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Arrebola JP, Muñoz A, Ferrero S, Larrea-Killinger C. Perceptions and Attitudes of Gynecologic and Pediatric Professionals Regarding Dietary Exposure to Chemical Pollutants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113946. [PMID: 32498397 PMCID: PMC7312743 DOI: 10.3390/ijerph17113946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
There is increasing concern regarding the potential implications of continuous dietary exposure to low doses of artificial chemical pollutants, particularly in critical life stages such as pregnancy and lactation. Within a wider social research, we analyzed the risk perception, discourses, and attitudes of health professionals regarding dietary exposure to artificial chemical contaminants. Data was collected by personal interviews on 35 health professionals from two Spanish regions. Although the participants' discourses were strongly dominated by the nutritional composition and microbiological contamination, 34 expressed some concern regarding metals, and 23 regarding pesticides. Although only one participant mentioned a plasticizer (i.e., bisphenol A), we noted an underlying concern, since six professionals admitted to recommending pregnant women to somewhat avoid plastic food containers, and were aware of mother-to-child transmission and accumulation of artificial chemicals. The ubiquity of the exposure, the inability to locate the threat, and contradictory messages can all create a sense of helplessness and subsequent cognitive adjustments. Our participants also reported a lack of information, particularly on emerging pollutants. In conclusion, we found a range of valuable discourses that can aid in orienting public health strategies aimed at health professionals who have a substantial influence on their patients.
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Affiliation(s)
- Juan Pedro Arrebola
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Correspondence:
| | - Araceli Muñoz
- School of Social Work, University of Barcelona, 08035 Barcelona, Spain;
- Food Observatory, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain
| | - Silvia Ferrero
- Obstetrics and Gynecology, Sant Joan de Déu University Hospital, 08950 Barcelona, Spain;
| | - Cristina Larrea-Killinger
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Food Observatory, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain
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Johnson AR, Kumar MG, Jacob R, Jessie MA, Mary F, Agrawal T, Raman V. Fear of Childbirth among Pregnant Women Availing Antenatal Services in a Maternity Hospital in Rural Karnataka. Indian J Psychol Med 2019; 41:318-322. [PMID: 31391663 PMCID: PMC6657479 DOI: 10.4103/ijpsym.ijpsym_292_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Pregnancy, though joyful, may be a time of fear and anxiety. Twenty percent of pregnant women in developed nations report a fear of childbirth, and 6%-10% describe a severe fear that is crippling. This could lead to adverse maternal and fetal outcomes. Data on fear of childbirth among pregnant women are lacking in India and would help in incorporating measures to enhance routine antenatal care. METHODOLOGY With the objective of documenting fear of childbirth and associated factors, a cross-sectional study was conducted in rural Karnataka among women availing antenatal care services, using a face-validated 30 item questionnaire developed by the authors which was then scored to determine fear of childbirth. RESULTS Of 388 women studied, 45.4% (176) had a fear of childbirth. The commonest fears documented were: not feeling confident about childbirth, being afraid or tense about the process of childbirth, fear of labor pains, and fear of cesarean section. Teenage pregnancy, nulliparity, primigravida status, and having no living child were significantly associated with fear of childbirth. CONCLUSION Overall, 45.4% (176) of women had a fear of childbirth. It is important to identify and address the various fears of childbirth that women may have, as revealed by this study, with a view to providing information and reassurance to the mother, with the aim of improved maternal and fetal outcomes.
