Women's views of the preterm labor experience

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

BACKGROUND

Preterm birth is a major cause of neonatal death and severe morbidity, so pregnant women experiencing symptoms of threatened preterm labour may be very anxious. The risk assessment and management that follows recognition of threatened preterm labour has the potential to either increase or decrease this anxiety. The aim of this study was to explore women's experience of threatened preterm labour, risk assessment and management in order to identify potential improvements in practice.

DESIGN

One-to-one semi-structured interviews with 19 women who experienced assessment for threatened preterm labour took place between March 2015 and January 2017. A purposive sample approach was employed to ensure participants from different risk and demographic backgrounds were recruited at an inner city UK NHS hospital. Interviews were recorded and transcribed. Data was managed with NVivo software and analysed using the Framework Approach. A public and patient involvement panel contributed to the design, analysis and interpretation of the findings.

FINDINGS

Data saturation was achieved after 19 interviews. 11 women were low risk and 8 were high risk for preterm birth. All high risk women had experience of being supported by a specialist preterm team. Four main themes emerged: (i) coping with uncertainty; (ii) dealing with conflicts; (iii) aspects of care and (iv) interactions with professionals. Both low and high risk women experiencing TPTL struggle to cope with the uncertainty of this unpredictable state. The healthcare management they receive can both help and hinder their ability to cope with this extremely stressful experience. High risk women were less likely to receive conflicting advice.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.

Maternal-Fetal Attachment and Maternal Identity according to Type of Stress Coping Strategies on Immigration Pregnancy Women

PURPOSE

The purpose of this descriptive survey study was designed to identify the stress coping types of married immigrant pregnant women and find out the differences in maternal-fetal attachment and maternal identity based on each types.

METHODS

151 married immigrant women who visited 3 women's hospitals located in J-do for pre-pregnancy checkup were selected as study objects. Data were analyzed by dsecriptive statistics, cluster analysis, t- test, ANOVA, and Scheffe multiple comparison test.

RESULTS

Cluster analysis revealed 4 distinct stress coping styles; low stress-coping involvement social support-oriented type, high stress-coping involvement hopeful thinking type, low stress-coping involvement type, effective stress coping types. Women frequently using effective stress coping type among the four types reported higher maternal-fetal attachment. The group of active coping styles got significantly higher score on maternal identity.

CONCLUSION

Proper stress coping of married immigrant pregnant women regarding pregnancies proved to result in high levels of maternal-fetal attachment and maternal identity. Studies measuring the stress coping styles that affect pregnancies should be continuously conducted.

Women's perspectives of the fetal fibronectin testing process: a qualitative descriptive study

Background

In 2009 the Ontario Ministry of Health and Long Term Care funded the implementation of province-wide fetal fibronectin testing in Ontario hospitals. This paper reports results from the provincial evaluation that sought to describe the experience of fetal fibronectin testing from the perspective of women with symptoms of preterm labour.

Methods

A descriptive qualitative design was used, employing semi-structured telephone and face-to-face interviews with women who had fetal fibronectin testing.

Results

Five hospitals participated in recruiting women for the study and 17 women were interviewed. Women described their experiences of fetal fibronectin testing as an emotional process that moves from expecting, to feeling, to hoping for reassurance; and then to re-defining what is required to feel reassured. Women described feeling anxious while waiting for fetal fibronectin results. When test results were negative, women described feeling a sense of relief that their symptoms would not likely lead to an imminent preterm birth. Women with positive results expressed feeling reassured by the care decisions and quick action taken by the health care team.

Conclusion

Fetal fibronectin testing was acceptable and beneficial to these women with symptoms of preterm labour. Implications for practice and future research are suggested.

Symptoms described by African American women evaluated for preterm labor

OBJECTIVE

To describe symptoms, self-care for symptoms, and lay consultations of African American women later diagnosed with a likelihood of preterm labor (PTL).

DESIGN

Qualitative descriptive study.

