pregnancy Research Articles

Associated factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy among early and late adolescents in Tanzania: a cross-sectional study

BackgroundAdolescent pregnancy is a serious reproductive health problem in Tanzania. However, the risk factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy in Tanzanian adolescents remain unexplored.MethodsWe collected baseline characteristics and information on attitudes and behaviors of reproductive health from 4161 Tanzanian adolescents in all 54 primary and secondary schools in the Korogwe district. We applied mixed effect multiple regression analyses stratified by sex to find the factors related to reproductive health attitudes and behaviors toward pregnancy.ResultsIn female students, regarding the attitudes of reproductive health, higher age, hope for marriage in the future, a talk with a parent about sex or pregnancy, and a higher hope score were significantly associated with a lower score. For the behaviors of reproductive health, higher age, a talk with a parent about sex or pregnancy, time to talk with a parent about daily life, and a higher hope score were significantly associated with a lower score. In male students, regarding the attitudes of reproductive health, a higher hope score was significantly associated with a lower score. For the behaviors of reproductive health, higher age, time to talk with a parent about daily life, and a higher hope score was significantly associated with a lower score.ConclusionsThe heterogeneous factor-outcomes association between female and male students suggested that sex-specialized interventions may be required to change their risky attitudes or behaviors of reproductive health. Although we cannot conclude as points of intervention, our study suggested that it may be practical to improve parent-adolescents communication about sex or reproductive health and change adolescents’ views of pregnancy or marriage for gaining financial or social status.

Fetal information as shared information: using NIPT to test for adult-onset conditions.

The possibilities of non-invasive prenatal testing (NIPT) are expanding, and the use of NIPT for adult-onset conditions may become widely available in the near future. If parents use NIPT to test for these conditions, and the pregnancy is continued, they will have information about the child's genetic predisposition from birth. In this paper, we argue that prospective parents should be able to access NIPT for an adult-onset condition, even when they have no intention to terminate the pregnancy. We begin by outlining the arguments against testing in such a situation, which generally apply the same considerations that apply in the predictive testing of a minor to the fetus in utero. We then contend, firstly, that there are important practical considerations that support availability of testing for prospective parents regardless of their stated intentions. Secondly, we object to the ethical equation of a fetus in utero with a minor. We base our analysis on a view of pregnancy that conceptualises the fetus as a part of the gestational parent, as opposed to the more common 'container' model of pregnancy. We suggest that fetal information is best conceptualised as shared information between the gestational parent and future child. Thus, it should be approached in similar ways as other kinds of shared information (such as genetic informationwith implications for family members), where a person has a claim over their own information, but should be encouraged to consider the interests of other relevant parties.

Nobody Puts Baby in the Container: The Foetal Container Model at Work in Medicine and Commercial Surrogacy

AbstractThis article argues that a particular metaphysical model permeates cultural practices surrounding pregnancy: the foetal container model. Widespread uncritical reliance on this view of pregnancy has been highly detrimental to women's liberty and reproductive autonomy. In this article, I extend existing critiques of the medical treatment of pregnant women to the context of the burgeoning commercial surrogacy industry. In doing so, I aim to show that our philosophical analysis in both spheres is constrained by the presupposition that the foetus and pregnant woman are metaphysically and ethically distinct entities. By exploring the similarities and differences between the expectations placed on pregnant women in these two spheres, I show that the foetal container model is not a homogeneous understanding of pregnancy applied consistently across contexts; rather, it has been used to justify various practices and attitudes toward pregnancy and pregnant women through different moral frameworks, in the service of different overarching aims.

Complex changes in von Willebrand factor-associated parameters are acquired during uncomplicated pregnancy.

BackgroundThe coagulation protein von Willebrand Factor (VWF) is known to be elevated in pregnancy. However, the timing and nature of changes in VWF and associated parameters throughout pregnancy are not well understood.ObjectivesTo better understand the changes in VWF provoked by pregnancy, we studied VWF-associated parameters in samples collected over the course of healthy pregnancies.MethodsWe measured VWF antigen (VWF:Ag), VWF propeptide (VWFpp), Factor VIII (FVIII), and ADAMTS13 activity in samples collected from 46 women during pregnancy and at non-pregnant baseline. We also characterized pregnant vs. non-pregnant VWF multimer structure in 21 pregnancies, and performed isoelectric focusing (IEF) of VWF in two pregnancies which had samples from multiple trimesters.ResultsVWF:Ag and FVIII levels were significantly increased during pregnancy. ADAMTS13 activity was unchanged. VWFpp levels increased much later in pregnancy than VWF:Ag, resulting in a progressive decrease in VWFpp:Ag ratios. FVIII:VWF ratios also decreased in pregnancy. Most pregnancies exhibited a clear loss of larger VWF multimers and altered VWF triplet structure. Further evidence of acquired VWF qualitative changes in pregnancy was found in progressive, reversible shifts in VWF IEF patterns over gestation.ConclusionsThese data support a new view of pregnancy in which VWF can acquire qualitative changes associated with advancing gestational age. Modeling supports a scenario in which both increased VWF production and doubling of the VWF half-life would account for the data observed. We propose that gestation induces a prolongation in VWF survival, which likely contributes to increased total VWF levels and altered VWF structure.

