Women's views and outcomes of an educational intervention designed to enhance psychosocial support for women during pregnancy

Background: Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues.

Methods: Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (< 20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later.

Results: Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09–1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10–2.08] and feeling depressed [OR 1.49, 1.16–1.93]; and concerns relating to sex [OR 1.35, CI 1.03–1.77] or their relationships [OR 1.36, CI 1.00–1.85] for doctors).

Conclusions: The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Changes in body image satisfaction during pregnancy : a comparison of high exercising and low exercising women

Objective: This study aimed to compare ratings of body image satisfaction (BIS) from 6 months prepregnancy to 23–30 weeks’ gestation for high exercising and low exercising pregnant women. The authors also aimed to assess and compare expectations of BIS for the post-partum period in high and low exercising women.

Design: A partial prospective approach was Implemented.

Sample: A total of 71 healthy pregnant women (40 high exercisers and 31 low exercisers) participated.

Methods: Participants completed a series of questionnaires at 15–22 weeks’ gestation and 23–30 weeks’ gestation.

Main outcome measures: There were two main outcome measures. At 15–22 weeks’ gestation there was an exercise inventory and two versions of the Body Cathexis Scale (BCS) (retrospective prepregnancy BIS and current BIS). At 23–30 weeks’ gestation there was an exercise inventory and two versions of the BCS (current BIS and projected post-partum BIS).

Results: At 15–22 weeks’ gestation, high exercisers demonstrated significantly higher levels of BIS compared to low exercisers. There were no other significant differences between groups. Within groups, high exercisers were significantly more satisfied with their bodies at 15–22 weeks’ gestation compared to 6 months prepregnancy, and expected to be less satisfied with their bodies at 6 weeks’ post-partum than they were during pregnancy. Low exercisers demonstrated no significant changes over time.

Conclusions: The findings suggest that women are able to assimilate the bodily changes of pregnancy without a negative shift in BIS. However, women who exercise during pregnancy may respond more favourably to changes in their bodies at early pregnancy compared to women who remain sedentary.

Vigorous exercise and birth outcomes in a sample of recreational exercisers : a prospective study across pregnancy

Objective: This study examined the question of whether vigorous exercise undertaken by recreational exercisers across pregnancy, defined in two ways, were associated with reduced infant birthweight and gestational age at birth.

Methods: A prospective approach was implemented. A total of 148 pregnant women participated. Average intensity duration and frequency of vigorous exercise reported were examined and compared with two existing definitions of vigorous exercise. Participants completed questionnaires (including retrospective reports on 3 months prepregnancy) and an exercise diary at 16–23 weeks pregnancy, 24–31 weeks pregnancy and 32–38 weeks pregnancy, and at 7 to 14 days post-partum a birth outcomes questionnaire was completed.

Results: There were no significant differences between exercise groups for birthweight and gestational age at birth.

Conclusions: There was no evidence that the intensity duration and frequency of vigorous exercise were associated with significant reductions in mean birth outcomes for the infants of women who participated in the study. Replication in a large, more diverse sample is recommended.

Interrelations between ceruloplasmin and Fe status during human pregnancy

It is well established that Fe and ceruloplasmin interact in animals and in in vitro models. However, Fe-mediated regulation of ceruloplasmin has never been investigated in humans. In an observational study, 53 pregnant women aged 19-39 yr (29.8±0.7 yr, mean ± SEM) were recruited at the Aberdeen Antenatal Clinic, Aberdeen Maternity Hospital, UK. All requirements for local ethical committees were followed. Venous blood samples were taken from each woman at 34 wk gestation for measurement of Fe status and ceruloplasmin. Various parameters were used to test for Fe status. The most sensitive one appeared to be soluble transferrin receptor, which increased with parity. In the population studied, there was no relationship between hemoglobin or ferritin and serum ceruloplasmin. However, using soluble transferrin receptor (sTfR) levels, we were able to demonstrate an inverse linear relationship (r=0.37, p=0.021, n=41) between Fe status and ceruloplasmin. Fe supplementation, number of previous pregnancies, and smoking habits did not affect this relationship. Our data support in vitro results showing regulation of ceruloplasmin by Fe and also suggest that the interactions between Fe and ceruloplasmin should be considered when Fe supplementation is given.

Examination of a multi-factorial model of body-related experiences during pregnancy : the relationships among physical symptoms, sleep quality, depression, self-esteem, and negative body attitudes

The aim of this cross-sectional study was to investigate relationships among women's body attitudes, physical symptoms, self-esteem, depression, and sleep quality during pregnancy. Pregnant women (N = 215) at 15–25 weeks gestation completed a questionnaire including four body image subscales assessing self-reported feeling fat, attractiveness, strength/fitness, and salience of weight and shape. Women reported on 29 pregnancy-related physical complaints, and completed the Beck Depression Inventory, Rosenberg Self-esteem Scale, and Pittsburgh Sleep Quality Index. In regressions, controlling for retrospective reports of body image, more frequent and intense physical symptoms were related to viewing the self as less strong/fit, and to poorer sleep quality and more depressive symptoms. In a multi-factorial model extending previous research, paths were found from sleep quality to depressive symptoms to self-esteem; self-esteem was found to be a mediator associated with lower scores on feeling fat and salience of weight and shape, and on higher perceived attractiveness.