SETTING

Two sites within the United States, one urban and one suburban high-risk maternity referral center.

PARTICIPANTS

Twenty-five African American women presenting for emergent care and subsequently diagnosed as "rule out PTL." Five of the women later delivered before 37 weeks gestation, of whom 4 had a preterm low-birthweight infant (<or=2,500 g).

MAIN OUTCOME MEASURE

Women's symptoms, self-care for symptoms, and lay consultations prior to seeking care for PTL.

RESULTS

The most common reason for seeking care was due to "pains," and the second most common was "cramping," with most women (n = 17) seeking care within 4 to 24 hours of first experiencing symptoms. Importantly, 15 of the women first contacted friends/family members before seeking care.

CONCLUSIONS

In African American women, implications about PTL teaching include adding the word "pain" as another teaching descriptor and targeting education to individuals whom the patient considers to be significant such as a close friend or family member.

Listening to the Voices of Hospitalized High-Risk Antepartum Patient

OBJECTIVE

To explore the needs of high-risk antepartum patients while hospitalized and to generate recommendations from the patients' perspective.

DESIGN

Qualitative descriptive.

PARTICIPANTS/SETTING

Thirteen female patients in a high-risk antepartum unit of a large tertiary hospital, Edmonton, Alberta.

DATA ANALYSIS

A qualitative data analysis process was followed.

RESULTS

The major themes and subthemes that emerged from interviews with participants included stressors associated with loss of control and feelings of being a burden. The need for privacy and sensitivity to family members was expressed. Participants' recommendations included being treated as a family unit, setting up accommodation for visiting family members, and wanting more organized activities to relieve boredom.

CONCLUSIONS

An understanding of the needs of high-risk antepartum patients while hospitalized from their perspective will help the primary caregiver such as the registered nurse improve the quality of the women's care, provide guidance about the management of stressors, and plan interventions to reduce stress and to involve their families.

Living With the Threat of Preterm Labor: Women’s Work of Keeping the Baby In

OBJECTIVE

To explore the social organization of women's preterm labor experiences.

DESIGN

Institutional ethnography investigated how the woman's experience is socially organized and for patterns of how something is organized to recur.

PARTICIPANTS/SETTING

Eight women who experienced preterm labor while living in one city in Western Canada volunteered to participate.

DATA ANALYSIS

Institutional ethnographic methodology guided the analysis of audiotaped transcribed interviews to understand the work these women do and the complexities of their everyday lives.

RESULTS

Women spoke about their fear of going home and feeling alone with the responsibility for their work of "keeping the baby in." Overall, preterm labor was experienced as a profound sense of personal responsibility for preventing preterm birth and was practiced as being "careful."

CONCLUSIONS

The assumption that the family is privately responsible for care work in the home results in the lack of assessment of resources for managing the medical plan on discharge and the lack of resources available or offered to assist families. The work of keeping the baby in conflicts with family care work responsibilities and can cause significant hardships for some women and families.

Deciding When It's Labor: The Experience of Women Who Have Received Antepartum Care at Home for Preterm Labor

OBJECTIVE

To describe how women who had received antepartum care at home for preterm labor managed subsequent episodes of preterm labor symptoms.

DESIGN

Grounded theory method.

SETTING

2 Canadian antepartum home care programs.

PARTICIPANTS

12 women who received antepartum care at home for preterm labor that had been diagnosed in hospital prior to 34 weeks gestation.

RESULTS

The core psychosocial process was reconciling body knowledge and professional knowledge. Study participants reported knowing something's not right and followed decision guides to seek help. If, when they returned to the hospital to see what's going on, they felt dissonance between what their bodies were telling them (body knowledge) and what their health care providers were telling them (professional knowledge) an overriding tension developed between not wanting to take a risk for the baby versus not wanting to overreact. These women reestablished their baselines of nonthreatening symptoms at a higher level by setting a new normal to avoid the humiliation associated with appearing to overreact. Attempting to ignore recurring symptoms of preterm labor delayed help seeking and caused anxiety.

