Referral and attendance at a specialist antenatal clinic: qualitative study of women's views

Experiences of women with hypertensive disorders of pregnancy: a scoping review

Background

Hypertensive disorders of pregnancy (HDP) constitute one of the leading causes of maternal and perinatal mortality worldwide, and are associated with an increased risk of recurrence and future cardiovascular disease. HDP affect women’s health condition, mode of birth and timing, length of hospital stay, and relationship with their newborn and family, with future life repercussions.

Aims

To explore the experiences of women with HDP from pregnancy to postpartum, and to identify (a) their perceptions and understanding of HDP, (b) their understanding of future health risks, and (c) the possible interventions by healthcare providers.

Methods

A scoping review was conducted following the Joanna Briggs Institute method and in accordance with the PRISMA-ScR checklist. The following databases were searched from 1990 to 2020 (October): MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, PsycINFO, and Google Scholar database. The Critical Appraisal Skills Programme (CASP) checklist was used as a guide for the qualitative analysis. Content analysis and synthesis of findings were conducted using Nvivo12.

Results

Of the 1971 articles identified through database searching, 16 articles met the inclusion criteria. After data extraction, content analysis yielded six categories: ‘Life-threatening disorder’, ‘Coping with HDP’, ‘Concerns for baby and challenges of motherhood’, ‘Fear of recurrence and health problems’, ‘Necessity of social and spiritual support’, and ‘Positive and negative experiences in the healthcare context’. Women faced complex difficulties from the long treatment process while transitioning to motherhood.

Conclusion

Our findings revealed the perceptions and understanding of women regarding HDP as a life-threatening disorder to both mothers and their babies which mothers need to cope with. Recovery of physical condition and the long-term psychological effects of HDP on women should be given attention by mothers and HCP to reduce future health risks. Importantly, a lifelong follow-up system is recommended for women with HDP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04463-y.

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.

Women's perceptions and experiences of severe maternal morbidity--a synthesis of qualitative studies using a meta-ethnographic approach

BACKGROUND

maternal mortality is a relatively rare event in high-income countries and some middle-income countries. There is however a rising trend in the overall rate of severe maternal morbidity in many of these countries due to the increasingly complex obstetric and medical needs of women who become pregnant. With the aim to identify how women's experiences of health services following severe maternal morbidity could be improved, we explored women's perceptions and experiences of severe maternal morbidity (defined as major obstetric haemorrhage, severe preeclampsia, eclampsia, HELLP syndrome, critical care unit admission) by synthesising evidence from qualitative studies.

METHODS

a systematic search of the literature was conducted using multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index (BNI), Web of Science and Scopus, using predetermined search strategies. Studies were selected based on pre-defined inclusion and exclusion criteria. The methodological quality of selected qualitative studies was assessed using relevant CASP appraisal tools. Evidence synthesis was undertaken using meta-ethnography. The synthesis involved three steps: (1) ascertaining how studies were related or dissimilar through comparison; (2) translating one study's findings into another and (3) synthesis of the translation.

FINDINGS

12 studies met inclusion criteria. Synthesis of these studies showed that women's experiences of severe maternal morbidity can be broadly categorised into three areas: experiencing the event of severe maternal morbidity, the immediate reaction to the event (physical experience, perception/interpretation of their situation, and emotion), and the aftermath (either a negative or positive experience), which are all interconnected. Women's experiences of severe maternal morbidity may be influenced by other factors such as the individuals' personal characteristics, pre-existing health conditions, feeling safe within the care provided, availability and accessibility of high quality health care, and their wider social support networks. Importantly, women's perceptions and experiences of severe maternal morbidity could be compounded by inadequate clinical management and care.

CONCLUSIONS

an experience of severe maternal morbidity and its subsequent management are physically and emotionally distressing, conjuring negative feelings and emotions and possibly poor postnatal outcomes. Findings suggest the importance of ensuring that the safety and quality of intrapartum interventions and models of postnatal care are enhanced, to reduce or prevent subsequent implications of an acute medical event on women and their families.

A metasynthesis of risk perception in women with high risk pregnancies

INTRODUCTION

risk perception in women with high risk pregnancies affects their decisions about perinatal care and is of interest to anyone involved in the care of pregnant women. This paper provides a metasynthesis of qualitative studies of risk perception in women with high risk pregnancies.

METHODS

a systematic search of eight electronic databases was conducted. Additional papers were obtained through searching references of identified articles. Six studies were identified that reported qualitative research into risk perception in relation to high risk pregnancy. A metasynthesis was developed to describe and interpret the studies.

FINDINGS

the synthesis resulted in the identification of five themes: determinants of risk perception; not seeing it the way others do; normality versus risk; if the infant is ok, I׳m ok; managing risk.

CONCLUSIONS

this metasynthesis suggests women at high risk during pregnancy use multiple sources of information to determine their risk status. It shows women are aware of the risks posed by their pregnancies but do not perceive risk in the same way as healthcare professionals. They will take steps to ensure the health of themselves and their infants but these may not include following all medical recommendations.

Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes

BACKGROUND

Amongst the risk factors for preterm birth, previous preterm delivery is a strong predictor. Specialised clinics for women with a history of spontaneous preterm delivery have been advocated as a way of improving outcomes for women and their infants.

OBJECTIVES

To assess using the best available evidence, the value of specialised antenatal clinics for women with a pregnancy at high risk of preterm delivery when compared with 'standard' antenatal clinics.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011).

SELECTION CRITERIA

All published, unpublished, and ongoing randomised controlled trials (including cluster-randomised trials) examining specialised compared with standard antenatal clinic care for women with a singleton pregnancy considered at high risk of preterm labour.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data.

MAIN RESULTS

We included three trials with 3400 women, all carried out in the USA. All focused on specialised clinics for women at high risk of preterm birth. Gestational age at delivery, preterm delivery, or both were primary outcomes in all studies. The interventions in the three trials differed.Overall there was very little data on our prespecified outcomes. For most outcomes a single study provided data, hence there was not the statistical power to detect any possible differences between groups. There was no clear evidence that specialised antenatal clinics reduce the number of preterm births.

AUTHORS' CONCLUSIONS

Specialised antenatal clinics are now an accepted part of care in many settings, and carrying out further randomised trials may not be possible. Any future research in this area should include psychological outcomes and should focus on which aspects of service provision are preferred by women. Such research could underpin further service development in this area.

Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care

BACKGROUND

Despite improvements over the past two decades, caries and its treatment remain a problem for Scottish children.

AIM

To investigate how the reported childhood dental care experiences of a group of Scottish parents impacted upon the dental treatment they accessed for their children.

STUDY DESIGN

In-depth, semi-structured interviews were conducted with 19 parents of varied age and social background whose children were referred to Dundee Dental Hospital for the assessment of dental extractions. Parents were encouraged to discuss their own and their child's experiences of dental care. The interview data were systematically coded using key theme headings, and summary charts constructed to facilitate the analysis.

RESULTS

A sense of 'uneasiness' pervaded the parents' comments and perceptions of the dental care provided for their children. This was conceptualized as parents 'remembering in words' and 'repeating through actions' their own childhood dental experiences. They remembered and repeated their childhood experiences by delaying dental treatment for themselves and their children.

CONCLUSIONS

Acknowledging the influence of parental dental experience would help ensure that parents of young children access routine care for their children and themselves.