• The confidential enquiry into maternal deaths 1997-2005: Implications for practice

      Oates, Margaret R. (2009)
      Most national policies for perinatal mental health in the UK have been influenced strongly by the Maternal Mortality Enquiries. These reveal that suicide in particular, and psychiatric causes of maternal death in general, are a leading cause of maternal mortality. In 1997-2002, suicide was the leading cause of maternal death (during pregnancy and for up to 1 year postpartum). However, the latest Enquiry (2003-2005) found a significant reduction in the number of suicides, which is now the second leading cause of maternal death. The majority of suicides had a previous psychiatric history. Those who died within 3 months of childbirth were suffering from severe mental illness, and most had a past history of severe affective disorder including puerperal psychosis. These identifiable risk factors were not detected in early pregnancy, or managed. There was often a delayed response to these women's rapidly deteriorating illness. None had been admitted to a mother-and-baby unit, or cared for by specialized perinatal psychiatric services in either their current or previous maternities. A consistent finding of the Enquiries has been the violent method of suicide, with few women dying from an intentional overdose of prescribed or over-the-counter medication. Substance misuse made a significant contribution to maternal mortality, from both medical and psychiatric causes. The reduction in maternal suicide might suggest that the recommendations of the last three Enquiries have had some impact. However, complacency is not justified and it remains true that many maternal suicides were predictable and perhaps preventable. © 2008 Elsevier Ltd. All rights reserved.
    • The power of shared philosophy: A study of midwives' perceptions of alternative birth care in Norway

      Crawford, Paul (2016)
      Aims: The aim of this study was to explore important factors that promote the best possible health for mother and child during pregnancy, birth and post-birth in an alternative birth clinic (ABC) in Norway.
    • The relationships between induced abortion, attitudes towards sexuality and sexual problems

      Bradshaw, Zoe; Slade, Pauline (2005)
      This study aimed to investigate whether abortion is associated with (i) changes in attitudes and feelings towards sexual matters (erotophobia-erotophilia), (ii) sexual problems, and (iii) whether erotophobia-erotophilia and sexual problems are associated. Ninety-eight women having a first-trimester abortion were investigated together with a comparison sample of 51 non-pregnant women. Standardised questionnaires assessing sexual problems and attitudes and feelings towards sexual matters were completed by the study sample (prior to and 2 months after abortion) and the non-pregnant comparison sample. The findings indicated that attitudes and feelings towards sexual matters were similar in the study and comparison sample, and were more positive 2 months after the abortion than prior to it. More sexual problems were experienced following the discovery of the pregnancy than prior to the pregnancy or in the 2 months after abortion. Levels of sexual problems reported by the study sample prior to pregnancy and by the comparison sample were similar. Erotophobia-erotophilia and sexual problems were moderately correlated in the study sample. In conclusion, becoming pregnant did not appear to affect erotophobia-erotophilia, but having the abortion was followed by more positive attitudes and feelings towards sexual matters. Becoming pregnant had short-term negative effects on sexual relationships but these were not sustained following abortion. © British Association for Sexual and Relationship Therapy.
    • The role of maternal prenatal attachment in a woman's experience of pregnancy and implications for the process of care

      Laxton-Kane, Martha (2002)
      This paper aims to review current knowledge concerning the development of prenatal attachment, the impact of demographic and pregnancy variables, and the implications for care and well-being of the foetus. The studies suggest that level of prenatal attachment, as assessed by questionnaires, typically increases throughout the course of pregnancy. It is likely that higher levels of social support are associated with increased levels of prenatal attachment but more research is needed into the association with this and other psychological variables. There is little evidence concerning the impact on prenatal attachment of procedures carried out as routine antenatal care or about the effects of high risk or surrogate pregnancies. An important area of emerging research involves investigating the implications of low levels of prenatal attachment and risk to the foetus. More research is needed into the relationship between prenatal attachment and how women care for themselves and their developing baby in terms of health-related behaviours. The current conceptual framework of the majority of prenatal attachment studies which focus on measuring levels rather than style can be considered over-simplistic. Greater integration with theoretical perspectives such as the development of maternal representations of care-giving would be beneficial.
    • The safety of anti-epileptic drug regimens: A qualitative study of factors determining the success of counselling women before conception