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Affiliation(s)
- Avita Rose Johnson
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - Melvin G Kumar
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - Rosy Jacob
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - Maria Arul Jessie
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - Fabiyola Mary
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - Twinkle Agrawal
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - Vijaya Raman
- Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India
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Understanding the EMR-Related Experiences of Pregnant Japanese Women to Redesign Antenatal Care EMR Systems. INFORMATICS 2019. [DOI: 10.3390/informatics6020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Woman-centered antenatal care necessitates Electronic Medical Record (EMR) systems that respect women’s preferences. However, women’s preferences regarding EMR systems in antenatal care remain unknown. This work aims to understand the EMR-related experiences that pregnant Japanese women want. First, we conducted a field-based observational study at an antenatal care clinic at a Japanese university hospital. We analyzed the data following a thematic analysis approach and found multiple EMR-related experiences that pregnant women encounter during antenatal care. Based on the observations’ findings, we administered a web survey to 413 recently pregnant Japanese women to understand their attitudes regarding the EMR-related experiences. Our results show that pregnant Japanese women want accessible, exchangeable, and biopsychosocial EMRs. They also want EMR-enabled explanations and summaries. Interestingly, differences in their demographics and stages of pregnancy affected their attitudes towards some EMR-related experiences. To respect their preferences, we propose amplifying the roles of EMR systems as tools that promote communication and woman-centeredness in antenatal care. We also propose expanding the EMR design mindset from a biomedical to a biopsychosocial-oriented one. Finally, to accommodate the differences in individual needs and preferences, we propose the design of adaptable person-centered EMR systems.
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Abstract
AIM To report an analysis of the concept of risk perception in pregnancy. BACKGROUND Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women. DESIGN Walker and Avant's method was selected to guide this analysis. DATA SOURCES Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied. METHODS Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified. RESULTS The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept. CONCLUSION Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.
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Affiliation(s)
- Suzanne Lydia Lennon
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Van Wagner V. Risk talk: Using evidence without increasing fear. Midwifery 2016; 38:21-8. [PMID: 27174012 DOI: 10.1016/j.midw.2016.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 04/03/2016] [Accepted: 04/15/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE this paper explores unexpected findings about how to "do risk talk" which emerged during a broader research project on of the application and misapplication of evidence-based practice in Canada. DESIGN the study used qualitative methods such as semi-structured interviews and thematic analysis of inter-professional maternity care conference presentations. SETTING Canada PARTICIPANTS fifty Canadian midwives, doctors and nurses involved in maternity care were interviewed to uncover the "how and whys" of differing interpretations and uneven application of evidence. RESULTS care providers described a "lean to technology" as an unexpected result of using evidence in their discussions with pregnant women. They perceived risk talk as undermining low intervention approaches and reassurance about the safety of birth. Across professional groups, interviewees described how they attempted to mitigate this unwanted effect. Their strategies to put risk in perspective include finding comparable everyday risks, using words and pictures to describe numbers and using absolute risk and numbers needed to treat rather than relative risk. They warned about the need to balance a culture of fear combined with maternal altruism. Time, reassurance, awareness and humility were seen as key tools. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE midwives and other maternity care providers can use a variety of techniques to put risk into perspective. It is important to discuss evidence and risk with an awareness that the process itself can exaggerate risk. Care providers in all professional groups were motivated to avoid contributing to a culture of fear about childbirth and increasing rates of intervention.
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Richens Y, Hindley C, Lavender T. A national online survey of UK maternity unit service provision for women with fear of birth. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.8.574] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yana Richens
- Consultant Midwife University College of London Hospital PhD Student NIHR Clinical Academic Training Doctoral Research Fellow Manchester University
| | | | - Tina Lavender
- Profesor of Midwifery Director of the Centre for Global Women's Health University of Manchester
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Jaju S, Al Kharusi L, Gowri V. Antenatal prevalence of fear associated with childbirth and depressed mood in primigravid women. Indian J Psychiatry 2015; 57:158-61. [PMID: 26124521 PMCID: PMC4462784 DOI: 10.4103/0019-5545.158152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM To investigate the antenatal prevalence of fear of childbirth and its association with depressed mood in low-risk primigravidae in a referral teaching hospital. SETTINGS AND DESIGN The study was conducted in a tertiary referral center catering to three districts in the state of Kerala. This was a cross-sectional study with internal comparison of associated factors. MATERIALS AND METHODS Malayalam translation (translation back translation) of Edinburgh Postnatal Depression Scale (EPDS) was self-administered by the participants. It was followed by a structured interview based on the International Classification of Diseases 10 (ICD 10) after which the EPDS scale was scored. STATISTICAL ANALYSIS Chi-square test was used to compare the presence of fear in women with a EPDS of ≥ 12 and the association of fear and depression. RESULTS Fear associated with childbirth was expressed by 17.7% women. The prevalence of depressed mood based on the EPDS (score > 12) was 9.8% but based on the ICD 10 criteria, the prevalence of depression was 8.7%. A significant number of women with depressed mood and clinical depression had fear of childbirth of some sort. CONCLUSIONS A significant number of primigravid women with depressed mood and clinical depression had fear of childbirth of some sort.
