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2.
Birth ; 46(3): 461-474, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31385354

RESUMO

BACKGROUND: Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. METHODS: Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). RESULTS: Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. CONCLUSIONS: The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.


Assuntos
Serviços de Saúde Materna/normas , Pais/psicologia , Morte Perinatal , Isolamento Social , Natimorto/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Recém-Nascido , Cuidado Pós-Natal/psicologia , Gravidez , Relações Profissional-Família , Pesquisa Qualitativa , Fatores de Risco , Fatores Socioeconômicos , Reino Unido
3.
Psychiatr Pol ; 53(2): 277-292, 2019 Apr 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-31317958

RESUMO

This article presents recommendations of the Polish Psychiatric Association regarding approach to pregnancy loss and unsuccessful in vitro treatment of infertility. From the psychological perspective pregnancy loss and perinatal death are amongst the most stressful events in human life - carrying increased risk of developing affective, anxiety or post-traumatic stress disorders. Psychologists, physicians and the rest of the medical staff should provide integrated and individualized care which should be based on respect, empathy and expertise. The necessary phases of support for women experiencing pregnancy loss are: (1) physician providing exhaustive informational support regarding state of health, potential causes of fetal death, further approach and phases of induced labor of the fetus/pregnancy termination/procedure, (2) facilitating psychological consultation at any time and (3) providing exhaustive information on current legal standing (health insurance and labor law). Experiencing recurrent in vitro fertilization failures may result in the emotional consequences similar to those observed in miscarriages. The prolonged frustration may favor developing depressive symptoms and escalate pathological anxiety. We present basic recommendations for psychotherapy and pharmacotherapy in pregnancy loss and unsuccessful in vitro infertility treatment.


Assuntos
Depressão/psicologia , Guias de Prática Clínica como Assunto , Complicações na Gravidez/psicologia , Natimorto/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Aborto Espontâneo , Depressão/prevenção & controle , Feminino , Humanos , Polônia , Gravidez , Complicações na Gravidez/prevenção & controle , Sociedades Médicas , Transtornos de Estresse Pós-Traumáticos/prevenção & controle
4.
Midwifery ; 77: 37-44, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254962

RESUMO

AIM: To explore the experience of both the mothers and the fathers regarding the care received during delivery in cases of stillbirth. DESIGN: A hermeneutic phenomenological study based on semi-structured interviews with eleven mothers and fathers who experienced stillbirth. PARTICIPANTS: A purposive sample was recruited in Hospital XXX of XX and through a local pregnancy loss support organization. METHODS: Interviews were recorded and transcribed verbatim and analysed using inductive thematic analysis. FINDINGS: Four main categories identified: 1) denial of grief, 2) the life and death paradox, 3) guilt, and 4) go through and overcome the loss. The parents manifested a lack of recognition of their loss and their parenthood. Although the midwife was the highest valued professional, not all the experiences were positive and the parents would have appreciated being accompanied by trained people with good communication skills. They also referred to in-hospital logistic barriers that complicated the process, as well as the fact that these births occurred in the same place where healthy deliveries were attended. CONCLUSION: Findings highlight the importance of tailoring support systems according to mothers' and fathers' needs. Promoting social and institutional recognition of this kind of loss and training healthcare professionals in the accompaniment of this type of mourning is useful to plan comprehensive care to facilitate the initiation and subsequent evolution of healthy mourning.


Assuntos
Pai/psicologia , Mães/psicologia , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Natimorto/psicologia , Adaptação Psicológica , Adulto , Luto , Pai/estatística & dados numéricos , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Mães/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/estatística & dados numéricos , Espanha/epidemiologia , Natimorto/epidemiologia
6.
BMC Pregnancy Childbirth ; 19(1): 129, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991981