CONCLUSIONS

To avoid delayed help seeking, nursing interventions should be geared to reducing anxiety and validating the experiences of women with recurring preterm labor symptoms.

Maternal role transition experiences of women hospitalized with PROM: a phenomenological study

This study investigated the subjective experiences of the maternal role transition during the first two weeks of hospitalization for premature rupture of the amniotic membranes (PROM). Thirteen pregnant couples participated in the study by completing interviews. Average gestation of the expectant mothers was 27 weeks and the women were already experiencing fetal movement during the first two weeks of hospitalization for PROM. Lincoln and Cuba's trustworthiness criteria were employed to evaluate methodological rigor. Colaizzi's phenomenological approach was used to analyze the structure of the experience. Four themes emerged: pending loss, concern about the safety of the fetus, identification of maternal roles, and the process of maternal role-making. The results provide a scientific basis for empowering nurses to assist with maternal role transition in high-risk pregnancies in a more sensitive and effective manner.

The "virtual focus group": using the Internet to reach pregnant women on home bed rest

OBJECTIVE

The purpose of this qualitative study was threefold: to investigate the effectiveness of a 'virtual focus group" as a mechanism for collecting qualitative data, to explore the lived experience of pregnant women confined to home bed rest following a diagnosis of preterm labor, and to assess the value of the virtual focus group as an online peer support group for women on home bed rest.

DESIGN

A qualitative, exploratory, descriptive investigation, carried out through the use of a virtual focus group, defined as an Internet-based research method that utilizes electronic mail (e-mail) to unite spatially and temporally separate participants in a text-based group discussion.

SETTING

Data collection was conducted via the Internet and consisted of a series of sequential questions presented by the researchers to the participants via e-mail over a 4-week period.

PARTICIPANTS

A purposive sample of 7 women who were on home bed rest for the treatment of preterm labor. Four participants were recruited from a World Wide Web site dedicated to discussions of high-risk pregnancy, and 3 from the perinatal service center of a large health maintenance organization in Northern California.

RESULTS

The virtual focus group process generated rich and detailed qualitative data. Three major categories and seven subcategories regarding the lived experience of home bed rest were identified: the effect of bed rest on participants' lives (transitioning onto bed rest, loss of control and activities, changes in identity and role, coping and personal growth, transitioning off bed rest), the effect of bed rest on relationships with others (relationships with the fetus and other children, relationships with husbands and extended family members), and the virtual focus group as an online peer support group. Participants were unanimous in their appreciation of the virtual focus group. All participants stated that their participation was valuable and beneficial in helping them to cope with the hardships of bed rest.

CONCLUSION

The findings suggest that the virtual focus group is a useful tool for both collecting qualitative data and mediating the challenges and isolation of home bed rest. Confinement to bed rest at home dramatically alters women's daily activities, self-perceptions, and interpersonal relationships. Understanding the impact of bed rest on women's lives can help nurses to develop appropriate interventions for this unique population. The use of the virtual focus group allows nurses to embrace the technology of the Internet to study and connect women on home bed rest, as well as other isolated and understudied patient groups.

Resolving the uncertainty of preterm symptoms: women's experiences with the onset of preterm labor

OBJECTIVE

To describe expectant women's experiences with the onset of preterm labor.

DESIGN

Qualitative, using grounded theory methods.

SETTING

Southwestern tertiary women's hospital.

PARTICIPANTS

Thirty pregnant women who were less than 35 weeks gestation, had experienced preterm labor within the past 7 days, and had no previous experience with preterm labor.

DATA SOURCE

Taped and transcribed interviews.

RESULTS

Themes that emerged from the interview data included the following: recognition and naming of sensations, a consistent pattern of attribution of symptoms, the threat or risk inferred by the attributed cause of the symptom pattern, the associated certainty or uncertainty about these attributions, the process of interpreting and verifying symptom meaning, and the decision to self-manage the symptoms or engage health care assistance. The core process of women experiencing the onset of preterm labor symptoms was identified as "resolving the uncertainty of preterm labor symptoms: recognizing and responding to the possibilities."