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Affiliation(s)
- Sanjay Jaju
- Department of Research, Ministry of Health, Oman
| | - Lamya Al Kharusi
- Department of Obstetrics and Gynecology, Sultan Qaboos University, Oman
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Relative bodies of knowledge: Therapeutic dualism and maternal–foetal individuation. SOCIAL THEORY & HEALTH 2014. [DOI: 10.1057/sth.2013.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Suzanne Lee
- Lecturer in Midwifery City University London
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Stoll K, Hall W, Janssen P, Carty E. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery 2013; 30:220-6. [PMID: 23968778 DOI: 10.1016/j.midw.2013.07.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE to examine attitudes towards birth that may be common among young adults who have been socialised into a medicalised birth culture. Specifically, we were interested in examining factors that might be associated with fear of birth and preferences for elective obstetric interventions among the next generation of maternity care consumers. DESIGN secondary analysis of an online survey of university students. SETTING British Columbia, Canada. PARTICIPANTS students from the University of British Columbia (n=3680). A quarter of the sample comprised Asian students, which allowed for analysis of cultural differences in attitudes towards birth. Both male and female students participated in the study; results are reported for the full sample, and by gender. MEASUREMENTS a six item fear of childbirth scale was developed, as well as a 4 item index that measures students' concerns over physical changes following pregnancy and birth and a 2 item scale that assesses students' attitudes towards obstetric technology. FINDINGS as we hypothesised, students who were more fearful of birth preferred epidural anaesthesia and birth by CS. Worries over physical changes following pregnancy and birth, favourable attitudes towards obstetric technology, and exposure to pregnancy and birth information via the media were also significantly associated with a preference for CS. Fear of birth scores were highest among students who reported that the media had shaped their attitudes towards pregnancy and birth. Asian students had significantly higher fear of birth scores and were more likely to prefer CS, compared to Caucasian students. IMPLICATIONS FOR PRACTICE young adults are contemplating pregnancy and birth in an increasingly technology-dependent society. Educational programmes aimed at reducing fear of childbirth and concerns over physical changes following pregnancy and childbirth might contribute to vaginal birth intentions among young adults. Midwives may use the findings to identify and counsel nulliparas who exhibit fear of birth and other childbirth attitudes that may predispose them to choose elective obstetric interventions.
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Affiliation(s)
- Kathrin Stoll
- Division of Midwifery, University of British Columbia, B54-2194 Health Sciences Mall, Vancouver, British Columbia, Canada V6T 1Z3.
| | - Wendy Hall
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Patricia Janssen
- School of Population & Public Health, University of British Columbia, Rm 103, 2206 East Mall, Vancouver, British Columbia, Canada V6T 1Z3.
| | - Elaine Carty
- Division of Midwifery, University of British Columbia, B54-2194 Health Sciences Mall, Vancouver, British Columbia, Canada V6T 1Z3
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Hammer RP, Burton-Jeangros C. Tensions around risks in pregnancy: a typology of women's experiences of surveillance medicine. Soc Sci Med 2013; 93:55-63. [PMID: 23906121 DOI: 10.1016/j.socscimed.2013.05.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 11/20/2022]
Abstract
The experience of pregnancy is currently driven by the development of surveillance medicine focused on the monitoring of a wide range of risks. Research usually relies on binary categories opposing women accepting medical surveillance to those resisting it. Recent studies have however underlined the complexity of women's experiences, as well as the ambivalence of their attitudes toward medical procedures and recommendations. Based on 47 qualitative semi-structured interviews conducted in Switzerland between 2008 and 2009, this paper presents the diversity of pregnant women's experiences of surveillance medicine through the description of four contrasting groups: "endorsing surveillance medicine", "coping with risks", "striving for certainty" and "questioning surveillance medicine". Taking into account various risks related to pregnancy, these empirically-grounded groups are discussed in relation to the cultural dynamics of contemporary risk discourses.