RESUMO

BACKGROUND: Pregnancy and infant loss has a pervasive impact on families, health systems, and communities. During and after loss, compassionate, individualized, and skilled support from professionals and organizations is important, but often lacking. Historically, little has been known about how families in Ontario access existing care and supports around the time of their loss and their experiences of receiving such care. METHODS: An online cross-sectional survey, including both closed-ended multiple choice questions and one open-ended question, was completed by 596 people in Ontario, Canada relating to their experiences of care and support following pregnancy loss and infant death. Quantitative data were analyzed descriptively using frequency distributions. Responses to the one open-ended question were thematically analyzed using a qualitative inductive approach. RESULTS: The majority of families told us that around the time of their loss, they felt they were not adequately informed, supported and cared for by healthcare professionals, and that their healthcare provider lacked the skills needed to care for them. Almost half of respondents reported experiencing stigma from providers, exacerbating their experience of loss. Positive encounters with care providers were marked by timely, individualized, and compassionate care. Families indicated that improvements in care could be made by providing information and explanations, discharge and follow-up instructions, and through discussions about available supports. CONCLUSIONS: Healthcare professionals can make a positive difference in how loss is experienced and in overall well-being by recognizing the impact of the loss, minimizing uncertainty and isolation, and by thoughtfully working within physical environments often not designed for the experience of loss. Ongoing supports are needed and should be tailored to parents' changing needs. Prioritizing access to specialized education for professionals providing services and care to this population may help to reduce the stigma experienced by bereaved families.


Assuntos
Aborto Espontâneo/psicologia , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pós-Natal/psicologia , Natimorto/psicologia , Luto , Estudos Transversais , Empatia , Feminino , Humanos , Recém-Nascido , Masculino , Ontário , Morte Perinatal , Cuidado Pós-Natal/métodos , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
8.
Soins Pediatr Pueric ; 40(306): 22-24, 2019.
Artigo em Francês | MEDLINE | ID: mdl-30661776

RESUMO

Practices around the care of stillborn babies have evolved considerably over the last 15 years. Perinatal bereavement care requires a team approach to support the parents experiencing this ordeal. The place of rituals is important as is the personalisation of the care. The humanity which surrounds such moments constitutes the foundation on which the future equilibrium of these bereaved families will be based.


Assuntos
Luto , Pais/psicologia , Relações Profissional-Família , Natimorto/psicologia , Comportamento Ritualístico , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
9.
Soins Pediatr Pueric ; 40(306): 25-27, 2019.
Artigo em Francês | MEDLINE | ID: mdl-30661777

RESUMO

Since 2008, upon presentation of a medical certificate attesting to birth, parents are able to request a stillbirth certificate and the registration of their baby in the family record book, and to choose his or her funeral. In addition to the acknowledgement of the memory of this stillborn baby, certain rights are granted, subject to conditions, to the parents, such as maternity and paternity leave, pension entitlements and the birth allowance.


Assuntos
Luto , Direitos Civis , Pais/psicologia , Natimorto/psicologia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
10.
J Nurs Res ; 27(3): e22, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30694221

RESUMO

BACKGROUND: Fetal death causes women to experience negative feelings after the loss. These lived experiences influence the future pregnancies and maternal health of women negatively. PURPOSE: The aim of this study was to investigate the experiences of women whose pregnancies were terminated because of medical indications. METHODS: A "design for definitive status study" type of qualitative research design was used. Ten women who were hospitalized between April and July 2017 at the Akdeniz University Clinic of Obstetrics and Gynecology and had subsequently experienced pregnancy loss during their hospitalization were enrolled as participants. Thematic analysis was used to analyze the data. RESULTS: The pregnancy loss experiences of participants were investigated under the five main themes of (a) lived experiences before the termination of pregnancy, (b) lived experiences after pregnancy termination, (c) willingness to see the baby after termination, (d) posttermination care requirements, and (e) physical condition of hospital rooms during hospitalization. The participants expressed feelings of hope, fear, and worry over being unsuccessful before fetal death and feelings of loneliness, disappointment, blame, and avoidance after fetal death. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: In the aftermath of fetal death, health professionals should use insightful and empathic communication skills to help mothers cope with their loss. In addition, some of the participants wanted to see their babies, and some did not. Thus, individualized care is very important for women who experience pregnancy loss.


