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| 2. |
- Asplin, Nina, et al.
(författare)
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Pregnancy termination due to fetal anomaly : women's reactions, satisfaction and experiences of care
- 2014
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 30:6, s. 620-627
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.METHOD:an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.SETTING:four fetal care referral centres in Stockholm, Sweden.PARTICIPANTS:11 women opting for pregnancy termination due to fetal malformation.FINDINGS:in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.CONCLUSION AND IMPLICATIONS FOR PRACTICE:The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.
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| 3. |
- Asplin, Nina, et al.
(författare)
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Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan
- 2012
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Ingår i: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives. - : Elsevier BV. - 1877-5764 .- 1877-5756. ; 3:2, s. 73-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.
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| 4. |
- Asplin, Nina, et al.
(författare)
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Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination
- 2013
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 4:2, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.DesignDescriptive study.SettingFour fetal care referral centres in Stockholm, Sweden.PopulationPregnant women with a detected fetal malformation.MethodsData was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.ResultsBoth women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).ConclusionThe decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.
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| 5. |
- Asplin, Nina
(författare)
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Women's experiences and reactions when a fetal malformation is detected by ultrasound examination
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met.
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| 6. |
- Björklund, Ulla, et al.
(författare)
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Audiovisual information affects informed choice and experience of information in antenatal Down syndrome screening : a randomized controlled trial
- 2012
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 86:3, s. 390-395
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the effects of an information film on making an informed choice regarding Down syndrome screening, and women's knowledge and experiences of information. METHODS: Randomized controlled trial including 184 women in the intervention group and 206 controls recruited from maternity units in Stockholm, Sweden. The intervention was an information film presented as a complement to written and verbal information. Data were collected via a questionnaire in gestational week 27. Three different measures were combined to measure informed choice: attitudes towards Down syndrome screening, knowledge about Down syndrome and Down syndrome screening, and uptake of CUB (combined ultrasound and biochemical screening). RESULTS: In the intervention group 71.5% made an informed choice versus 62.4% in the control group. Women in the intervention group had significantly increased knowledge, and to a greater extent than the control group, experienced the information as being sufficient, comprehensible, and correct. CONCLUSIONS: An information film tended to increase the number of women who made an informed choice about Down syndrome screening. Participants were more satisfied with the information received. PRACTICE IMPLICATIONS: Access to correct, nondirective, and sufficient information is essential when making a choice about prenatal diagnostics. It is essential with equivalent information to all women.
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| 7. |
- Björklund, Ulla, et al.
(författare)
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Does an information film about prenatal testing in early pregnancy affect women's anxiety and worries?
- 2013
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Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology. - : Taylor & Francis. - 0167-482X .- 1743-8942. ; 34:1, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To explore if an information film about prenatal examinations affects pregnant women's worry and anxiety. Methods: Randomized controlled study. The intervention was an information film about prenatal examinations. Data was collected in gestational week 26 by a questionnaire including the STAI (State-Trait Anxiety Inventory) instrument and further questions about worry. A total of 184 women in the intervention group and 206 in the control group filled in the questionnaire. Results: There were no statistically significant differences between the groups neither in state nor trait anxiety. Regarding worry about the possibility of something being wrong with the baby and worry about giving birth, there were no statistically significant differences between the groups. The women stated that to see the film increased their worry rather than decreased it. Conclusion: An informational film as additional information to complement written and verbal information about prenatal testing does not appear to increase women's anxiety and worries. However, the informational film may cause worry at the time of viewing which should be taken into consideration.
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| 8. |
- Georgsson Öhman, Susanne, et al.
(författare)
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Does an informational film increase women's possibility to make an informed choice about second trimester ultrasound?
- 2012
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Ingår i: Prenatal Diagnosis. - : Wiley. - 0197-3851 .- 1097-0223. ; 32:9, s. 833-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate effects of an informational film on making an informed choice regarding second trimester ultrasound.METHOD: Randomized controlled study. The intervention was an informational film about prenatal examinations. Data were collected at gestational week 26.RESULTS: A total of 184 women in the intervention group and 206 women in the control group participated in the study. Of those in the intervention group, 81.3% made an informed choice regarding second trimester ultrasound examination compared with 76.1% in the control group (p = 0.21). Women making an informed choice scored higher in knowledge about the examination (p < 0.001), had higher degree of education (p < 0.001), and spoke more frequently Swedish as mother tongue (89.5% vs 74.7%, p = 0.01).CONCLUSIONS: An informational film does not increase women's knowledge or the number of women making an informed choice about the second trimester ultrasound. Women who did not make an informed choice about the second trimester ultrasound had a lower level of education and less knowledge about second trimester ultrasound screening.
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| 9. |
- Georgsson Öhman, Susanne, et al.
(författare)
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Does fetal screening affect women's worries about the health of their baby? : a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening
- 2004
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 83:7, s. 634-40
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. METHOD: Two thousand and twenty-six women were randomly allocated to an ultrasound examination at 12-14 gestational weeks (gws) including risk assessment for Down's syndrome or to a routine scan at 15-20 gws. Questionnaires including the State-Trait Anxiety Inventory (STAI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS) were filled in at baseline in early pregnancy, at 24 gws and 2 months after delivery. RESULTS: No statistically significant differences were found between the trial groups regarding women's worries about the health of the baby, general anxiety and depressive symptoms during pregnancy or 2 months after delivery. Women's worries about something being wrong with the baby in the early ultrasound group and routine group, respectively, decreased from baseline (39.1% versus 36.0%) to mid-pregnancy (29.2% versus 27.8%), and finally to 2 months after delivery (5.2% versus 6.6%). CONCLUSION: Fetal screening for Down's syndrome by an early ultrasound scan did not cause more anxiety or concerns about the health of the baby in mid-pregnancy or 2 months after birth than in women who had a routine scan.
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| 10. |
- Georgsson Öhman, Susanne, et al.
(författare)
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Effect of first-trimester ultrasound screening for Down syndrome on maternal-fetal attachment : a randomized controlled trial
- 2010
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Ingår i: Sexual & Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 1:3, s. 85-90
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective was to investigate how ultrasound screening for Down syndrome (DS) in the first trimester, compared with a routine ultrasound examination in the second trimester, affected Maternal–Fetal Attachment (MFA) in mid-pregnancy. Method: This study of 2026 pregnant women was a sub-study of a larger RCT aiming at evaluating the effect of fetal screening for Down syndrome (DS) by means of an ultrasound scan, including measuring fetal nuchal translucency in gestational weeks 12–14. Women were randomly allocated either to the intervention or to a control group where routine care with an ultrasound scan in gestational week 17–20 was offered. Data were collected by questionnaires before randomization and in gestational week 24. MFA was measured by a modified version of the Cranley Maternal–Fetal Attachment Scale (CMFAS). Results: The mean score of MFA was 3.50 in the intervention group and 3.44 in the control group (p = 0.04). The mean scores on all subscales were slightly higher in the intervention group, but only statistically significant regarding “Differentiation of self from fetus” (p = 0.01). Conclusion: Ultrasound screening for DS in the first trimester may have a modest positive effect on MFA in mid-pregnancy, compared with a ultrasound scan in the second trimester.
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