Content uploaded by Rita de Cássia Sobreira Lopes
Author content
All content in this area was uploaded by Rita de Cássia Sobreira Lopes on Jun 02, 2018
Content may be subject to copyright.
A preview of the PDF is not available
Living each week as unique: Maternal fears in assisted reproductive technology pregnancies
Abstract and Figures
Objective
To explore women's fears during pregnancy following conception via assisted reproductive technology (ART).
Methods
19 expectant first-time mothers were interviewed during the third trimester of pregnancy using a semi-structured schedule. Perceptions of and feelings about pregnancy were assessed. Content analysis was used to identify themes and subthemes.
Findings
Four overarching themes emerged: the baby's survival, the health of the baby, the efficacy of the mother and childbirth. Of these, the most commonly reported fears were related to miscarriage or fetal death, and the baby being born with an abnormality.
Conclusions and implications
In addition to fears that are experienced by some women who conceived spontaneously, the women in this study who conceived via ART reported other fears, such as miscarriage or fetal death, that are more specific to this context. This suggests that these concerns should be taken into consideration when providing psychological support for ART mothers.
Figures - uploaded by Rita de Cássia Sobreira Lopes
Author content
All figure content in this area was uploaded by Rita de Cássia Sobreira Lopes
Content may be subject to copyright.
... The increasing use of ART around the world (Ranjbar et al., 2020) as well as the difficulties experienced during pregnancy (Dornelles et al., 2014;Hammarberg et al., 2008;Huang et al., 2019) give rise to the importance of better understanding the experience of expecting parents who conceive using these technologies. However, we note that few recent systematic reviews offer a summary of the subject, and that, most of the time, the studies focus only on the experience of the mother. ...
... This finding was graded as moderate confidence because of minor concerns regarding methodological limitations, relevance, coherence, and adequacy. (Dornelles et al., 2014;French et al., 2015;Lin et al., 2013) Women doubted they were actually pregnant even after a positive pregnancy test result. ...
... This finding was graded as moderate confidence because of minor concerns regarding methodological limitations, relevance, coherence, and adequacy. (Dornelles et al., 2014;French et al., 2015;Huang et al., 2019;Lin et al., 2013;Ranjbar et al., 2015;Toscano and Montgomery, 2009;Turgeon et al., 2018;Warmelink et al., 2016a) Sometimes fears surrounding the success of the pregnancy dampened attachment to the fetus, while for others, this sense of attachment was present even before the embryo was implanted. ...
Background
Across the world, a growing number of couples are directly or indirectly affected by infertility. Advances in assisted reproductive technologies are now enabling many of them to plan to have a child. As pregnancies resulting from assisted reproductive technologies are being experienced by a growing number of couples, it is important to better understand their experiences and the difficulties they encounter during the prenatal period.
Objective
This literature review aims to synthesize the qualitative results of primary studies in order to better understand couples’ experiences of pregnancy resulting from assisted reproductive technologies, after having experienced infertility.
Design
A meta-synthesis was conducted in accordance with the guidelines put forth by Sandelowski and Barroso in order to carry out an integrative analysis of the knowledge resulting from qualitative studies on this phenomenon.
Data sources
The literature search was carried out between October and November 2020. Seven electronic databases were searched (CINAHL, Medline, PsycNet, SCOPUS, ScienceDirect, CAIRN, ERUDIT) and 14 eligible articles were selected.
Review methods
The data from the “results” and “findings” sections of each of the articles were synthesized through thematic analysis to examine and summarize the topics found in the articles selected and develop the main themes.
Results
The thematic analysis is structured around four themes to describe and interpret different aspects of the experience of pregnancy resulting from ART, namely: 1) travelling a long and complex journey; 2) moving on with paradoxical emotions; 3) struggling with an emerging identity; and 4) reorganizing relationships. These results shed light on the complex issues faced by couples previously affected by infertility during a pregnancy resulting from assisted reproductive technologies.
Conclusion
The journey of a pregnancy resulting from assisted reproductive technologies must be recognized in order to offer support in line with the challenges faced by couples. This research will allow for a deeper understanding of women's experience, as well as that of their partner's, in a more specific way, and to better understand the impact on family and loved ones.