Assuntos
Adaptação Psicológica , Mães/psicologia , Natimorto/psicologia , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Serviços de Saúde Materna , Pesquisa em Enfermagem , Pesquisa Qualitativa , Turquia , Adulto Jovem
11.
BJOG ; 126(1): 12-21, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30099831

RESUMO

BACKGROUND: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement. OBJECTIVE: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs. SEARCH STRATEGY: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL. SELECTION CRITERIA: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs. DATA COLLECTION AND ANALYSIS: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES). MAIN RESULTS: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth. CONCLUSIONS: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately. TWEETABLE ABSTRACT: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.


Assuntos
Atitude do Pessoal de Saúde , Países em Desenvolvimento , Pais/psicologia , Natimorto/psicologia , Luto Contido , Feminino , Humanos , Cuidado Pós-Natal/psicologia , Cuidado Pós-Natal/normas , Gravidez , Pesquisa Qualitativa , Estereotipagem
12.
Ultrasound Obstet Gynecol ; 54(2): 215-224, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30294945

RESUMO

OBJECTIVE: The PARENTS 1 study (Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death) found that parents would endorse the opportunity to give feedback into the perinatal mortality review (PNMR) process. In subsequent focus groups, healthcare professionals were positive about parental engagement, although they considered that there may be significant challenges. The objective of this study was to develop core principles and recommendations for parental engagement in PNMR in the UK. METHODS: A two-round Delphi technique was followed to reach consensus on core principles for parental engagement in the PNMR process; Round 1 included a national consensus workshop and Round 2 an online questionnaire. The consensus meeting was attended by a national panel of stakeholders (clinical and academic experts, parent advocates, managers and commissioners) in stillbirth and neonatal and bereavement care. To develop recommendations for parental engagement, participants discussed four key areas comprising: communication with parents, including receiving feedback; the format of the PNMR meeting; the parental engagement pathway; and challenging aspects of engaging with parents in reviews. Content analysis was conducted to generate recommendations from the meeting for a subsequent anonymous web-based survey. Attendees of the consensus workshop and members of the PARENTS 2 Project Advisory Board were asked to rank recommendations using a 9-point Likert scale from 1 (not important) to 9 (critically important). It had been agreed a priori, in compliance with established Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, that 'consensus' would be achieved if over 70% of participants scored the principle as 'critical' (score of 7-9) and fewer than 15% scored the principle as 'not important' (score of 1-3). Principles for which consensus was achieved were included in the core recommendations. RESULTS: Of the 29 invited stakeholders, 22 participated in the consensus meeting and 25 (86% response rate) in the subsequent online questionnaire in June 2017. Consensus was agreed on 12 core principles. Of the 25 participants, 96% agreed that a face-to-face explanation of the PNMR process was of critical importance, 72% considered that parents should be offered the opportunity to nominate a suitable advocate, 92% believed that responses to parents' comments should be formally documented, 96% indicated that it was vital for action plans to be translated into lessons learnt and that this process should be monitored, and 100% of stakeholders voted that a plain-English summary should be produced for the parents following the meeting. There was good agreement on a further seven principles. CONCLUSIONS: Key national stakeholders were unanimously supportive of parental engagement in the PNMR process and agreed on core principles to make this process feasible, meaningful and robust. A 6-month pilot of parental engagement in the PNMR process (PARENTS 2 study) in two UK units took place after the consensus on core principles. In collaboration with the National Perinatal Epidemiology Unit, the findings will inform the national standardized PNMR tool. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Pessoal de Saúde/educação , Mortalidade Perinatal/tendências , Participação dos Interessados/psicologia , Natimorto/psicologia , Atitude do Pessoal de Saúde , Comunicação , Consenso , Técnica Delfos , Feminino , Grupos Focais/métodos , Pessoal de Saúde/psicologia , Humanos , Recém-Nascido , Masculino , Pais/psicologia , Morte Perinatal/prevenção & controle , Inquéritos e Questionários , Reino Unido/epidemiologia
13.
MCN Am J Matern Child Nurs ; 44(1): 27-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30531587