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Affiliation(s)
- Raphaël P Hammer
- University of Health Sciences, Institute of Health Research, 21, av. de Beaumont, 1011 Lausanne, Switzerland.
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Bayrampour H, Heaman M, Duncan KA, Tough S. Predictors of perception of pregnancy risk among nulliparous women. J Obstet Gynecol Neonatal Nurs 2013; 42:416-27. [PMID: 23773117 DOI: 10.1111/1552-6909.12215] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine factors associated with perception of pregnancy risk using a conceptual framework based on a review of the relevant literature and the psychometric model of risk perception. DESIGN A correlational study. SETTING Ambulatory care and antepartum units of two tertiary hospitals and selected obstetricians' offices and prenatal classes in Winnipeg, Canada. PARTICIPANTS A convenience sample of nulliparous women in their third trimester with a singleton pregnancy. METHODS Between December 2009 and January 2011, the following questionnaires were completed by 159 nulliparous women: the Perception of Pregnancy Risk Questionnaire, the Pregnancy-related Anxiety scale, Knowledge of Maternal Age-related Risks of Childbearing Questionnaire, the SF-12v2 Health Status Survey, the Multidimensional Health Locus of Control, and the Prenatal Scoring Form. Pearson's r correlations and stepwise multivariable linear regression analyses were conducted to achieve the research objectives. RESULTS Of the eight proposed factors in the conceptual framework, five factors were significant predictors of perception of pregnancy risk, including pregnancy-related anxiety, maternal age, medical risk, perceived internal control, and gestational age, accounting for 47% to 49% of the variance in risk perception. An interaction between the pregnancy-related anxiety score and maternal age was found. CONCLUSIONS These results contribute to the literature on perception of pregnancy risk by identifying a new predictor (gestational age), supporting the role of previously known factors in the state of pregnancy, and proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. This knowledge may have implications for developing more effective risk communication models.
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Affiliation(s)
- Hamideh Bayrampour
- Department of Pediatrics, University of Calgary, Alberta Centre for Child, Family & Community Research, Child Development Centre, 2888 Shaganappi Trail NW, Calgary, Alberta.
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Lee S, Ayers S, Holden D. A metasynthesis of risk perception in women with high risk pregnancies. Midwifery 2013; 30:403-11. [PMID: 23770044 DOI: 10.1016/j.midw.2013.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 04/17/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Suzanne Lee
- School of Health Sciences, City University, London, England, UK.
| | - Susan Ayers
- School of Health Sciences, City University, London, England, UK
| | - Des Holden
- Surrey and Sussex Healthcare NHS Trust, Surrey, England, UK
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Lee S, Ayers S, Holden D. Risk perception of women during high risk pregnancy: A systematic review. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2012.701277] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Béland M, Chabot K, Goulet Gervais L, Morin A, Gosselin P. Évaluation de la peur de l’accouchement. Validation et adaptation française d’une échelle mesurant la peur de l’accouchement. Encephale 2012; 38:336-44. [DOI: 10.1016/j.encep.2011.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 06/16/2011] [Indexed: 10/15/2022]
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Melas PA, Georgsson Öhman S, Juth N, Bui TH. Information Related to Prenatal Genetic Counseling: Interpretation by Adolescents, Effects on Risk Perception and Ethical Implications. J Genet Couns 2011; 21:536-46. [DOI: 10.1007/s10897-011-9418-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 10/06/2011] [Indexed: 11/28/2022]
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Adams J, Sibbritt D, Lui CW. The use of complementary and alternative medicine during pregnancy: a longitudinal study of Australian women. Birth 2011; 38:200-6. [PMID: 21884228 DOI: 10.1111/j.1523-536x.2011.00480.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine is increasingly prevalent in contemporary Western societies. The objective of this study was to explore trends and patterns in complementary and alternative medicine practitioner consultations and the use of complementary and alternative medicine consumption before, during, and after pregnancy and between pregnancies. METHODS Analysis focused on data from 13,961 women from the younger cohort of the Australian Longitudinal Study on Women's Health collected between 1996 and 2006. Chi-square tests were employed for the cross-sectional analysis of categorical variables and t tests for continuous variables. Generalized estimating equations were used to conduct multivariate longitudinal analysis. RESULTS Complementary and alternative medicine use among pregnant and nonpregnant women continued to increase over the 10-year period. Although pregnancy status was not predictive of the use of alternative treatments, pregnant women employed these therapies or modalities for the relief of pregnancy-related complaints and symptoms. Analysis also revealed that women used complementary and alternative treatments selectively during pregnancy. CONCLUSIONS This study highlights the need for further research that is sensitive to the consumption of specific complementary and alternative therapies or modalities and to the wider contexts within which women perceive risk associated with their use of complementary and alternative treatments.