From Object of Inquiry to Subject of Public Policy: A History of the Fetus

Today, fetal images are ubiquitous. We encounter them everywhere—from family scrapbooks to car advertisements. Frequently, moreover, they are in- tended to send a political message—on billboards protesting legal abortion, for instance. But their pervasive presence is a recent phenomenon. A century ago, most people had no clear idea what a fetus might look like. Indeed, visitors to the 1893 World's Columbian Exposition in Chicago were able to view handcrafted wax models of embryos. These were objects of curiosity and scientific inquiry. Created by German artist-scientist Friedrich Ziegler, the model embryos were part of a display that also held wax models of starfish, sea urchins, beetle larvae, trout, chicks, and frogs, as well as of developing hearts, brains, skulls, eyes, ears, and teeth. Ziegler's exhibit, Sara Dubow tells us, won the fair's highest prize for its evolutionary and developmental illustration of the fair's theme: progress (p 25). Its inclusion in the exposition illustrates the growing scientific and public curiosity towards fetal life, which made the fetus an increasingly popular object of inquiry. Ourselves Unborn follows this history from the mid-nineteenth century to the present. The fetus has long captured the imagination of scientists and the public. And for more than a century, it has been an object of political controversy. Dubow eloquently illustrates how central a role the fetus has played over the past 150 years. She does so by following the history of the fetus from the criminalization of abortion in the latter part of the nineteenth century, to protective labor legislation that excluded women from certain jobs because of their reproductive capacity, to the criminal prosecution for child endanger- ment of pregnant substance-abusers. Ourselves Unborn joins a growing body of work that emerged in the mid-1990s about the fetus. Over the past two decades, historians, sociologists and medical anthropologists have analyzed the impact that medical technology has had on our view of pregnancy and

Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives

BackgroundMore than 30% of the pregnancies in women aged 35 and over are unintended. This paper compares perceptions about contraceptive methods and use among women with and without an unintended pregnancy after turning age 35.MethodsSemi-structured, in-depth interviews were conducted with 17 women. They were all 35 to 49 years old, regularly menstruating, sexually active, not sterilized, not desiring a pregnancy in the near future, and at least 3 months postpartum. We purposely sampled for women who had had at least one unintended pregnancy after age 35 (n = 9) and women who did not (n = 8). We assessed partnership, views of pregnancy and motherhood, desired lifestyle, perceived advantages and disadvantages of using and obtaining currently available well-known reversible contraceptives in the U.S. ''We also assessed contraceptive methods used at any time during their reproductive years, including current method use and, if appropriate, circumstances surrounding an unintended pregnancy after age 35.'' Each interview was taped and transcribed verbatim. Data were analyzed using Grounded Theory. Analysis focused on partnership, views of pregnancy, motherhood, desired lifestyle and perceived advantages and disadvantages of various reversible contraceptive methods.ResultsThe women without an unintended pregnancy after age 35 were more likely to (1) use contraceptive methods that helped treat a medical condition, (2) consider pregnancy as dangerous, or (3) express concerns about the responsibilities of motherhood. The women who experienced an unintended pregnancy after age 35 were more likely to (1) report unstable partnerships, (2) perceive themselves at lower risk of pregnancy, or (3) report past experiences with unwanted contraceptive side effects. There was a greater likelihood a woman would choose a contraceptive method if it was perceived as easy to use, accessible, affordable and had minimal side effects.ConclusionsWomen's perspective on contraceptive use after age 35 varies. Public health messages and health providers' care can help women in this age group by reviewing their fertility risks, as well as all contraceptive methods and their associated side effects. The impact of such interventions on unintended pregnancy rates in this age group should be tested in other areas of evidence-based medicine.