RESUMO

PURPOSE: The purpose of this study was to determine the extent to which labor and delivery nurses used the tenets of Swanson's middle-range theory to care for women whose babies were stillborn. STUDY DESIGN AND METHODS: A secondary analysis of qualitative in-depth interview data from 20 labor and delivery nurses obtained during a recent grounded theory study was conducted using the directed content analysis method. The five caring processes as described in Swanson's theory were used as a priori codes to conduct the analysis. RESULTS: Nursing care of a woman experiencing a stillbirth included finding a way to connect with her and to understand what she was experiencing (knowing), spending extra time with her (being with), protecting her and preserving her dignity (doing for), providing information and explanations in a clear and methodical manner (enabling), and ensuring that she did not blame herself to facilitate the grieving/healing process (maintaining belief). CLINICAL IMPLICATIONS: The caring processes outlined in Swanson's theory of caring provide a valuable guide that can be used when caring for women experiencing stillbirth.


Assuntos
Empatia , Enfermeiras e Enfermeiros/normas , Teoria de Enfermagem , Enfermagem Obstétrica/métodos , Natimorto/psicologia , Adulto , Atitude Frente a Morte , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa Qualitativa
14.
BJOG ; 126(6): 745-753, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30576088

RESUMO

OBJECTIVE: To investigate whether less invasive methods of autopsy would be acceptable to bereaved parents and likely to increase uptake. DESIGN: Mixed methods study. SETTING: Bereaved parents recruited prospectively across seven hospitals in England and retrospectively through four parent support organisations. SAMPLE: Eight hundred and fifty-nine surveys and 20 interviews with bereaved parents. METHODS: Cross-sectional survey and qualitative semi-structured telephone interviews. MAIN OUTCOME MEASURES: Likely uptake, preferences, factors impacting decision-making, views on different autopsy methods. RESULTS: Overall, 90.5% of participants indicated that they would consent to some form of less invasive autopsy [either minimally invasive autopsy (MIA), non-invasive autopsy (NIA) or both]; 53.8% would consent to standard autopsy, 74.3% to MIA and 77.3% to NIA. Regarding parental preferences, 45.5% preferred MIA, 30.8% preferred NIA and 14.3% preferred standard autopsy. Participants who indicated they would decline standard autopsy but would consent to a less invasive option were significantly more likely to have a lower educational level (odds ratio 0.49; 95% CI 0.35-0.70; P = 0.000062). Qualitative findings suggest that parents value NIA because of the lack of any incision and MIA is considered a good compromise as it enables tissue sampling while easing the parental burden associated with consenting to standard autopsy. CONCLUSION: Less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. Further health economic, validation and implementation studies are now required to assess the viability of offering these in routine widespread clinical care. TWEETABLE ABSTRACT: Mixed methods UK study finds less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience.


Assuntos
Feto Abortado/patologia , Autopsia/métodos , Anormalidades Congênitas , Morte Fetal/etiologia , Pais/psicologia , Morte Perinatal/etiologia , Natimorto , Luto , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/patologia , Aconselhamento/métodos , Estudos Transversais , Tomada de Decisões , Inglaterra , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Gravidez , Complicações na Gravidez/psicologia , Pesquisa Qualitativa , Natimorto/psicologia
15.
J Health Psychol ; 24(1): 65-78, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28810447

RESUMO

Healthcare professionals' psychological involvement in perinatal loss is a largely overlooked subject by healthcare systems, scientific research and prevention policies. A systematic scientific review has been carried out about emotional experiences, attributed meanings and needs conveyed by healthcare professionals in relation to perinatal loss. We identified 213 studies between 1985 and 2015, 20 of which were included in the present study for qualitative analysis. Our results point out the need for a targeted vocational training in perinatal loss, enabling healthcare professionals to achieve a proper management of their own internal states.


