Pregnancy loss in lesbian and bisexual women: An online survey of experiences

Background: Although pregnancy loss is a distressing health event for many women, research typically equates women’s experiences of pregnancy loss to ‘married heterosexual women’s experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women’s experiences of miscarriage, stillbirth and neonatal death. Methods: This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses. Results: The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals. Conclusions: The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women’s experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

“Considering there’s supposedly nothing wrong with me, it’s not a life”: Women’s Narratives of Distress, Visiting Herbalists, and Being Well in the 21st Century

Distress can have a profoundly negative impact on the well-being of women (who are the main receivers of treatment for distress). Distress also poses a huge financial problem for the United Kingdom, the cost of which is predicted to reach over £26bn by 2026. A growing body of research has shown that various medicinal plants have potential to treat different aspects of distress. However, there is little research investigating the patient experience of western herbal practice (WHP), and none investigating women’s experiences of WHP for distress. In response, this longitudinal study utilised interviews with twenty-six women who were visiting herbalists for distress across the south-east of The United Kingdom to elicit their stories of distress, as well as their experiences of WHP. The narratives were analysed from a constructionist standpoint, using inductive thematic analysis. The participants’ narratives highlighted the profound impact of everyday distress, whilst feelings associated with distress (anxiety, low mood, isolation, shame and guilt) were frequently communicated via the use of metaphors. These negative feelings, often combined with unsuccessful biomedical encounters, frequently led to the women feeling desperate when first visiting a herbalist. The participants’ experiences of WHP showed that an accessible practitioner and good therapeutic relationship combined with flexible herbal treatment, allowed women with diverse stories of distress to overcome feelings of desperation. Ongoing support allowed the women to feel like they had a safety net as they journeyed from a place of distress, back into the wider world. These findings were supported by more unusual negative accounts, which showed how the herbal therapeutic process could be unsuccessful if elements were missing. This research is of significance as it helps to deepen our understanding of women’s experiences of distress – particularly perceptions of stigma which surround feelings of shame (linked to an inability to cope) and guilt (linked to the perceived impact of distress on others). The research also has relevance for WHP, as it highlights which positive aspects of WHP are of particular importance to women patients who are living with distress.

Intimate Partner Violence and Pregnancy Intentions: A Qualitative Study

Aim and Objective In this qualitative study we explored women’s pregnancy intentions and experiences of intimate partner violence before, during and after pregnancy. Background Unintended pregnancies in the context of intimate partner violence can have serious health, social and economic consequences for women and their children. Design Feminist and phenomenological philosophies underpinned the study to gain a richer understanding of women’s experiences. Methods Eleven women who had been pregnant in the previous two years were recruited from community-based women’s refuges in one region of the United Kingdom. Of the eleven women, eight had unplanned pregnancies, two reported being coerced into early motherhood, and only one woman had purposively planned her pregnancy. Multiple in-depth interviews focused on participants’ accounts of living with intimate partner violence. Experiential data analysis was used to identify, analyse and highlight themes. Results Three major themes were identified: men’s control of contraception, partner’s indiscriminate response to the pregnancy, and women’s mixed feelings about the pregnancy. Participants reported limited influence over their sexual relationship and Accepted Article This article is protected by copyright. All rights reserved. birth control. Feelings of vulnerability about themselves and fear for their unborn babies’ safety were intensified by their partners’ continued violence during pregnancy. Conclusion Women experiencing intimate partner violence were more likely to have an unintended pregnancy. This could be attributed to male dominance and fear, which impacts on a woman’s ability to manage her birth control options. The women’s initial excitement about their pregnancy diminished in the face of uncertainty and ongoing violence within their relationship. Relevance to clinical practice Women experiencing violence lack choice in relation to birth control options leading to unintended pregnancies. Interpreting the findings from the victim-perpetrator interactive spin theory of intimate partner violence provides a possible framework for midwives and nurses to better understand and respond to women’s experiences of violence during pregnancy.