... The literature indicates that the most common concerns expressed by pregnant women related to themselves, their pregnancy, giving birth, their child's health and well-being and parenting [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Studies have also reported that maternal worries were most intense in early and late pregnancy [9,14], when pregnancy-related anxiety was also at its highest [27]. ...
... Studies have shown that pregnant women were most concerned about whether they would be good mothers and adjust to parenthood [10,11,14,16,20,22]. Previous literature showed that pregnant women were also concerned about how they would cope with their new baby [9,16,20,23] and whether there would be room in their hearts and lives for the new child [11]. ...
... Previous literature showed that pregnant women were also concerned about how they would cope with their new baby [9,16,20,23] and whether there would be room in their hearts and lives for the new child [11]. Concerns were also raised about breastfeeding [22,24] and whether mothers had the ability to raise their children well [18]. Shahoein et al. [18] reported that some mothers were so concerned about the responsibility of being a parent that they regretted getting pregnant in the first place. ...
Previous research on the fears and anxieties of expectant mothers has focused mostly on their fears about giving birth rather than parenting. This study aims to describe mothers’ fears and concerns about parenthood during pregnancy and to examine the similarities and differences in the perspectives of primiparous and multiparous mothers. The qualitative research for this study was conducted in three postpartum units in Finland and focused on the responses to an open-ended question about parenting fears and concerns that was part of a questionnaire given to 250 mothers after they had given birth. The responses from the 128 mothers who answered this question were subject to inductive content analysis. Fears and concerns on parenthood included worries about coping with the future and everyday life with their new baby, the psychological burden of parenthood, their maternal resources and self-efficacy, meeting their baby’s needs, their baby’s health, concerns about their relationship with their partner and financial issues. Primiparous and multiparous mothers shared many of the same concerns, but some differences emerged. The findings contribute an interesting perspective to the social debate about declining birth rates and their psychosocial causes. Further studies are needed to examine the fears and concerns of younger adults, and even teens, about parenthood.
... Researchers support the notion that women using fertility treatments experience more pregnancy-related anxiety and fears than women who conceive spontaneously (Dornelles et al., 2014;McMahon et al., 2013). Even successful fertility treatment may be followed by distress, uncertainty, and delays in early interaction with the long-awaited baby (Ladores & Aroian, 2015;Lehto et al., 2019). ...
In this narrative study, we explored the meaning infertile women attribute to social support in coping with their infertility-related challenges. Written accounts and episodic interviews with 26 previously infertile Finnish women were used as data. Two different coping story types emerged: coping alone and coping with support. In the coping alone type women neither sought nor received support. Their coping appeared as a lonely struggle. In the coping with stories, women turned to their spouses, peers, or professionals, but still emphasized that they would have needed more support. Based on our findings, we underline the need for individually tailored support.
... Japan conducted the largest number of ART cycles among 65 countries in 2011, along with 20.7% of all egg retrieval reported in the registries. 1 The percentage of total live births resulting from ART in Japan has increased from 0.5% in 1996 to 6.0% in 2017. 2 After successful fertility treatment, women experience psychosocial challenges specific to pregnancy following ART. Women who become pregnant after infertility may experience anxiety surrounding maternal and fetal survival, normality, [3][4][5][6] and other complex social issues related to infertility treatment. 5,7 In early pregnancy, these women reported experiencing paradoxical feelings, such as joy and fear, or hope and uncertainty, [8][9] and had difficulty perceiving themselves as pregnant women. ...
Objective:
This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology.
Introduction:
Pregnant women following assisted reproductive technology experience unique challenges to their identity when transitioning to motherhood. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology.
Inclusion criteria:
Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion.
Methods:
Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis.
Results:
This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology, and were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low.
Conclusions:
The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology for these women. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed.
Systematic review registration number:
PROSPERO CRD42019138200.
... İnfertiliteden gebeliğe geçiş yapma zorluğu, doğum sonu döneme uyumunun azalmasına ve postpartum depresyon belirtilerinin daha fazla görülmesine sebeb olabilmektedir. İnfertil çiftlerin tedavi süresince yaşadıkları; tekrarlayan gebelik kayıpları, doğum sonu dönemde anksiyete, bebeği kaybetme korkusu gibi sorunlarla karşımıza çıkmaktadır (24). İnfertil ebeveynlerin doğum sonu döneme uyumlarında ve ebeveynlik rolünü öğrenme sürecinde; fiziksel yorgunluk, uykusuzluk, maddi sıkıntılar, sosyal izolasyon oluşmaktadır (25,26). ...
