Women’s experiences of commercial three-dimensional ultrasound scans

Ultrasound has become a routine part of UK maternity care and has a range of diagnostic and screening purposes. The last two decades have seen the development of three-dimensional (3D) scans, which use computer software to produce a seemingly 3D image of the foetus (Rankin et al 1993). Four-dimensional (4D) scans include the dimension of time, i.e. moving images of the foetus. This technology does currently have limited diagnostic use (Campbell 2002, Kurjak et al 2007) though it can be helpful in screening for facial anomalies. Over the last two decades 3D and 4D scans have become available to expectant parents (Roberts 2012) through commercial screening companies. They are generally marketed as ‘bonding scans’ or ‘reassurance scans’ (Wadephul 2013), in line with claims that the more ‘baby-like’ images enhance the parental relationship with the foetus and provide reassurance to expectant parents (Campbell 2002). This is not supported by research into the psychological impact of 3D and 4D scans, which suggests that while these scans may enhance parental recognition of the foetus , they do not increase ‘bonding’ or reassurance compared to conventional two-dimensional (2D) scans (Righetti et al 2005, Rustico et al 2005, Leung et al 2006, Sedgmen et al 2006, Lapaire et al 2007, de Jong-Pleij et al 2013). These studies offered 3D/4D scans as part of their research, rather than exploring women’s experiences of scans they had actively sought out and paid for. The case studies presented in this paper are part of a larger PhD study exploring discourses of 3D/4D scans and women’s experiences of having these scans (Wadephul 2013). The case studies aim to explore why individual women choose commercial 3D/4D scans, what their expectations and experiences are and how the scans affect their psychological experience and their maternal-foetal relationship

The impact of antenatal psychological group interventions on psychological well-being : a systematic review of the qualitative and quantitative evidence

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being of pregnant women. This systematic review examines interventions targeting women with elevated symptoms of, or at risk of developing, perinatal mental health problems, with the aim of understanding the successful and unsuccessful features of these interventions. We systematically searched online databases to retrieve qualitative and quantitative studies on psychological antenatal group interventions. A total number of 19 papers describing 15 studies were identified; these included interventions based on cognitive behavioural therapy, interpersonal therapy and mindfulness. Quantitative findings suggested beneficial effects in some studies, particularly for women with high baseline symptoms. However, overall there is insufficient quantitative evidence to make a general recommendation for antenatal group interventions. Qualitative findings suggest that women and their partners experience these interventions positively in terms of psychological wellbeing and providing reassurance of their ‘normality’. This review suggests that there are some benefits to attending group interventions, but further research is required to fully understand their successful and unsuccessful features

‘Welcome to the World’: parents' experiences of an antenatal nurturing programme

Background The transition to parenthood lays the foundations for the parent-infant relationship, but can also be a time of increased vulnerability. It can therefore be a suitable time for interventions to increase parents’ emotional wellbeing and support couple relationships as well as the relationship with the baby. Aims This study aimed to explore the experiences of attendees at an antenatal nurturing programme and its effect on their experiences of the early postnatal period. Methods A total of 36 attendees took part in six focus groups across the UK. Findings Participants’ experiences of the programme were very positive; it provided knowledge and skills and gave participants a safe space in which to explore feelings and concerns.The programme encouraged participants to nurture themselves, as well as their babies and their relationships. Some groups formed strong support networks, while others did not. Conclusion Participants felt they had benefitted from the programme, particularly in terms of their emotional wellbeing and couple relationships

Maternal and paternal expectations of antenatal education across the transition to parenthood

Background: Understanding parents' expectations of the knowledge and skills that they will acquire during antenatal classes provides an opportunity to tailor classes more closely to their needs. Aims: To explore whether a programme of antenatal classes met parents' expectations across the transition to parenthood. Methods: This study used research evaluation data to explore parents' expectations from antenatal classes as they transitioned from pregnancy to the postnatal period. Findings: Findings indicated that expectant mothers and fathers had different learning needs at different times, and that while expectant mothers were clear about what they want to know from classes, fathers entered classes with unspecific learning needs.These became slightly more focused as pregnancy progresses, but generally speaking, remained fairly vague. Conclusion: Understanding parents expectations of antenatal classes, and exploring the value of classes among attendees has the potential to result in improved attendance, reduced dropout rates and overall greater satisfaction