Sentido de coerência : ligação materno-fetal e estilo de vida da mulher durante a gravidez

RESUMO - Um dos grandes desafios actuais enfrentados pela Saúde Pública diz respeito ao fardo representado pelas doenças crónicas não transmissíveis enquanto co-responsáveis pela maioria das mortes que ocorrem no mundo, pela significativa e progressiva redução da qualidade de vida e aumento das incapacidades dos indivíduos afectados e por uma fasquia bastante elevada das despesas em saúde. Entretanto, a complexa dinâmica genética, biológica, psicológica, afectiva, sócio-cultural e ambiental que envolve o comportamento humano, tão amplamente relacionado com algumas destas doenças – doenças cardiovasculares, alguns tipos de cancro, obesidade, hipertensão, diabetes e doenças osteo-articulares – impõe o desafio constante da busca de novas e efectivas intervenções em promoção da saúde que influenciem positivamente os estilos de vida dos indivíduos, dos grupos e das comunidades. Sendo o sentido de coerência um traço da personalidade do indivíduo desenvolvido sob a influência directa ou indirecta dos mesmo factores acima referidos, o estabelecimento de uma relação entre este constructo e os comportamentos humanos pode revelar-se promissor para a elaboração de novas intervenções em promoção da saúde. Por sua vez, a gravidez, talvez por influência da ligação materno-fetal, pode representar um ponto de viragem na vida da mulher no que respeita ao sentido de coerência e aos comportamentos de saúde e um bom começo na vida do bebé que irá nascer sob a influência dos mesmos. Com a finalidade de contribuir para a construção de intervenções efectivas em promoção da saúde, através da descoberta de prováveis potencialidades salutogénicas dos constructos referidos – sentido de coerência e ligação materno-fetal –, foi desenvolvido um estudo quantitativo, observacional que teve por objectivos: ampliar o conhecimento sobre as mudanças do sentido de coerência no decorrer da vida, especificamente durante a gravidez; ampliar o conhecimento acerca das relações de alguns factores de natureza sócio-demográfica, psico-afectiva e obstétrica com o sentido de coerência das mulheres grávidas e com a ligação materno-fetal; e identificar possíveis relações entre o sentido de coerência, a ligação materno-fetal e o estilo de vida das mulheres grávidas, este último representado pelos hábitos alimentares, consumo de cafeína, consumo de álcool, hábitos tabágicos, prática regular de actividade física e ganho de peso durante a gravidez. O presente relatório descreve a concepção e os resultados deste estudo, que envolveu a uma amostra de 61 mulheres grávidas que estavam a ser acompanhadas nos serviços de saúde materna dos Centros de Saúde de Carnaxide extensão Linda-a-Velha e de Oeiras, no Distrito de Lisboa, Portugal, entre os meses de Fevereiro e Julho de 2005. Os resultados demonstram que, para a amostra de 61 mulheres grávidas que responderam ao inquérito por questionário de auto-resposta, foram encontradas associações estatisticamente significativas entre o sentido de coerência e a escolaridade e entre o sentido de coerência e a percepção do próprio estado de saúde. Além disso, foi encontrada alguma evidência das associações entre o sentido de coerência e a faixa etária, estado civil e rendimento mensal familiar e foi observada alguma tendência para que as mulheres grávidas com níveis de sentido de coerência mais elevados consumissem menos álcool do que as mulheres grávidas com níveis de sentido de coerência inferiores. Entretanto, as demais associações testadas não foram confirmadas. Relativamente à ligação materno-fetal, foram encontradas, para a amostra de 41 mulheres grávidas que participaram do segundo momento de colheita de dados do estudo, entre a 20ª e a 24ª semanas de gravidez, associações estatisticamente significativas com a escolaridade e o nível de rendimento familiar das mulheres grávidas, não tendo sido confirmadas as demais associações testadas. Embora não tenham sido estatisticamente evidenciadas as relações entre o sentido de coerência e a ligação materno-fetal e entre estes e os comportamentos de saúde, o carácter preliminar destes resultados, devido à subjectividade do processo de selecção não probabilístico da amostra estudada e à reduzida dimensão desta amostra, e a escassez de estudos descritos na literatura fazem com que seja prudente a realização de estudos de follow-up, com amostras de maiores dimensões, aleatórias e representativas da população, para que sejam estabelecidas quaisquer conclusões acerca destas questões.-----------------------------ABSTRACT - One of the greatest challenges faced by Public Health in nowadays is the burden represented by chronic diseases as co-responsible for the majority of deaths that occurs in the world, for the meaningful and progressive reduction of quality of life and increase of disabilities in affected individuals and for an important part of health expenses. However, the complexity of the genetic, biological, psychological, emotional, social, cultural and environmental dynamics that involves human behaviours related to some of these diseases – cardiovascular diseases, some kind of cancers, obesity, hypertension, diabetes and joint and bone diseases – poses the continuous challenge of searching for new and effective interventions of health promotion that positively influence individuals, groups and community lifestyles. Due to the fact that sense of coherence is an individual personality trace directly or indirectly influenced by the same factors listed above, the discovery of a relationship between this construct and human behaviours might be promising to the creation of new health promotion interventions. On the other hand, pregnancy may represent a turn point to the mother’s life and a good start in the baby’s life in relation to sense of coherence and health behaviours and It might occur because of the influence of maternal-fetal attachment. With the purpose of contributing with the creation of effective health promotion interventions through the discovery of probable salutogenic potentials in the referred constructs – sense of coherence and maternal-fetal attachment – , it was developed a quantitative observational study with the following objectives: to increase knowledge about changes in sense of coherence throughout life, specifically during pregnancy; to increase knowledge about the relationship between sense of coherence and maternal-fetal attachment and some social, demographical, psychological, emotional and obstetric factors of pregnant women; to identify probable relationships between sense of coherence, maternal-fetal attachment and pregnant women’s lifestyles, represented by diet habits, caffeine consumption, alcohol consumption, smoking habits, physical activity habits and weigh gain during pregnancy. This report describes the structure and the findings of this study involving a sample of 61 pregnant women who had been followed by health professionals in the mother health services of Carnaxide (Linda-a-Velha unity) and Oeiras Health Centres, in Lisbon, Portugal, between February and July of 2005. The results show that, for the 61 pregnant women who filled the self-reported questionnaire, it was found a statistically significant association between sense of coherence and education level. It was also found some evidence of the associations between sense of coherence and age, marital status and mensal household income and a trend toward pregnant women with higher levels of sense of coherence to drink less alcoholic beverages than pregnant women with lower levels of sense of coherence. However, the others associations tested were not confirmed. Regarding maternal-fetal attachment, it was found, for the sample of 41 women who participated in the second moment of data collection, between the 20th and the 24th week of pregnancy, statistically significant associations with education level and mensal household income. The others associations tested were not confirmed. Although the associations between sense of coherence and maternal-fetal attachment and between these constructs and health behaviours were not confirmed, all findings presented here are considered preliminary because of small dimension of sample and non-probabilistic criteria used for sample selection. What’s more, there are almost no studies described in the literature which could confirm or contradict these findings. Therefore, it is better to be careful and develop follow-up studies, with bigger and representative of population samples, before draw any conclusions about these theme.