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Affiliation(s)
- Jon Adams
- School of Population Health, University of Queensland, Brisbane, Australia
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Dahlen HG, Barclay L, Homer CS. ‘Reacting to the unknown’: experiencing the first birth at home or in hospital in Australia. Midwifery 2010; 26:415-23. [DOI: 10.1016/j.midw.2008.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 05/27/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
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Risk assessment and risk distortion: finding the balance. J Midwifery Womens Health 2009; 54:191-200. [PMID: 19410211 DOI: 10.1016/j.jmwh.2009.02.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/15/2009] [Accepted: 02/04/2009] [Indexed: 11/23/2022]
Abstract
Pregnancy and birth have been conceptualized as medically problematic, with all pregnant women considered at risk and in need of medical monitoring. Universal application of risk scoring and surveillance as preemptive strategies in an effort to reduce risk is now standard obstetric practice. Labeling women "high risk" can result in more unnecessary interventions and have negative psychologic sequelae. When perceived pregnancy risk is out of proportion to the real risk, and when risk management procedures are applied to all women with benefit for only a few, the use of technology in caring for pregnant women becomes normalized. A learned reliance on technology can diminish women's own authoritative knowledge of pregnancy and birth. This may also have the unintended consequence of contributing to birth fear, a phenomena becoming more widely recognized. Health care provider-patient communication about pregnancy risk can be presented in a manner that encourages informed compliance rather than informed choice. Evidence-based risk assessment is essential to providing optimal prenatal care. Using tools such as the Paling Palette can help health care providers present balanced and readily understood information about risk.
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Carlsson IM, Hallberg LRM, Odberg Pettersson K. Swedish women's experiences of seeking care and being admitted during the latent phase of labour: A grounded theory study. Midwifery 2009; 25:172-80. [PMID: 17600602 DOI: 10.1016/j.midw.2007.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 02/03/2007] [Accepted: 02/06/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour. DESIGN a qualitative interview study using the grounded theory approach. SETTING the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600-1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth. PARTICIPANT eighteen Swedish women, aged 22-36, who were admitted to the labour ward while they were still in the latent phase of labour. FINDINGS 'Handing over responsibility' to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of labour and their experiences of the latent phase of labour. The categories, which all related to the core category, were labelled: (1) 'longing to complete the pregnancy,' (2) 'having difficulty managing the uncertainty,' (3) 'having difficulty enduring the slow progress,' (4) 'suffering from pain to no avail' and (5) 'oscillating between powerfulness and powerlessness.' CONCLUSIONS AND IMPLICATIONS FOR PRACTICE findings indicate that women being admitted to the labour ward in the latent phase of labour experienced a need for handing over responsibility for the labour, the well-being of the unborn baby, and for themselves. Midwives have an important role in assisting women with coping during the latent phase of labour, and in giving the women opportunity to hand over responsibility. This care should include validation of experienced pain and confirmation of the normality of the slow process, information and support.
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Affiliation(s)
- Ing-Marie Carlsson
- School of Social and Health Sciences, Halmstad University, PO Box 823, SE-301 18 Halmstad, Sweden.