Conceptualising women's perinatal well-being: a systematic review of theoretical discussions

Background: Perinatal well-being has increasingly become the focus of research, clinical practice and policy. However, attention has mostly been on a reductionist understanding of well-being based on a mind-body duality. Conceptual clarity around what constitutes well-being beyond this is lacking. Aim: To systematically review theoretical discussions of perinatal well-being in the academic literature.Design and methods: A search of online databases identified papers which discussed perinatal well-being theoretically, taking a multi-dimensional approach to well-being. Thematic synthesis was used to identify and synthesize relevant elements within the included papers.Findings: Eight papers were identified for inclusion in this review. All contributed a number of elements towards a theoretical discussion of perinatal well-being. Three themes were developed: (1) the importance of a number of general domains of women’s lives and domains specific to the perinatal period, (2) well-being as a subjective and individual experience with physical/embodied, affective, and psychological/cognitive aspects, and (3) the dynamic nature of well-being. Conclusions and implications for practice: Perinatal well-being is a complex, multi-dimensional construct. Current theoretical discussions in the academic literature do not provide a comprehensive model or conceptualisation covering all aspects of well-being during the perinatal period. Further theoretical work is required, particularly with regards to theorising well-being during labour and birth, the perinatal period as a continuum, and the role played by women’s expectations. The themes identified in this review contribute to a tentative model of perinatal well-being, taking note particularly of the dynamic nature of well-being. This model should be refined and validated through empirical work and can then be used to underpin further research and the development of a multi-dimensional measure of perinatal well-being

A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health

Aim: To ascertain whether a new framework examining midwifery practice in perinatal mental health is supported by the research literature.Background: The identification and care of women with perinatal mental health problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which impact on midwives’ ability to identify, assess and care for women with perinatal mental health problems. Design: This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis.Data sources: Relevant electronic databases were searched for the period from January 2007 to December 2016; 33 studies from nine countries met the inclusion criteria.Review methods: Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain.Results: All five domains are substantially represented in the literature, thus supporting the proposed framework. A number of sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organisational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organisational level. Conclusion: The proposed framework was confirmed and can be used to inform practice, policy and research

A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health

Aim: To ascertain whether a new framework examining midwifery practice in perinatal mental health is supported by the research literature.Background: The identification and care of women with perinatal mental health problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which impact on midwives’ ability to identify, assess and care for women with perinatal mental health problems. Design: This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis.Data sources: Relevant electronic databases were searched for the period from January 2007 to December 2016; 33 studies from nine countries met the inclusion criteria.Review methods: Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain.Results: All five domains are substantially represented in the literature, thus supporting the proposed framework. A number of sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organisational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organisational level. Conclusion: The proposed framework was confirmed and can be used to inform practice, policy and research

3D Ultrasound in Pregnancy: Discourses, Women’s Experiences and Psychological Understanding