... 1 The percentage of total live births resulting from ART in Japan has increased from 0.5% in 1996 to 5.5% in 2016. 2 Various studies have described experiences specific to pregnancy after ART. Women who become pregnant after infertility were reported to have greater specific anxiety, such as fetal survival and normality [3][4][5][6] and other complex issues. 5,7 In early pregnancy, these women reported experiencing paradoxical feelings such as joy and fear, or hope and uncertainty, 8,9 and had difficulty perceiving themselves as pregnant women. ...
Objective:
This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART).
Introduction:
Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART.
Inclusion criteria:
This review will consider any qualitative research data from empirical studies published from 1992-2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART.
Methods:
This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include: MEDLINE, CINAHL, PsycINFO, ProQuest, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese). Titles and abstracts will be screened by two independent reviewers in full. The full-text of selected studies will be assessed in detail, and findings and their illustrations will be extracted and aggregated. Any disagreements between the reviewers that arise at each stage will be resolved through discussion, or by a third reviewer.
Background
Existing research indicates that pregnant women who conceived through fertility treatment might experience more stress and anxiety compared to women who conceived spontaneously. Therefore, these women might have additional antenatal care needs.
Methods
A search for both quantitative and qualitative studies was performed in PubMed, PsycINFO, CINAHL and MEDLINE through May 2021, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. 21 articles met the inclusion criteria. After methodological quality appraisal using the Mixed Methods Appraising Tool, 15 studies were included in the review.
Results
Analysis of the studies identified behavioral, relational/social, emotional, and cognitive needs and women’s preference about maternity care. Women who conceived through fertility treatment reported lower social and physical functioning scores and elevated levels of anxiety and depression compared to women who conceived spontaneously. They reported difficulties adjusting to pregnancy and experienced a care gap between discharge from the fertility clinic and going to local maternity care services for their first consultation, and a care gap postpartum.
Conclusions
Women who conceived through fertility treatment have additional antenatal care needs. We recommend to offer these women more frequent check-ins, and to pay attention to the impact of their infertility and treatment on their pregnancy.
Purpose: This study investigated the correlation between mother-infant bonding and postpartum depression in women with a history of infertility. Methods: The sample consisted of 169 women divided into two: infertile group (n=56) and fertile group (n=112). Data were collected using a descriptive information questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), and the Mother-to-Infant Bonding Scale (MIBS). Results: The fertile and infertile groups had a mean age of 28.95±3.38 and 36.55±3.55, respectively (p=0.001). The infertile group had a higher mean MIBS score (3.73±2.91) than the fertile group (1.50±1.29) (p=0.001). However, there was no significant difference in EPDS scores between the two groups (p > 0.05). Moreover, there was a positive correlation between MIBS and EPDS score in the fertile group (r = 0.354, p = 0.001), suggesting that the higher the risk for postpartum depression, the lower the mother-infant bonding. There was no correlation between MIBS and EPDS score in the infertile group (p > 0.05). Conclusion: Future studies should recruit larger samples of infertile women with cultural and ethnic diversity and take confounding factors into account to investigate the relationship between postpartum depression and mother-infant bonding.
Men undergoing assisted reproductive technology : relationship with medical staff and psychological experiences
The aim of this study was to explore whether there is a link between satisfaction with the relationship with medical staff and the level of anxiety and depression in men undergoing assisted reproductive technology. Twenty-seven men participated and were assigned to two different groups, depending on whether they were “fathers” or “non-fathers”. They were first interviewed and then they completed three questionnaires. The quality of the relationship with the medical staff is negatively correlated with levels of anxiety and depression. The “non-fathers” group had significantly higher levels of anxiety and depression than the “fathers group. The importance of the relationship with the medical staff for men, in this particular context, is discussed.
Review question:
What is the effect of antenatal parenting education on parenting stress, maternal depressive symptoms and maternal confidence, compared to usual care, for expectant primiparous women in Asian countries?