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Fenwick J, Gamble J, Nathan E, Bayes S, Hauck Y. Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women. J Clin Nurs 2009; 18:667-77. [DOI: 10.1111/j.1365-2702.2008.02568.x] [Citation(s) in RCA: 188] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Georgsson Ohman S, Grunewald C, Waldenström U. Perception of risk in relation to ultrasound screening for Down's syndrome during pregnancy. Midwifery 2007; 25:264-76. [PMID: 17920172 DOI: 10.1016/j.midw.2007.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 04/02/2007] [Accepted: 04/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE to explore how information about being at risk of carrying a fetus with Down's syndrome was understood, and whether the actual risk and the woman's perception of risk was associated with worry or depressive symptoms during and after pregnancy. DESIGN AND SETTING observational study. The sample was drawn from the intervention group of a Swedish randomised controlled trial of ultrasound screening for Down's syndrome by nuchal translucency measurement. MEASUREMENTS data were collected by three questionnaires. Questions were asked about recall of the risk score and perception of risk. The Cambridge Worry Scale and the Edinburgh Postnatal Depression Scale measured worry and depressive symptoms, respectively, on all three occasions. FINDINGS of the 796 women who provided data for this study, one in five was unaware that the risk score was noted in her case record. In total, 620 women stated that they had received a risk score, but only 64% of them recalled the figure exactly or approximately. The actual risk was associated with the perceived risk, but of the 31 women who perceived the risk to be high, only 14 were actually at high risk. A high-risk score was not associated with worry or depressive symptoms in mid-pregnancy, in contrast to a woman's own perception of being at high risk. Two months postpartum, no associations were found between maternal emotional well-being and actual or perceived risk. CONCLUSIONS information about fetal risk is complicated and women's perception of risk does not always reflect the actual risk, at least not when presented as a numerical risk score. The possibility that the information may cause unnecessary emotional problems cannot be excluded. IMPLICATIONS FOR PRACTICE caregivers should ascertain that information about fetal risk is interpreted correctly by pregnant women.
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Affiliation(s)
- Susanne Georgsson Ohman
- Department of Woman and Child Health, Karolinska Institutet, Sophiahemmet University College, Box 5605, Stockholm SE-114 86,
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Doust J, Mannes P, Bastian H, Edwards AGK. Interventions for improving understanding and minimising the psychological impact of screening. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd001212.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hauck Y, Fenwick J, Downie J, Butt J. The influence of childbirth expectations on Western Australian women's perceptions of their birth experience. Midwifery 2006; 23:235-47. [PMID: 17097202 DOI: 10.1016/j.midw.2006.02.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 01/16/2006] [Accepted: 02/08/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. DESIGN a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. SETTING Perth, Western Australia. PARTICIPANTS 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. FINDINGS the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. IMPLICATIONS FOR PRACTICE the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.
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Affiliation(s)
- Yvonne Hauck
- Curtin University of Technology, School of Nursing and Midwifery, Perth, WA, Australia.
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Fisher C, Hauck Y, Fenwick J. How social context impacts on women's fears of childbirth: a Western Australian example. Soc Sci Med 2006; 63:64-75. [PMID: 16476516 DOI: 10.1016/j.socscimed.2005.11.065] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 11/30/2005] [Indexed: 11/17/2022]
Abstract
This paper addresses the limited sociological understanding of the phenomena of childbirth fear using data from a qualitative research project conducted in Western Australia. This qualitative study used an exploratory descriptive design, with 22 women identified as being fearful of birth participating in an in-depth interview. Data analysis using the method of constant comparison revealed that social context, explored within the framework of the medicalisation of childbirth, and the intervening circumstances in which the women gave birth, impacted on how and why they experienced fear. As such, this paper argues that fear of childbirth has social as well as personal dimensions and is both a prospective and retrospective phenomena. The analysis identified prospective fear as both social and personal. The social dimensions were labelled as 'fear of the unknown', 'horror stories' and 'general fear for the well-being of the baby'. Personal dimensions included the 'fear of pain', 'losing control and disempowerment' and 'uniqueness of each birth'. Retrospective fear was exclusively personal and was clustered around the themes of 'previous horror birth' and 'speed of birth'. The analysis also revealed two central factors that mediated against childbirth fear: positive relationships formed with midwives, and the support women received from their informal network. Understanding and unpacking the dimensions of women's childbirth fear, and understanding the nature of relationships that mediate women's fear, provides health care professionals with information on which to base potential intervention strategies and support women in ways that lessen rather than heighten their fear.