Childbirth expectations and experiences and associations with mothers’ attitudes to pregnancy, the child and motherhood

Objective: The aim of this study was to investigate whether a woman’s childbirth experience could be predicted by Raphael‐Leff’s model of antenatal views of pregnancy and motherhood (the Facilitator, Regulator, Reciprocator, and Conflicted or Bipolar mother). Design and methods: In a monocentric prospective observational cohort study, 298 expecting mothers completed a booklet with questionnaires (including the Facilitator scale, Regulator scale, and Salmon Item List) at 30–36 gestational weeks (T1). A follow‐up booklet was completed at 8–12 weeks postpartum (T2). Obstetric outcome was retrieved from the electronic patient files. Results: At T2, women reported less distress and less difficulty than they had expected at T1. Women tending to the Facilitator orientation expected more fulfilment and less distress, whereas women tending to the Regulator orientation expected less fulfilment and more distress. Similar associations were found for the actual childbirth experience. However, the significance of the contribution to the childbirth experience disappeared when controlled for obstetric history, maternal expectations, and obstetric and neonatal outcome. In addition, primiparious women tending to the Facilitator orientation reported less intrapartum feelings of fulfilment when they had an assisted delivery. Conclusion: The maternal orientations contribute, to some extent, to the understanding of the variations in the childbirth experience.

Depressive symptomatology in pregnant and postpartum women. An exploratory study of the role of maternal antenatal orientations

Little is known about how an expecting woman's view of pregnancy, the child, and motherhood relates to antenatal and postpartum depressive symptomatology. In this study, we investigated the influence of the maternal orientations, as described by Raphael-Leff (Psychological processes of childbearing. The Anna Freud Centre, London, 2005), on the prevalence of depressive symptoms in pregnant and postpartum women. Four hundred three pregnant women participated in a longitudinal study and completed the EPDS and the HADS-D in each pregnancy trimester and between 8 to 12 and 20 to 25 weeks postpartum. In addition, measures of maternal orientation (PPQ), personality (NEO-FFI), coping styles (UCL), adult attachment (RQ), and parental bonding (PBI) were completed antenatally. Bivariate and multivariate analyses revealed that Neuroticism and the Regulator orientation are positively associated with the EPDS and HADS-D in both pregnant and postpartum women. These associations decreased in strength but remained significant after controlling for previous responses on the EPDS and HADS-D. Small negative associations were found between the Facilitator orientation and the HADS-D scores during pregnancy and the early postpartum period. However, this association did not hold its statistical significance within the hierarchical multiple regression models. The maternal orientations have a small but significant and independent contribution in the variance of depressive symptomatology in pregnant and postpartum women.

Antenatal care perceptions of pregnant African women attending maternity services in Melbourne, Australia

to explore the experiences and concerns of an African-born sample of pregnant women receiving antenatal care in Melbourne, Australia. qualitative in-depth interviews. the African Women's Clinic located in Melbourne's western suburbs, an area known for social deprivation and high numbers of recently arrived African migrants. 18 pregnant African-born women were interviewed. African women receiving pregnancy care in Australia undergo a process of adjustment as they travel from a view of pregnancy as not 'special' to valuing continuous antenatal care. Five themes were identified along the trajectory: pregnancy is not special; resettlement is a priority; childbearing is a normal process; coming to value continuous pregnancy care; and cultural sensitivity is important. Throughout each stage, valuing and acceptance of Australian pregnancy care were mediated by the women's cultural beliefs. the African population in Melbourne is not homogenous, and women's experiences differ with cultural background, residential status, educational level and prior experience. All, however, seem to progress through phases of adjustment to value continuous antenatal care. In this climate of change, the provision of a supportive sensitive service appears to promote acceptance of services and attendance at appointments.

Normal birth: a thing of the past or the new future for primary health care?

This paper will explore the similarities and contrasts between the United Kingdom, Netherlands and Australian systems of maternity service delivery, focusing on the status of midwives as primary care providers. Increasingly, women in western industrialized nations are subject to medical models of maternity care. These medical models stem from the field of obstetrics, which has an increasing influence in determining service provision in all three countries. The World Health Organization has stated that midwives are the most appropriate primary carers for women during pregnancy and childbirth. Yet the rise of obstetrics as a dominant model of care has displaced midwives as primary carers, giving greater privilege to an obstetric construction of pregnancy and childbirth. While midwives are educated to understand and support normal physiological birth and assess and respond to deviations (wellness model), by contrast, obstetricians are educated to assess risk and address concerns through active clinical management (illness model). It will be argued that the fundamental difference between midwifery and obstetric views of pregnancy and childbirth rest on the differing perceptions of wellness and illness; that the obstetric view has gained broad dominance as a result of unequal power relationships; and, that this in turn has altered service delivery to privilege medical models of care. While service delivery in the UK and Australia has tended to follow a similar pattern of dislodging midwives as primary carers, the Netherlands system of maternity care, while broadly resisting the displacement of midwives as primary carers, is nonetheless provided within a medicalized framework. By contrast, in the UK and Australia there is an increasing awareness of the need to reconfigure maternity services to give greater autonomy to midwifery practitioners, a situation that is not as relevant in the Netherlands. The conclusion highlights the need to develop core principles to strengthen maternity care systems in order to ensure that midwives are not further alienated from service provision, and that strong midwifery workforces can be sustained. The discussion is based on research undertaken during a study tour of the United Kingdom and Netherlands by the author.