      Pashley, Sarah; O'Donoghue, Michael F. (2009)
      Background and Methodology: It is our experience that women who are already pregnant are commonly referred to our service for advice about the safety of anti-epileptic drug regimens. We know of no study that explores why epilepsy-specific preconception advice may be suboptimal. Women who had been referred to the epilepsy service before or during their most recent pregnancy were invited for interview. A thematic analysis of the interviews was used to compare the factors in women who planned their pregnancies with those who did not.; Results: Over half the women had an unplanned pregnancy and most considered they had received inadequate advice from primary care. Women with planned pregnancies sought out information, perceived the teratogenesis risks as more threatening, and were proactive in seeking a safe pregnancy. Women with unplanned pregnancies seemed less threatened by the risks of teratogenesis, experienced more social disadvantage, were more likely to have misunderstandings about epilepsy and pregnancy, and were vulnerable to deficiencies in primary care epilepsy management.; Discussion and Conclusions: The success of counselling was determined by a combination of access to care, and the attitudes and social context of women. Identifying those women at risk of unplanned pregnancy and tailoring counselling and treatment to their needs may reduce adverse pregnancy outcomes.;
    • Trans people's reproductive options and outcomes

      Richards, Christina (2014)
      Trans people are those people whose sex assigned at birth does not align with their gender identity - a condition that can cause marked distress. Consequently, many trans people seek to change their gender, often permanently. Most usually that change is to male or female although sometimes the change is to a non-binary gender form. However, as the last of these is less usual this commentary will consider only trans people who identify as male or female. [PUBLICATION] 10 references
    • Twin birth: an additional risk factor for poorer quality maternal interactions with very preterm infants?

      Beer, Charlotte; Glazebrook, Cris (2013)
      BACKGROUND: Twin birth can be considered an additional risk factor for poor interactions between mothers and their very preterm (VP; <32 weeks' gestation) infants.
    • Urine tests for Down's syndrome screening

      Guo, Boliang (2015)
      Background: Down's syndrome occurs when a person has three copies of chromosome 21, or the specific area of chromosome 21 implicated in causing Down's syndrome, rather than two. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life. The risk of a Down's syndrome affected pregnancy increases with advancing maternal age. Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive and false negative screening tests (i.e. invasive diagnostic testing, and the possibility that a miscarried fetus may be chromosomally normal). The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down's syndrome will have. Objectives: To estimate and compare the accuracy of first and second trimester urine markers for the detection of Down's syndrome. Search methods: We carried out a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), EMBASE (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2011, Issue 7), MEDION (25 August 2011), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), The National Research Register (archived 2007), Health Services Research Projects in Progress database (25 August 2011). We studied reference lists and published review articles. Selection criteria: Studies evaluating tests of maternal urine in women up to 24 weeks of gestation for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection. Data collection and analysis: We extracted data as test positive or test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. We used hierarchical summary ROC (receiver operating characteristic) meta-analytical methods to analyse test performance and compare test accuracy. We performed analysis of studies allowing direct comparison between tests. We investigated the impact of maternal age on test performance in subgroup analyses. Main results: We included 19 studies involving 18,013 pregnancies (including 527 with Down's syndrome). Studies were generally of high quality, although differential verification was common with invasive testing of only high-risk pregnancies. Twenty-four test combinations were evaluated formed from combinations of the following seven different markers with and without maternal age: AFP (alpha-fetoprotein), ITA (invasive trophoblast antigen), s-core fragment, free shCG (beta human chorionic gonadotrophin), total hCG, oestriol, gonadotropin peptide and various marker ratios. The strategies evaluated included three double tests and seven single tests in combination with maternal age, and one triple test, two double tests and 11 single tests without maternal age. Twelve of the 19 studies only evaluated the performance of a single test strategy while the re aining seven evaluated at least two test strategies. Two marker combinations were evaluated in more than four studies; second trimester s-core fragment (six studies), and second trimester s-core fragment with maternal age (five studies). In direct test comparisons, for a 5% false positive rate (FPR), the diagnostic accuracy of the double marker second trimester s-core fragment and oestriol with maternal age test combination was significantly better (ratio of diagnostic odds ratio (RDOR): 2.2 (95% confidence interval (CI) 1.1 to 4.5), P = 0.02) (summary sensitivity of 73% (CI 57 to 85) at a cut-point of 5% FPR) than that of the single marker test strategy of second trimester s-core fragment and maternal age (summary sensitivity of 56% (CI 45 to 66) at a cut-point of 5% FPR), but was not significantly better (RDOR: 1.5 (0.8 to 2.8), P = 0.21) than that of the second trimester s-core fragment to oestriol ratio and maternal age test strategy (summary sensitivity of 71% (CI 51 to 86) at a cut-point of 5% FPR). Authors' conclusions: Tests involving second trimester s-core fragment and oestriol with maternal age are significantly more sensitive than the single marker second trimester s-core fragment and maternal age, however, there were few studies. There is a paucity of evidence available to support the use of urine testing for Down's syndrome screening in clinical practice where alternatives are available.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.