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Hofberg K, Ward MR. Fear of Childbirth, Tocophobia, and Mental Health in Mothers: The Obstetric–Psychiatric Interface. Clin Obstet Gynecol 2004; 47:527-34. [PMID: 15326415 DOI: 10.1097/01.grf.0000132527.62504.ca] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kristina Hofberg
- Department of General Adult Psychiatry, Trust HQ, St. George's Hospital, Stafford, United Kingdom.
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Rostant K, Steed L, O'Leary P. Prenatal screening and diagnosis: a survey of health care providers' knowledge and attitudes. Aust N Z J Obstet Gynaecol 2004; 43:307-11. [PMID: 14714717 DOI: 10.1046/j.0004-8666.2003.00079.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To survey the knowledge and attitudes of health care providers in Western Australia, Australia towards prenatal screening and diagnostic procedures for fetal anomalies. DESIGN A self-administered mail survey. SAMPLE 30 obstetricians and 313 general practitioners (GPs). RESULTS Overall, relative to GPs, obstetricians expressed more positive attitudes towards prenatal tests. Moreover, GPs felt they had a greater need for additional information. Further group differences were found in attitudes towards the value of the tests and confidence in the availability and ease of coordination of follow-up services according to geographical area. Female health care providers were significantly more confident about the availability of follow-up services and had higher knowledge scores. They were also more likely to practice in the metropolitan area. Further group differences were found in attitudes according to participation in professional development. CONCLUSION Overall, health care providers felt antenatal screening and diagnostic tests were valuable and they felt they could benefit from further information. Knowledge was high, however, it is unclear whether this knowledge is being communicated to women. Given that antenatal practices are rapidly evolving, continuing education and ongoing professional development is critical.
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Affiliation(s)
- Kristie Rostant
- Genomics Directorate, Department of Health, Western Australia, Australia
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Rostant K, Steed L, O'Leary P. Survey of the knowledge, attitudes and experiences of Western Australian women in relation to prenatal screening and diagnostic procedures. Aust N Z J Obstet Gynaecol 2004; 43:134-8. [PMID: 14712969 DOI: 10.1046/j.0004-8666.2003.00041.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the knowledge, attitudes and experiences of women in Western Australia (WA) regarding prenatal procedures. DESIGN A self-administered mail survey. SAMPLE The survey was sent to all women who gave birth during July 2001 (n = 1801). The participants were 633 women aged 15-45. RESULTS The mean total knowledge score was 16 out of a possible 26 (62%). The average score for all three attitude factors was four, 'agree', on a Likert scale of five. Women who reported they had private health insurance and women in the metropolitan area had significantly higher knowledge levels and had significantly more positive attitudes towards the adequacy of information. Those who did not have a screening test had less positive attitudes towards the value of the tests and had less confidence in results. Those with higher educational attainments had higher knowledge and less positive attitudes towards the value of the tests. CONCLUSIONS Women felt positive towards the value of the tests, were confident in their results and felt positive towards the adequacy of information; however, their understanding of this information seems to be poor. It seems that the choice to undergo testing is not well informed. It was clear women need more support, information, explanations, and more time to absorb the information.
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Affiliation(s)
- Kristie Rostant
- Genomics Branch, Department of Health, Perth, Western Australia, Australia
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Abstract
Pregnancy is a major life event for all women. However, when a psychiatric disorder is added to or exacerbated by the pregnancy then the problem requires expert knowledge from more than one area of medicine. This paper looks at pregnancy and the relationship with depression, eating disorders, and pathological fear of childbirth or tokophobia. It also examines the outcome for these women and their babies. Mental illness is a serious concern. It is now recognised that death from suicide is the leading cause of maternal death overall. Research in these areas is relatively sparse but an attempt is made to collate what is known.
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Affiliation(s)
- K Hofberg
- South Staffordshire Healthcare NHS Trust, St George's Hospital, Stafford, UK.