Social context and the experience of a sample of U.S. women taking RU-486 (mifepristone) for early abortion.

Of 50 women seeking an abortion in Rochester, New York, between November 1999 and January 2001, 35 went on to complete an in-depth interview from 1 to 6 weeks after their follow-up clinical visit. A higher proportion of women who defined their pregnancy as a baby indicated emotional distress during their in-depth interview compared to those who saw their pregnancy as only having the potential to become a baby. The authors conclude that abortion might be made less difficult through public education about the different views of pregnancy and abortion throughout U.S. history. It might be important for abortion counselors to first ask a woman how she defines her pregnancy. A larger study is warranted.

Ethical Issues in Maternal -- Fetal Medicine

Ethical Issues in Maternal -- Fetal Medicine

Pregnant bodies, pregnant minds

Philosophers and artists frequently make use of metaphors drawn from female bodily experiences of pregnancy and childbirth to express intellectual or artistic creativity. While philosophical and artistic originality are presented as a kind of spiritual pregnancy, women's bodily pregnancies are often presented as at best intellectually or spiritually insignificant, to be valued solely for their products — physical children. I contrast the view of pregnancy found in philosophers such as Plato and Nietzsche, and artists such as Chagall, with an understanding of pregnancy influenced by feminist body art, and focus on the significance of the extent and pace of change that women experience during pregnancy.

The Trade-Off between Hormonal Contraceptives and Condoms among Adolescents

Adolescents' dual use of condoms and hormonal contraceptives is low, and the motivations underlying their decisions to combine contraceptives are not understood. To examine how pregnancy concerns, sexually transmitted disease (STD) concerns and type of sexual partner influence contraceptive use, we recruited 436 sexually experienced adolescents from two clinics. In structured interviews, we asked adolescents to describe their recent partners, their method use, and their pregnancy and STD concerns. Data were analyzed using logistic regression. The odds that adolescents used condoms with main partners were significantly lower among those who used hormonal contraceptives than among nonusers of these methods (odds ratios, 0.4 for young women and 0.3 for young men). With casual partners, no association existed between adolescents' condom and hormonal contraceptive use. Concerns about pregnancy and STDs influenced this association for women with main partners. Among young women who perceived pregnancy as more negative, hormonal contraceptive users had reduced odds of using condoms (0.1). No association existed between use of the two methods among young women whose view of pregnancy was less negative. Young women who perceived themselves to be less at risk of acquiring an STD had reduced odds of using condoms if they were using hormonal contraceptives (0.2). Among young women who perceived themselves to be more at risk of acquiring an STD, no association existed. Adolescents trade off between hormonal contraceptives and condoms according to partner type and perceived risks. Adolescents' dual-method use may improve if providers tailor counseling to adolescents' perceived risk of STDs and pregnancy, and if they address prevention of both as a related decision.

The views and anticipated needs of women in early pregnancy

To assess the expectations of antenatal care of pregnant women at the outset of pregnancy. Questionnaire study within a randomised controlled trial, comparing traditional antenatal care with a more flexible schedule. Eleven primary care centres providing midwifery care in Avon. Five hundred and ninety-three pregnant women at low risk of obstetric complications presenting for antenatal care. A questionnaire was completed by women who agreed to participate in the trial shortly after antenatal booking. The questionnaire explored women's views on their attitudes to pregnancy and antenatal care, the locus of control related to pregnancy, the planning of the pregnancy and expectations of care. Comparisons between nulliparous and multiparous women in terms of their views of antenatal care, and their stated preference for a particular package of care. There was no difference in their views of pregnancy as an event entailing risk. On a locus of control scale that measured women's perceptions of factors which might affect their babies' health, nulliparous women rated antenatal care higher than multiparous women (P = 0.0001). However, this was not associated with any difference between the two groups in their stated preference for traditional or flexible care. Approximately half of the women expressed no preference, and of those who did 61% would opt for traditional care. Almost one-fifth of the whole sample welcomed the idea of flexible care. These data support the evidence of previous studies that there remains a strong desire among pregnant women to receive a 'traditional' pattern of care, even among those who have previously experienced normal pregnancy. However, a minority can be identified at the outset of pregnancy who may welcome a change to a more flexible pattern of care.