Impact of compliance with different guidelines on physical activity during pregnancy and perceived barriers to leisure physical activity

The aims of the this prospective study were to analyze physical activity (PA) engagement during the first and second trimesters, considering the different guidelines published on PA, to document the individual characteristics associated with the accomplishment of these guidelines and to examine pregnant women’s perceived barriers to leisure PA, using a socioecological framework. A sample of 133 pregnant women in two stages – at 10–12 weeks’ gestation (T1) and 20– 22 weeks’ gestation (T2) – were evaluated. PA was assessed by accelerometry during the T1 and T2 evaluation stages. Socio-demographic characteristics, lifestyle factors and barriers to leisure PA were assessed via questionnaire. A large proportion of women (ranging from 32% to 96%) did not reach the levels of PA recommended by the guidelines. There were no significant differences between T1 and T2 with regard to compliance with PA recommendations. A decrease in PA levels from T1 to T2 was noted for all recommendations. No associations were found between participants’ characteristics and adherence to the recommendations in T1 and T2. No significant differences were found in barriers to leisure PA between T1 and T2. The most commonly reported barriers to leisure PA were intrapersonal, not health related. Our results indicate that there were no differences between trimesters regarding compliance of PA recommendations, and perceived barriers were similar in both trimesters.

Women, Work and the Iowa Economy, September 2008

Women play a substantial and crucial role in the Iowa economy. Women make up almost half the labor force, participating in the labor force at one of the highest rates in the nation. At the same time, disparities persist as to women’s prospects for success in that same economy. For instance, although women in Iowa are more likely than men to receive post-secondary education, they are also more likely to be in poverty and to earn a lower wage than male peers. The “gender gap,” the difference between male and female wages, is a much-discussed but often misunderstood tool that helps measure women’s success in the workforce. Women’s median wages are lower than men’s median wages largely because of differences in male and female occupations and work history, although gender discrimination in the workforce also plays a role. This report investigates Iowa’s gender gap in ways that clearly show both its causes and effects and suggests policy responses that could ensure women’s full and equal participation in Iowa’s economic future. Understanding the differences between men’s and women’s experiences in the state economy is important for developing policies that can effectively address barriers to economic success for all Iowans.