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Darbyshire P, Collins C, McDonald HM, Hiller JE. Taking antenatal group B Streptococcus seriously: women's experiences of screening and perceptions of risk. Birth 2003; 30:116-23. [PMID: 12752169 DOI: 10.1046/j.1523-536x.2003.00230.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Early-onset group B streptococcal disease is a serious cause of neonatal morbidity and mortality. Although screening protocols for group B streptococcus are common, little is known of women's perceptions of this screening and the disease itself. The purpose of this study was to gain an understanding of women's experiences, knowledge, and perceptions about this bacteria and its screening. METHODS Nine focus group interviews with 35 women explored their experiences and understanding of group B streptococcus screening. Transcribed interview data were interpreted to identify and articulate the women's experiences. RESULTS Most women had little knowledge or understanding of group B streptococcus, obtaining their information largely from the stories or experiences of friends or family. Women struggled to understand the meaning and implications, both physical and "moral," of the disease for their baby and for themselves, clearly indicating both the subjective and statistical importance of the concept of risk for pregnant women. CONCLUSIONS Group B streptococcus continues to be poorly understood by pregnant women who try to understand and weigh up its risks and implications so as to make the best decisions about screening. The women participated in screening ultimately, however, since it was seen to be patently "best for baby," relatively easy for them to undergo, and part of routine antenatal care.
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Affiliation(s)
- Philip Darbyshire
- Department of Nursing and Midwifery Research & Practice Development, Women's & Children's Hospital, University of South Australia, North Adelaide, South Australia, Australia
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Zar M, Wijma K, Wijma B. Relations between anxiety disorders and fear of childbirth during late pregnancy. Clin Psychol Psychother 2002. [DOI: 10.1002/cpp.305] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cĵté-Arsenault D, Dombeck MT. Maternal assignment of fetal personhood to a previous pregnancy loss: relationship to anxiety in the current pregnancy. Health Care Women Int 2001; 22:649-65. [PMID: 12141842 DOI: 10.1080/07399330127171] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The degree of personhood a mother assigns to her dead fetus (i.e., whether she felt she lost a pregnancy or a baby) may help explain the meaning of a perinatal loss and the amount of anxiety experienced in a subsequent pregnancy. This descriptive study of 72 multigravidas with a history of one or two perinatal losses was conducted to understand the relationships between the assignment of fetal personhood and the influence of that assignment on state anxiety and pregnancy anxiety in a subsequent pregnancy. Assignment of personhood was significantly related to pregnancy anxiety and to the gestational age of the first loss but not to state anxiety. Understanding and responding to women's perceptions of perinatal losses and their significance for women may be one way to support them in subsequent pregnancies.
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Zar M, Wijma K, Wijma B. Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women. ACTA ACUST UNITED AC 2001. [DOI: 10.1080/02845710121310] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kornman LH, Wortelboer MJ, Beekhuis JR, Morssink LP, Mantingh A. Women's opinions and the implications of first- versus second-trimester screening for fetal Down's syndrome. Prenat Diagn 1997; 17:1011-8. [PMID: 9399348 DOI: 10.1002/(sici)1097-0223(199711)17:11<1011::aid-pd193>3.0.co;2-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Two groups of pregnant women were questioned regarding their opinions on serum screening for Down's syndrome in the first trimester of pregnancy. One group comprised 83 women attending our antenatal clinic who were questioned at the time of the existing second-trimester screening test. Seventy-six per cent of those who participated in the second-trimester screening programme would have preferred the test to have been in the first trimester, mainly because of the easier termination of pregnancy and/or the earlier reassurance provided. The remaining 24 per cent could see no advantage in the earlier time frame. Of the 49 women who had declined second-trimester screening, only two would have participated in screening had it been in the first trimester. The other group comprised those women attending our antenatal diagnosis clinic who were considering chorionic villus sampling (CVS). Forty-four per cent of these women would have allowed serum screening in the first trimester to influence their decision as to whether to undergo definitive prenatal diagnostic testing. In general, those women who made use of second-trimester serum screening would also do so in the first trimester. Those who declined the existing screening programme would also decline first-trimester screening. Many women currently deciding to undergo CVS would allow a first-trimester screening test to influence their decision.
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Affiliation(s)
- L H Kornman
- Groningen University Hospital, Department of Obstetrics and Gynaecology, The Netherlands
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Svensson J, Galloway D, Clune L, Green P. Re: Fearing the worst--why do pregnant women feel 'at risk'? Aust N Z J Obstet Gynaecol 1997; 37:247-8. [PMID: 9222481 DOI: 10.1111/j.1479-828x.1997.tb02268.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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