CONCLUSIONS

Preterm labor often is not within expectant women's consciousness. They may attribute the symptoms to nonthreatening causes, which results in delays in seeking care for preterm labor. Education about symptom patterns at the onset of preterm labor will increase the probability that women and their health care providers will recognize and interpret the early, subtle symptoms that herald the onset of preterm labor. Uncertainty in illness theory and attribution theory offer frameworks for understanding women's experiences with the onset of preterm labor.

Preterm birth: a continuing challenge

Although preterm birth has been a major focus of study for the past two decades by health care providers in several disciplines, it remains more prevalent in the United States than in many developed countries and continues to be a prime reason for infant death (mortality) and illness (morbidity). In the past 10 years, preterm rates have risen in the United States from 10.6% in 1990 to 11.6% in 2000. Low birthweight rates have increased from 7.0% in 1990 to 7.6% in 2000. This column reviews recent studies addressing preterm and low birthweight births, including changing demographics, the role of assisted reproductive technology, smoking, domestic violence, the experience of women, and treatment strategies.

Antepartum bed rest: effect upon the family

OBJECTIVE

To identify the effects of antepartum bed rest upon the family.

DESIGN

Descriptive, retrospective survey.

PARTICIPANTS

A national random selection of 89 women who had been prescribed antepartum bed rest in the hospital or at home and who contacted a high-risk pregnancy support group for information.

MAIN OUTCOME MEASURE

An open-ended questionnaire.

RESULTS

Families experienced difficulty assuming maternal responsibilities, anxiety about maternalfetal outcomes, and adverse emotional effects on the children. Child care was managed by various people across time. Child care problems included negative reactions from the children, concern about the quality of the provider, and maternal worry about care. Families also experienced financial difficulties, the majority of which were not compensated by insurance or work benefits. Almost all, 96.6%, families received some type of support during bed rest. Instrumental support was the most commonly received; however, emotional support was considered the most helpful. The least helpful type of support was that which was unreliable. The primary providers of support to the family were parents and family, followed by friends. The women reported that health care providers offered minimal support to the family.

CONCLUSION

Despite support, antepartum bed rest creates difficulties that affect the entire family and its finances.

An explanatory model of preterm labor

The purpose of this article is to describe women's explanatory model of their preterm labor (PTL) experiences. Fourteen young adult (20 to 23 years of age) women living in the southeast, who were hospitalized for the treatment of PTL, participated in this naturalistic study. Stress was the dominant theme that all participants used to explain what had precipitated PTL. All women described multiple stressors and chaos in their lives, which preceded their admission to the hospital for PTL. Meanings of PTL were intertwined with dysfunctional families and problematic relationships. All 9 women who delivered at term were able to find a friend or family member to provide support that allowed the women to relax and reduce the stress in their lives. In contrast, women who delivered preterm had no one in their lives that could provide help and support. Women's conceptualizations of PTL suggest that culturally appropriate interventions to reduce stress and mobilize support may help improve birth outcomes after an episode of PTL.