Pathology, Danger, and Power: Women's and Physicians' Views of Pregnancy and Childbirth in Weimar Germany

This article shows how the very real risks of reproduction were culturally constituted by expectant mothers and physicians in Germany following the first World War. Both saw a strong potential for maternal and fetal death and injury. However, expectant mothers and physicians differed in the extent to which they regarded risk as contingent or inherent. Most physicians believed that pregnancy and childbirth first became dangerous in conjunction with a wide variety of other ailments, including complications specific to pregnancy. This view of pathology held a promise of prevention or at least treatment. Physicians further participated in inventing new, modern understandings of pathology, which also encompassed factory work as a reproductive hazard. Expectant mothers, in contrast, viewed pregnancy and childbirth as inherently dangerous based on their experiences and those of the women they knew, which not infrequently involved illness, disability, or close encounters with death. Many of them also held the ancient idea that a woman could harm the foetus with her imagination. As a result, though women varied in their beliefs (influenced by class, education, region, and religion), as a group they feared childbirth. Paradoxically, competition among lay and medical ideas gave women new options while also gradually enhancing medical authority.

Pregnancy and employment: The perceptions and beliefs of fellow workers

This study investigated working peoples perceptions and beliefs of pregnancy and employment. One hundred and sixty-nine respondents completed a postal questionnaire, the main part of which consisted of 40 Likert scaled items about pregnancy and work. Analysis of the results revealed a main effect of gender whereby women were more positive than men (F(l,l61) = 36.51; p < 0.0001). There were also main effects of age, whereby people aged between 26 and 45 were the most positive (<F(4,164) = 3.53; p < 0.009), and workplace, whereby the university workers were more positive than workers in a manufacturing industry (F(l,16l) = 3.51; p < 0.017). Direct experience, or a partner's experience, of working during pregnancy had an effect on total scores which approached significance, but having worked with a pregnant woman was only linked to more positive responses if that experience was also rated positively. The results are interpreted in terms of differences in proximity to the experience of working during pregnancy. There is some evidence, from analyses of different categories of items in the questionnaire, that negative views of pregnancy and employment may arise from the negative stereotype of pregnant women as invalids.

Obstetricians' and midwives' contrasting perceptions of pregnancy

Abstract The aim of the current study was to compare the attitudes towards pregnancy of obstetricians, midwives and pregnant women. Fifteen obstetricians, 14 midwives and 136 pregnant women completed a questionnaire assessing attitudes towards pregnancy. Obstetricians, midwives and pregnant women had different views of pregnancy: obstetricians were more likely to view it as a state involving risk, while midwives were more likely to view it as a normal process. Pregnant women held views in between these two. Whatever the reasons for these differences, such differing perspectives within the same team providing care to pregnant women may reduce the effectiveness of this care by adversely affecting communication and decision-making. These hypotheses await further study.

How pregnant workers see their work, its risks and the right to precautionary leave in Québec.

In 1981, the Québec government passed a law providing "precautionary leave" or reassignment to other jobs for pregnant workers exposed to a risk for their health or that of their fetus. This measure was much more popular than expected, with about 30% of pregnant workers taking leave in 1987. Uncertainty about what constitutes a risk for pregnancy, conflicts between views of pregnancy as a social or private act, and differing ideas on employers' responsibility for protection of pregnant workers have combined with worries about cost to stimulate debate on this law. Since 1986, there has been pressure on the government to restrict access to precautionary leave. This article describes research designed to answer some of the questions raised during the debate. Data banks of the Health and Safety Commission and responses of 2500 women workers were examined to characterize the jobs of women who did and those who did not take leave. Leave was usually taken by those who worked in sectors traditionally associated with risks, and women who applied for precautionary leave more often reported their working conditions to be difficult. Women taking leave accorded more importance to their maternal and domestic roles, but equal value to their roles in the workplace. The article concludes that the popularity of the measure is not due to laziness or lack of responsibility on the part of women workers, but to poor conditions in women's traditional jobs. It is suggested that more emphasis be placed on improving conditions rather than on early leave from work.

Education the gestation of a childbirth education diploma

A proposed 2-year post-graduate Diploma in Childbirth Education is described. The proposed course is based on the assumptions that preparation for parenthood involves a holistic view of pregnancy, birth and the early parenthood years and that such preparation should be directed towards couples or families rather than only mothers. Also evident in the proposed Diploma is the multidisciplinary nature of the education that is required, spanning both biological and social sciences. The planning of the Diploma is described together with its conception, embryonic and fetal development and anatomy. Complications occurring during its gestation and delivery are outlined.