Iowa's Barriers to Prenatal Care Project, August 2013

The findings in this summary are based on the Iowa Barriers to Prenatal Care project. Ongoing since 1991, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all of Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg. The questionnaire is distributed to nearly ninety maternity hospitals across the state of Iowa. Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal and requesting their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation. The present yearly report includes an analysis of large Iowa cities, African American mothers, and a trend analysis of the last ten years. Also presented in this report is a frequency analysis of all variables included in the 2012 questionnaire. Unless otherwise noted, all entries reflect percentages. Please note that because percentages were rounded, total values may not equal 100%. Data presented are based upon 2012 questionnaires received to date (n = 23,674). All analyses reflect unweighted percentages of those responding.

Iowa's Barriers to Prenatal Care Project, July 2015

The findings in this summary are based on the Iowa Barriers to Prenatal Care project. Ongoing since 1991, the purpose of this project is to obtain brief, accurate information about women delivering babies in Iowa hospitals. Specifically, the project seeks to learn about women’s experiences getting prenatal or delivery care during their current pregnancy. Other information is included which may be pertinent to health planners or those concerned with the systematic development of health care services. This project is a cooperative venture of all of Iowa’s maternity hospitals, the University of Northern Iowa Center for Social and Behavioral Research, and the Iowa Department of Public Health. The Robert Wood Johnson Foundation funded the first three years of this project. The current funding is provided by the Iowa Department of Public Health. The Director is Dr. Mary Losch, University of Northern Iowa Center for Social and Behavioral Research. The Coordinator for the project is Rodney Muilenburg. The questionnaire is distributed to nearly ninety maternity hospitals across the state of Iowa. Nursing staff or those responsible for obtaining birth certificate information in the obstetrics unit are responsible for approaching all birth mothers prior to dismissal to request their participation in the study. The questionnaire takes approximately ten minutes to complete. Completed questionnaires are returned to the University of Northern Iowa Center for Social and Behavioral Research for data entry and analysis. Returns are made monthly, weekly, or biweekly depending on the number of births per week in a given hospital. Except in the case of a mother who is too ill to complete the questionnaire, all mothers are eligible to be recruited for participation. The present yearly report includes an analysis of large Iowa cities, frequencies by income, and a trend analysis of the last ten years. Also presented in this report is a frequency analysis of all variables included in the 2014 questionnaire. Unless otherwise noted, all entries reflect percentages. Please note that, because percentages were rounded, total values may not equal 100%. Data presented are based upon 2014 questionnaires received to date (n = 24,696). All analyses reflect unweighted percentages of those responding.

A Narrative Inquiry of Women in Administration: Their Voices Heard

This narrative study examined women’s experiences in leadership positions in an educational setting in Southern Ontario. Semi-structured interviews with 4 women (2 principals and 2 vice principals) revealed 4 key themes: (a) considerations prior to entering into leadership and confidence instilled by others to continue on that path; (b) ongoing challenge of maintaining work−life balance; (c) others’ perceptions of women in leadership positions; and (d) increasing number of women in leadership positions. The researcher used feminist standpoint theory to analyze data collected during interviews, which gave voice to the study’s participants and shed some light on women’s gendered experiences in leadership positions. Findings suggest that historical roots significantly influence society to continue with stereotypical gender roles, though some participants have overcome certain stereotypes. The literature review and participants’ experiences suggest that women have made some progress throughout history yet society needs to remain vigilant while striving for gender equality.

L’environnement de naissance : saisir l’expérience d’accouchement en maison de naissance