A prospective study of factors that lead to body dissatisfaction during pregnancy

This study examined changes in body image and predictors of body dissatisfaction during pregnancy. It was expected that higher levels of depression, social comparison tendencies, teasing, societal pressure to be thin and public self-consciousness would predict body dissatisfaction prospectively. Healthy pregnant women (n = 128) completed questionnaires on three occasions during their pregnancies reporting on a total of four time points: 3 months prior to pregnancy (retrospectively reported), in the early to mid-second trimester, the late-second/early-third trimester, and the latter part of the third trimester. For the most part women reported adapting to the changes that occurred in their body; however, women were most likely to experience higher levels of body dissatisfaction in early to mid-second trimester. Findings related to predictors of body dissatisfaction revealed that both social and psychological factors contributed to body image changes in pregnancy. Implications of the findings are discussed.

An examination of financial counselling discourses in Victoria

This thesis investigates the model of practice invoked by the Victorian financial counselling sector. It analyses why community development is inconsistent with the sector's casework approaches to practice, identifies the emergence of a different model of practice and explains financial counselling within the current theoretical context of risk society.

Unique invulnerability for unwanted pregnancy : cognitive or motivational?

The cognitive and motivational explanations of Unique Invulnerability (UI) for unwanted pregnancy (whereby individuals believe that their risk is less than that of the average female) were contrasted. Eight studies were conducted. Contrary to popular belief, it was found that the two different measures of UI (indirect-comparison (ICQ) and direct-comparison (DCQ)) were not equivalent; the findings suggest that while UI tapped by ICQs is cognitive in nature, UI tapped by DCQs is motivational in nature

Intention to claim a Medicare rebate among women receiving private Victorian pregnancy termination service

Objectives: To determine the proportion of women who have pregnancy terminations as private patients in Victoria who do not intend to claim a procedure fee rebate from Medicare, to compare characteristics of women who intend to submit a Medicare claim with those who do not and to compare the findings to the results from a similar study conducted in NSW in 1992.

Design, setting and participants: This was a cross-sectional observational study over a 12-week period. Women having a pregnancy termination service in eight large Victorian private clinics were invited to complete a brief written questionnaire.

Outcome measurer: The proportion of women who did not have a Medicare card or who had a Medicare card but did not intend to use it to claim from Medicare.

Results: Of the 1,329 women who responded, 13.1% either did not have a Medicare card or did not intend to use their card to claim a Medicare rebate. A further 20.7% of respondents were not sure about whether they would submit a claim. Women who intended to claim a Medicare rebate were different from women who did not according to age, language spoken at home, residency, citizenship and distance travelled to the service. These results are very similar to the findings from the 1992 NSW study.

Conclusion: Between 13.1% and 33.8% of private Victorian pregnancy terminations were estimated to not be recorded at the Health Insurance Commission. Health Insurance Commission records of Medicare rebate claims for pregnancy terminations are an incomplete and somewhat biased record of the services that are provided and are likely to have been so for some time.

Travel undertaken by women accessing private Victorian pregnancy termination services

Objective: To investigate the extent and cost of travel undertaken by women accessing Victorian termination of pregnancy services.

Design, setting and participants: This was a multi-centre, cross-sectional observational study of women receiving privately funded pregnancy termination services, conducted between November 2002 and June 2003 at eight major pregnancy termination service providers in Victoria.

Main outcome measures: Distance travelled, money and time expended undertaking travel, and reasons women chose particular clinics.

Results: Of the 1,244 Australian resident respondents who resided in Victoria, 9.3% travelled more than 100 km to access services. Teenagers were 2.5 times more likely than other respondents to travel further than 100 kilometres (km) (18.2% compared with 7.8%, OR=2.5, 95% CI 1.5-4.2, p<0.001). Women originated from all Australian States and Territories except South Australia and 13.7% were from Statistical Divisions other than Melbourne. More than one-third of respondents (41.3%) chose their clinic because they were referred by a doctor or general practitioner.

Conclusion: Many pregnancy termination patients face substantial and immediate costs beyond the service fee, as well as the diffculties associated with poor continuity of care and signifcant time away from home. Patients and service providers should be consulted further to determine appropriate clinical services, support services and subsidy schemes for the sizeable proportion of patients who undertake long-distance travel to access pregnancy termination services.