Stress, pre-term labour and birth outcomes

Stress, pre-term labour and birth outcomes Preliminary studies have suggested that stress may be associated with the onset, treatment and outcomes of pre-term labour; however, a systematic comparison of the stress of women with and without pre-term labour has not been reported. Therefore, the purpose of this exploratory study was to compare the stress (daily hassles and mood states) and birth outcomes of black and white women who experienced pre-term labour (PTL) during pregnancy with those who did not. The convenience sample consisted of 35 pregnant women hospitalized in 1996-1997 for the treatment of PTL (24-35 weeks gestation) and 35 controls matched on age, race, parity, gestational age and method of hospital payment. Women in the PTL group had significantly higher tension-anxiety and depression-dejection on the Profile of Mood States (POMS), lower mean birthweight and mean gestational age, and a higher percentage of babies born <37 weeks and weighing 2500 g or less. Black women in the PTL group and white women in the control group had significantly higher scores on the fatigue sub-scale of the POMS and the work and future security sub-scales of the Daily Hassles Scale. Women in the PTL group whose babies weighed 2500 g or less had significantly higher scores on the health, inner concern and financial responsibility sub-scales of the Daily Hassles Scale. The findings from this study indicate the need for further exploration of the interaction of race and stress in understanding and preventing PTL and low birthweight and the need to examine the role of social support in preventing pre-term birth after an episode of PTL.

Antepartum support group for women hospitalized on bed rest

PURPOSE

To identify the themes of discussion spontaneously voiced during an antepartum support group by high-risk pregnant women who were hospitalized on bed rest.

DESIGN

Descriptive and exploratory, using content analysis.

METHODS

Support groups were held weekly in a tertiary level hospital in a Midwestern state. The convenience sample consisted of 27 women hospitalized for treatment of either preterm labor, incompetent cervix, placenta previa, premature rupture of membranes, or multiple gestation. The group, which was led by the investigator, was unstructured and nondirective. Process recordings of women's spontaneous verbalizations were made during each of 13 antepartum support group sessions.

RESULTS

The women identified seven discussion themes: methods of coping, concerns about family, negative emotions, relationships with caregivers, psychosocial losses associated with bed rest treatment, side effects of medical treatments, and concerns for the safety for self and/or fetal health.

CLINICAL IMPLICATIONS

An unstructured support group that provides women on hospital bed rest with an opportunity to talk in a confidential and supportive environment may be an important antepartum nursing intervention in helping them cope.

Perceptions of bed rest by women with high-risk pregnancies: A comparison between home and hospital

BACKGROUND

Bed rest at home or in the hospital is a commonly prescribed treatment for women experiencing complications of pregnancy. This focused ethnographic study examined bed rest from the high-risk pregnant woman's perspective and compared perceptions of women cared for in the home with those in hospital.

METHODS

A convenience sample of 24 pregnant women who had been on bed rest for at least seven days was recruited from the antepartum unit of a tertiary care hospital and from an antepartum home care program in western Canada. Data were collected in 1994 through interviews and participant diaries. Content analysis was used to identify themes.

RESULTS

Bed rest had a significant emotional and social impact on pregnant women and their families in both settings. Overall, bed rest in hospital seemed to be associated with more sources of stress than at home. In hospital, women had to cope with separation from home and family, lack of privacy, hospital discomforts, and incompatible roommates, whereas women at home struggled with role reversal and the temptation to do more activity than was recommended. Stressors not unique to but exacerbated by hospitalization included concerns about the children, a sense of missing out, a sense of confinement and being a prisoner, boredom, feelings of depression and loneliness, and negative impact on the relationship with their partner.

CONCLUSION

Study findings raise questions about the appropriateness of routine prescription of bed rest. Health care professionals should propose and develop home care programs as an alternative to antepartum hospitalization.

The preterm labor experience: a balancing act

The purpose of the study was to identify how women described, interpreted, and managed their preterm labor experience. Ten married, middle-class women participated in an in-depth, tape-recorded interview in the hospital after preterm labor was stabilized; periodically over the telephone after discharge from the hospital; and in the hospital, home, or via telephone after birth, for a total of 31 interviews. Using qualitative data analysis techniques, the findings were conceptualized as five recursive stages: becoming aware that something was wrong and feeling unbalanced, making sense of the experience as they sought to understand why preterm labor occurred, trying different strategies to re-create a balance in their lives, addressing other life stressors that threatened restoring balance, and emerging from the preterm labor experience with added growth. An increased understanding of the preterm labor experience from the women's perspective can be helpful to health care professionals and others who support women during pregnancy.