L’aménagement des maisons de naissance est actuellement en hausse sur le territoire québécois, pour répondre à la forte demande des femmes pour un service sage‐femme et également pour répondre au désir des femmes de donner naissance dans un milieu alternatif à l’hôpital ou à la maison. La problématique consiste à s’interroger sur la pertinence de l’environnement actuel des maisons de naissance, à savoir s’il soutient les besoins des femmes qui y donnent naissance, mais également si cet environnement affecte l’expérience d’accouchement des femmes, dans le but futur que les maisons de naissance soient parfaitement adaptées aux nécessités des femmes qui y accouchent. Cette problématique, axée sur la relation personne‐environnement avec point d’ancrage l’expérience sensible de l’usagère, est adressée en premier lieu par une analyse critique des maisons de naissance de Montréal, puis en analysant le discours des femmes, recueillis sous forme d’entretiens semi‐dirigés, pour en exprimer l’expérience d’accouchement en ces lieux. Se basant sur les principes d’études en relations personnes‐environnement, cette recherche vise ainsi à saisir les besoins relatifs au lieu de naissance à travers l’expérience sensible de la femme et des liens affectifs que tisse celle‐ci avec l’environnement lors de son accouchement, plus particulièrement au sein des maisons de naissance. Cette recherche vise également à saisir comment, à l’inverse, l’environnement de naissance affecte l’expérience de la femme lorsqu’elle donne naissance. Parmi les constats de cette recherche, nous réalisons que l’environnement affecte l’expérience d’accouchement dans une certaine mesure et qu’il aurait avantage à se faire des plus discret, afin de ne pas affecter la concentration des femmes durant leur travail. Cette « bulle » que les femmes se forment durant l’accouchement s’avère très importante dans le bon déroulement de la naissance; l’environnement devrait permettre et la mise en place de cette « bulle » et sa continuité jusqu’à la naissance de l’enfant. La poursuite des recherches sur le sujet pourrait entre autres mener à un modèle d’aménagement non rigide pour les maisons de naissance et pourrait également contribuer à l’amélioration des maisons de naissance existantes ainsi que celles à venir.

Les rêves durant la grossesse : étude de leur nature et de leur rôle prédictif dans l’adaptation psychologique à la maternité

De nombreux cliniciens œuvrant en périnatalité constatent que l’activité onirique est plus foisonnante et perturbée durant la grossesse. Certains croient d’ailleurs que le caractère plus vif, réaliste et marquant des rêves de cette période permette aux femmes d’avoir une plus grande accessibilité à leur monde intrapsychique, ce qui faciliterait la résolution d’enjeux relationnels laissés jusqu’alors en suspens. D’autres avancent aussi que les rêves permettent aux futures mères d’intérioriser leur rôle maternel grâce au développement de représentations mentales ayant trait, entre autres, à la future relation mère-bébé. Or, bien que ces notions soient fortement ancrées dans la littérature clinique, elles demeurent, en revanche, peu étudiées sur le plan empirique. Le premier objectif de cette thèse visait à offrir une meilleure description de l’activité onirique au troisième trimestre (≥26 semaines) d’une première grossesse, incluant le rappel onirique, la prévalence des rêves dysphoriques et le contenu des rêves. Nos résultats montrent pour la première fois que, lorsqu’ils sont collectés prospectivement, les rêves des femmes enceintes ne sont pas plus fréquents, mais ils sont nettement plus perturbés (article 1) et globalement plus négatifs (article 2) que ceux d’un groupe témoin constitué de femmes non enceintes et sans enfant. Le deuxième article montre aussi que, sur le plan thématique, les rêves de la grossesse incorporent, en plus des préoccupations typiques de cette période, des images de la femme en relation avec un enfant. Les processus plus généraux de la formation d’imageries oniriques, tels que le développement de la trame narrative et la valence des interactions entre personnages, se montrent quant à eux similaires entre les femmes enceintes et non enceintes. Le deuxième objectif de cette thèse visait à évaluer le rôle prédictif des rêves de la grossesse dans l’adaptation psychologique à la maternité, via l’étude de caractéristiques oniriques affectives et représentationnelles bien spécifiques (article 3). Nous montrons pour la première fois que les rêves qui dépeignent négativement la rêveuse et ceux qui incorporent la relation de la rêveuse avec sa propre mère prédisent indépendamment, et au-delà des symptômes dépressifs prénataux, l’adaptation de la femme aux chamboulements affectifs et relationnels que suscite la venue d’un premier enfant. Les résultats de cette thèse appuient l’hypothèse de la continuité onirique, qui stipule que les préoccupations de l’éveil transparaissent dans les rêves. Ce travail s’inscrit également dans la lignée des conceptions théoriques voulant que les rêves occupent une fonction adaptative pour l’équilibre psychologique.