Assuntos
Aborto Espontâneo/psicologia , Pessoal de Saúde/psicologia , Serviços de Saúde Materna , Morte Perinatal , Natimorto/psicologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez
16.
BMJ Open ; 8(12): e024278, 2018 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-30580272

RESUMO

INTRODUCTION: After the death of a child during pregnancy, birth or in the neonatal period, parents often experience feelings of guilt, disenfranchisement, feelings of betrayal by one's own body and envy of others. Such bereavement results in high rates of distress: psychologically, emotionally, physiologically and existentially. These data are collected using a national, longitudinal cohort to assess grief in mothers and their partners after the death of a child during pregnancy, birth or in the neonatal period. Our aim is to achieve a general description of grief, emotional health, and existential values after pregnancy or perinatal death in a Danish population. METHODS AND ANALYSIS: The cohort comprises mothers and their partners in Denmark who lost a child during pregnancy from gestational week 14, during birth or in the neonatal period (4 weeks post partum). We began data collection in 2015 and plan to continue until 2024. The aim is to include 5000 participants by 2024, generating the largest cohort in the field to date. Parents are invited to participate at the time of hospital discharge or via the Patient Associations homepage. Data are collected using web-based questionnaires distributed at 1-2, 7 and 13 months after the loss. Sociodemographic and obstetric variables are collected. Validated psychometric measures covering attachment, continuing bonds, post-traumatic stress, prolonged grief, perinatal grief and existential values were chosen to reach our aim. ETHICS AND DISSEMINATION: The study was approved by The Danish National Data Protection Agency (no. 18/15684, 7 October 2014). The results will be disseminated in peer-reviewed and professional journals as well as in layman magazines, lectures and radio broadcasts.


Assuntos
Aborto Espontâneo/psicologia , Adaptação Psicológica , Luto , Saúde Mental , Morte Perinatal , Natimorto/psicologia , Adulto , Dinamarca , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez , Inquéritos e Questionários
17.
Creat Nurs ; 24(4): 258-262, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30567969

RESUMO

The stillbirth of her son prompted this nurse to look inside herself for the tools needed to move forward both personally and professionally. The first tasks were to learn how to trust herself again and find hope for the future. This journey prompted her to create a nonprofit organization, Star Legacy Foundation, that utilizes what she learned, and to expand her definition of what it means to be a health-care professional.


Assuntos
Fundações , Pais/psicologia , Natimorto/psicologia , Feminino , Humanos , Masculino
18.
J Obstet Gynecol Neonatal Nurs ; 47(6): 760-770, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30292774

RESUMO

OBJECTIVE: To explore the potential factors that mediate the relationship between mindfulness and symptoms of posttraumatic stress (PTS) in women who experienced stillbirth. DESIGN: A cross-sectional analysis of baseline data before women's participation in an online mindfulness intervention (i.e., online yoga). SETTING: This was a national study, and women participated in their own homes. PARTICIPANTS: Women who experienced stillbirth (N = 74) within the past 2 years and resided in the United States. METHODS: Women were recruited nationally, primarily through social media. Participants (N = 74) completed baseline assessments (self-report mental and physical health surveys) via a Web-based survey tool. We conducted an exploratory factor analysis of the COPE Inventory subscales to reduce the number of variables before entry into a mediation model. We then tested the mediation effects of sleep quality, self-esteem, resilience, and maladaptive coping on the relationship between mindfulness and PTS symptoms. RESULTS: Through the exploratory factor analysis we identified a two-factor solution. The first factor included nine subscales that represented adaptive coping strategies, and the second factor included five subscales that represented maladaptive coping strategies. Results from multiple mediation analysis suggested that mindfulness had a significant inverse relationship to PTS symptoms mediated by sleep quality. CONCLUSION: Mindfulness practices may have potential benefits for grieving women after stillbirth. Evidence-based approaches to improve sleep quality also may be important to reduce PTS symptoms in women after stillbirth.