Psychosocial impact of high-risk pregnancy: hospital and home care

This article has reviewed research on the psychosocial impact of high-risk pregnancy on women undergoing antepartum hospitalization or home care, and discussed implications for health care professionals arising from the results of these studies. It is evident that high-risk pregnancy is very stressful for pregnant women and their families, irrespective of the setting of care. However, hospitalization seems to be associated with a greater number of stressors, the most predominant being separation from home and family. Wherever possible, health care professionals should strive to develop safe and acceptable alternatives to antepartum hospitalization.

Antepartum home care for high-risk pregnant women

Home care for women experiencing complications of pregnancy is a rapidly growing specialty. A variety of models of antepartum home care have emerged. Provision of effective antepartum home care requires knowledge and clinical skills in perinatal and home health nursing and an understanding of the structure and function of the home health care system. Nursing care in the home encompasses case coordination, maternal and fetal assessment, maternal education regarding the woman's risk situation and self-monitoring requirements, and provision of support. Antepartum home care for conditions such as hypertension in pregnancy, preterm labor, and hyperemesis gravidarum is discussed.

Adolescents' description and management of pregnancy and preterm labor

OBJECTIVE

To describe adolescents' experiences with pregnancy and preterm labor.

DESIGN

Naturalistic inquiry, a qualitative study using intensive, open-ended, tape-recorded interviews and constant comparative data analysis.

SETTING

Antepartum units of two hospitals in the southeastern section of the United States.

PARTICIPANTS

Eight African American and five white adolescents, ages 14-19 years, hospitalized for preterm labor.

RESULTS

The findings are broadly conceptualized as (a) describing pregnancy and preterm labor and (b) managing pregnancy and preterm labor. "Responding to Pregnancy" consisted of descriptions of the adolescents' reactions to pregnancy (initial concern and dislike) and pathophysiologic responses that put the adolescents at risk for preterm labor. "Responding to Preterm Labor" included the various ways that adolescents became aware of preterm labor and their various understandings of the causes and consequences of preterm labor. Vignettes illustrate how adolescents managed pregnancy and preterm labor with ease or with difficulty. Adolescents who received support from others, especially their mothers, tended to deliver near or at full-term.

CONCLUSIONS

Nurses can use the findings from this study as a guide for assessing and monitoring adolescents throughout pregnancy. Advanced practice nurses may have the educational background and philosophy of care to provide the most appropriate prenatal care to pregnant adolescents. Research is needed to further explore stressful experiences and support in adolescents' lives and how these are related to preterm labor and birth.

Factors influencing the attitudes held by women with type II diabetes: a qualitative study

Results of formal diabetes education are still considered unsatisfactory but could be improved by being more patient centred. The purpose of this study was to investigate attitudes of people with diabetes toward their disease and its treatment from their point of view and the research question answered was, 'What are the feelings and beliefs of people with NIDDM about diabetes and its treatment?' Data were collected through in-depth interviews using the general interview guide approach. Seven interviews with adult type II diabetes from rural Illinois were tape recorded and transcribed. The naturalistic content analysis revealed four categories: physician's reaction at diagnosis; perceived seriousness of diabetes; physician-patient relationship; and self-care. A finding that was not described in any literature reviewed by the researcher was that the reaction and attitude physicians displayed toward patients at the point of diagnosis were crucial in influencing attitudes toward perceived seriousness of the disease and consequently compliance. Newly diagnosed patients showed strong motivation with regard to treatment. However, difficulties in adhering to a treatment plan and inadequate perceived seriousness of the disease were factors contributing to a lack of compliance. Participants reported that when diabetes complications started their compliance improved.

A nursing model for a community hospital preterm birth prevention program

Newer interventions for the treatment of preterm labor led to the development of a nursing program for preterm birth prevention. The Roy adaptation model was used as a framework for patient and community education. Quality improvement activities provided the impetus for nursing practice changes. Tools were developed to produce a comprehensive, consistent approach for patient care from assessment to discharge.