Perspective maternelle de la consultation anténatale pour travail préterme : une approche relationnelle

Une femme à risque d’un accouchement prématuré vit un enjeu de santé très éprouvant et stressant ; elle sera souvent hospitalisée pour recevoir des traitements médicaux visant à prolonger la grossesse et améliorer le pronostic du bébé. Dans ce contexte, une consultation avec un néonatalogiste est demandée. Plusieurs associations professionnelles médicales ont émis des lignes directrices sur cette consultation, insistant sur le besoin d’informer les parents au sujet des complications potentielles de la prématurité pour leur enfant. Ces recommandations s’inspirent du point de vue médical, et très peu d’études ont examiné la perspective, les attentes et les besoins des parents à risque d’un accouchement prématuré. Ce projet de thèse a pour objectif de proposer un modèle de relation médecin-patient informé de la perspective maternelle de la consultation anténatale, pour développer une approche clinique répondant à leurs besoins. Afin d’examiner cette problématique de façon complète, un travail constant de va-et-vient a été effectué entre la recension de données empiriques et une réflexion normative bioéthique féministe. Un projet de recherche empirique a d’abord permis d’explorer les attentes et le vécu de ces femmes. Les participantes espéraient recevoir plus que de l’information sur les complications de la prématurité. Elles souhaitaient que le néonatologiste soit attentif à leur situation particulière et qu’il développe une relation de confiance avec elles, leur permettant d’explorer leurs futurs rôles de mères et les encourageant à formuler leurs propres questions. Le cadre théorique féministe d’autonomie relationnelle a ensuite permis de proposer une approche de soin qui sache répondre aux besoins identifiés par les patientes, tout en adressant des enjeux de pouvoir intrinsèques à la clinique, qui influencent la santé et l’autonomie de ces femmes. Cette approche insiste sur l’importance de la relation de soin en clinique, contrastant avec un modèle encourageant une vision réductrice de l’autonomie, dans laquelle un simple transfert de données scientifiques serait équivalent au respect de la norme médicolégale du consentement éclairé. Ce modèle relationnel propose des actions concrètes et pratiques, encourageant les cliniciens à entrer en relation avec chaque patiente et à considérer l’influence qu’ils exercent sur l’autonomie relationnelle de leurs patientes.

Internet- den nya barnmorskan? : En enkätstudie om hur gravida kvinnor söker information om graviditet och förlossning via Internet

Bakgrund: Internet används globalt inom många områden och aktuell forskning visar att gravida kvinnor använder Internet till att söka information om graviditet och förlossning. En graviditet innebär många frågor hos kvinnan och kvinnor söker efter information för att få en trygghet och försäkran om att allt är normalt med deras hälsa och barnet i magen. Syfte: Syftet är att undersöka gravida kvinnors informationssökning via Internet avseende graviditet och förlossning. Metod: Beskrivande tvärsnittstudie. Datainsamling skedde via en enkätundersökning och data analyserades med deskriptiv och jämförande ansats. Resultat: Nästan alla kvinnor i undersökningen använde Internet för att söka information om graviditet och förlossning. Kvinnorna söker information om barnets utveckling, kost/näring och graviditetslängd i hög utsträckning. Högutbildade kvinnor har andra kriterier för trovärdighet på hemsidor än kvinnor med lägre utbildning. Slutsats: Barnmorskor bör vara medvetna om gravida kvinnors användning av Internet samt själva skapa sig en uppfattning om informationen som de gravida kvinnorna läser på Internet. Vår studie visar att barnmorskors rekommendation av hemsidor på Internet har stor betydelse för gravida kvinnor.  

Gravida kvinnors tankar om amning

Internationellt sett är amningsfrekvensen i dagens Sverige hög, men har minskat något senaste åren. Studier visar att inställningen till amning är positiv, men att kvinnor upplever svårigheter i samband med amning samt en brist på information och stöd. Syftet med fördjupningsarbetet var att belysa gravida kvinnors tankar om amning, amningsinformation och stöd. Studien genomfördes med kvalitativ ansats, där data samlades in genom fokusgruppsintervjuer med 18 gravida kvinnor hösten 2012. Data bearbetades med innehållsanalys. Analysen gav ett övergripande tema; Balans mellan förväntningar och svårigheter. Fem kategorier framkom; Att vara medveten om amningens fördelar, Att vara medveten om svårigheter med amning, Att planera för sin kommande amning, Att påverkas av sin omgivning och Att ha förväntningar på stöd inför kommande amning. Resultatet visade att gravida kvinnor var medvetna om amningens fördelar och svårigheter, omgivningen påverkade deras tankar och kvinnorna ansåg ofta att amningen ”löser sig naturligt”. Tydligast framkom kvinnors känsla av bristande kunskap om amningsproblem och en önskan att få amningsinformation sent i graviditet. Amningsinformation som ges under graviditet bör vara varierad, innehållsrik och förbereda föräldrarna på att amning kan vara påfrestande. Det är viktigt att involvera partnern i information och förberedelser för amning.   Nyckelord: amning, graviditet, amningsstöd, amningsinformation, amningsproblem