Assuntos
Depressão , Atenção Plena/métodos , Natimorto , Transtornos de Estresse Pós-Traumáticos , Adaptação Psicológica , Adulto , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Feminino , Pesar , Humanos , Entrevista Psiquiátrica Padronizada , Gravidez , Resiliência Psicológica , Higiene do Sono , Natimorto/epidemiologia , Natimorto/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia
19.
Perspect Sex Reprod Health ; 50(3): 119-127, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29969174

RESUMO

CONTEXT: Women who view themselves as having difficulty becoming pregnant (i.e., being subfecund) may feel that they do not need to use contraceptives to prevent unintended pregnancy. However, subfecundity perceptions are not always medically accurate and may therefore confer a false sense of protection. The extent to which perceived fecundity is related to contraceptive use is not well understood. METHODS: Multinomial logistic regression was used to investigate the relationship between perceived fecundity at age 25-30 and contraceptive use among 2,091 women from the National Longitudinal Survey of Youth 1997 cohort. RESULTS: Compared with women who considered themselves very likely to become pregnant, those who thought that they were only somewhat likely and those who viewed themselves as not very likely to do so had significantly higher risks of not using contraceptives within the next year (risk ratios, 1.9 and 2.4, respectively). Results were similar in analyses controlling for either a medical diagnosis of infertility, a history of multiple miscarriages or stillbirths, or absence of pregnancy following at least six months of unprotected sex, suggesting that perceived subfecundity operates independently of experienced subfecundity. CONCLUSION: Because few studies have investigated fecundity perceptions in their own right, more research is needed to understand how women evaluate their fecundity and to integrate these perceptions into broader frameworks describing women's perception of pregnancy risk. Such work may help identify potential levers to improve contraceptive use.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Fertilidade , Aborto Habitual/psicologia , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Infertilidade Feminina/psicologia , Estudos Longitudinais , Razão de Chances , Percepção , Gravidez , Natimorto/psicologia , Sexo sem Proteção/psicologia
20.
BMC Pregnancy Childbirth ; 18(1): 302, 2018 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-30012104

RESUMO

BACKGROUND: Pakistan has the highest rate of stillbirths globally. Not much attention has been given so far to exploring the sociocultural factors hindering the reportage of stillbirths and the causes of death. Therefore, the aim of this study was to assess the perspectives of parents, communities and healthcare providers regarding the sociocultural practices and health system-related factors contributing to stillbirths and their underreporting. METHODS: This study used a qualitative approach including in-depth interviews and 14 focus group discussions to collect data from four districts of Pakistan. We conducted 285 in-depth interviews and 14 focus group discussions with health professionals - mainly active in the areas of maternal and child health - and parents who had experienced stillbirth. Constant comparative method and analytical induction method were performed to analyze the data. RESULTS: The results of this study show that stillbirth is frequently misclassified and, therefore, an underreported phenomenon in Pakistan. It is an outcome of sociocultural practices, such as the social meaning of stillbirth and their understanding about the conflict between cultural and medical anatomy. In addition to grief and psychological distress, it endangers the maternal identity and worth in society in contrast to the mothers of live-born children. CONCLUSION: The misclassification of stillbirth, especially by healthcare providers, is a significant impediment to designing preventive strategies for stillbirth. We recommend that the reporting system for stillbirth should be aligned with the WHO definition of stillbirth to avoid its underreporting. Reporting procedures at a more administrative level need to be made uniform and simplified.


Assuntos
Cultura , Nascimento Vivo , Serviços de Saúde Materno-Infantil , Mães/psicologia , Natimorto , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Nascimento Vivo/epidemiologia , Nascimento Vivo/psicologia , Serviços de Saúde Materno-Infantil/normas , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , /estatística & dados numéricos , Paquistão/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Pesquisa Qualitativa , Percepção Social , Natimorto/epidemiologia , Natimorto/etnologia , Natimorto/psicologia
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