This study explores discourses around private three- and four-dimensional (3/4D) ultrasound scans in pregnancy, the experiences of women who have 3/4D scans and what impact these scans may have on pregnant women. A critical discourse analysis of scanning company websites was undertaken to explore the discourses, identities and genres set up on the websites. Longitudinal interviews exploring women’s experiences of 3/4D scans were analysed using interpretative phenomenological analysis. Case studies, using longitudinal questionnaire and interview data, were used to investigate the psychological impact of 3/4D scans on pregnant women. The critical discourse analysis revealed mixed discourses, identities and genres. While 3/4D scans are not overtly medical, they nevertheless contain medical aspects. They are promoted as enhancing bonding and reassurance. In the interview analysis, two superordinate themes emerged: ‘Getting to know the baby’ and ‘Experiences of pregnancy’. While the women’s physical and emotional experiences of pregnancy varied considerably, there were more convergences in the desire to ‘get to know’ the fetus and how women approached this. While routine and 3/4D scans played an important role, fetal movement also emerged as a significant factor. The case studies showed that the psychological impact was not consistent. Scans had no effect on fetal health locus of control, may have reduced anxiety about specific issues for some women and may have had a positive impact on some components of bonding for some women. It is not possible to state categorically that they reduce anxiety or increase bonding. The psychological impact of 3/4D scans appears to be individually mediated and depends on pregnancy experience and individual psychological differences, highlighting the significance of individual factors in both research and practice.Two opposing discourses portray 3/4D scans as either beneficial, by enhancing reassurance and bonding, or problematic, by undermining women’s embodied knowledge and experience and being potentially risky. This study suggests that neither of these two conflicting discourses are reflected in women’s experiences. The women in this study were not motivated primarily by bonding or reassurance when choosing 3/4D scans, but considered them a nice experience; on the other hand, the scans do not seem to have had a detrimental impact either. The interview analysis suggests that women acquire knowledge about the fetus through scans and fetal movement and combine these to make sense of the fetus. This study also provides evidence that the concept and measurement of bonding during pregnancy is problematic and that professional and academic perspectives are not necessarily reflected in women’s experiences

A systematic exploration of a perinatal wellbeing framework through women's experiences of lumbo-pelvic pain

Background: Women's wellbeing during the perinatal period has received increasing attention in research, policy and practice, but is often poorly defined and conceptualised. We have developed a framework of perinatal wellbeing (PWB) which we will refine further in this review, using the example of lumbo-pelvic pain (LPP). Perinatal LPP, which includes lower back pain (LBP) and pelvic girdle pain (PGP), is common and can significantly affect women's wellbeing. Aim: The aims of this review are (1) to synthesise research into women's experiences of LPP and (2) to use these findings to contribute further to developing our framework of PWB. Designs and methods: A systematic search of online databases was conducted for qualitative studies exploring women's experiences of LPP linked to the perinatal period; 15 papers describing 11 studies were identified. A framework synthesis approach (Carroll et al., 2011; Carroll et al., 2013) was used to synthesise studies, using the PWB framework as the a priori framework. Findings: The review highlights the impact of LPP on all areas of women's lives and their functioning at every level, as well as the impact of a range of factors on women's experiences. Only one study explored women's experiences of LBP, all others focused on PGP. Findings illustrate how multi-faceted women's wellbeing is in the context of LPP, particularly the importance of relationships and support, but also the role played by wider socio-cultural discourses of pregnancy and motherhood and by women's individual circumstances and characteristics. Findings underline the interconnectedness of physical, emotional and psychological experiences. The review largely confirmed, and further elaborated, the domains of the original framework, but also led to some changes, notably the inclusion of an ‘individual factors’ domain describing women's individual circumstances and characteristics. The limited discussion of LPP during labour and birth was notable. Conclusions and implications: Findings support the framework, but also provide evidence for some changes, thus further refining the framework. Women's wellbeing in the perinatal period (with regards to LPP, other issues, or generally) should not be considered in isolation, but needs to take account of women's life context. The perinatal period should be considered a continuum, rather than seeing each part in isolation. For clinical practice, the review underlines the importance of distinguishing between PGP and LBP and offering appropriate, individualised support

Maternal-fetal relationships and psychological health: Emerging research directions

Maternal representations of, and relationships with, the unborn baby appear to be associated with psychological health in pregnancy and beyond, and might play an important role in identifying women who need additional support, as well as providing an arena to develop positive pregnancy experiences. The mechanisms and pathways linking maternal–fetal relationships, psychological health and important outcomes are complex. This article provides an overview of some of the key findings in this area and identifies some important emerging directions for future research: the nature and form of maternal–fetal relationships and how best to measure them, the mediating and moderating factors linking maternal–fetal relationships with psychological health and other outcomes in pregnancy and beyond, and the importance and acceptability of the concept of maternal–fetal relationships to women