When plans to become parents cannot be realized due to a couple's infertility, it is possible to resort to assisted reproduction techniques. However, the physical and emotional stress caused by these techniques may accord pregnancy and parenthood specific characteristics, with yet unknown repercussions. Through this qualitative study, based on interviews with three women in the third trimester of pregnancy, who conceived with the aid of different assisted reproduction techniques, this study aimed to understand the process of becoming a mother in this context. The results were discussed based on the concept of maternal constellation, the understanding of the experience of pregnancy and the notion of stages of conception in infertile couples. The results primarily revealed a fear of losing the baby and feelings of being incapable of having a normal pregnancy, bringing unique challenges to this moment.
The mother's relationship with her baby is constructed since the prenatal period and is infl uenced by her expectations regarding the baby and the interaction she establishes with him/her. This fi rst relationship serves as a prelude of the mother-infant relationship established after birth. The aim of this study was to investigate the pregnant women's expectations and feelings regarding the baby. Thirty-nine primiparous pregnant women, in the last trimester of gestation, aged 19 to 37, took part in this study. The pregnant women were individually interviewed and their answers were examined through content analysis. The results indicated that, since pregnancy, mothers try to give the baby more identity, holding expectations and feelings regarding his/her sex, name, psychological characteristics, health, besides interacting with him/her. This seems to constitute an important investment for the baby's psychic constitution, besides enabling mothering.
IntroductionPregnancy and emotional upheaval: risks and resiliencyThe psychological unfolding of pregnancyPsychopathology in pregnancyPrevention and early interventionCAPEDP-Attachment: a French project to promote parental skills and decrease disorganized attachmentReferences
Background: Psychological outcomes of successful in vitro fertilization (IVF) treatment are poorly understood, particularly in couples experiencing a multiple birth. Methods: Anxiety and depression at 18 weeks of pregnancy, 28 weeks of pregnancy, and at 6 weeks postpartum were compared in couples conceiving twins or triplets following IVF (IVFM), couples conceiving a single baby (IVFS), and couples conceiving without treatment for infertility (NC). Parenting stress was also assessed at 1 year postpartum. Results: The IVFM group was significantly more anxious at 18 weeks and 28 weeks of pregnancy than both the IVFS group and the naturally conceiving group. Over 30% of female partners in this group had levels of anxiety suggestive of a clinical disorder. There was no evidence that women conceiving following IVF treatment were at increased risk of developing postnatal depression. In couples with a single birth, male rates of postpartum depression were significantly lower than those of females, but in the IVFM group, men had rates that were higher but statistically similar to females. Conclusion: Psychological complications of multiple IVF pregnancies include increased anxiety during pregnancy and, for fathers, poorer mental health in the early postpartum period.
Investigated attitudes toward pregnancy and motherhood in interviews with 110 childless women in the last trimester of pregnancy. 30 Ss had serious, congenital cardiac defects diagnosed and treated before pregnancy, and 40 Ss had miscarried at least twice previously. Two questionnaires were also administered. The 70 Ss with high-risk pregnancies evaluated motherhood lower than Ss in their 1st, uncomplicated pregnancy. However, the high-risk Ss were more likely to report having planned their pregnancies and had changed their lifestyles in gestation markedly to increase their chances for successful outcome of pregnancy. Ss in the miscarriage group reported valuing family life the least. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
IntroductionDepression and anxiety during pregnancyBipolar disorderSchizophreniaPost-partum psychosisConclusion
References
IntroductionPregnancy and the ‘placental paradigm’The model of maternal orientationsMotheringPostnatal disturbancesContagious arousalPaternal orientationsConclusion
References
To evaluate whether older first-time mothers (≥37 years) have higher rates of postpartum depression compared with younger first-time mothers, controlling for mode of conception and known risk factors for postpartum depression.
Prospective cohort study.
Assisted reproductive technology (ART) clinics in two large Australian cities and public and private antenatal clinics and/or classes in the vicinity of ART clinics.
Nulliparous women who had conceived spontaneously (n = 295) or through ART (n = 297) in three age-groups: younger, 20 to 30 years (n = 173); middle, 31 to 36 years (n = 214); and older, ≥37 years (n = 189).
Semistructured interviews and questionnaires.
Major depressive disorder in the first 4 months after birth as assessed by structured diagnostic interview.
The study performed 592 complete pregnancy assessments and 541 postpartum assessments. The prevalence of major depressive disorder was 7.9%, at the lower end of community rates. Neither maternal age-group nor mode of conception was statistically significantly related to depression.
Older first-time mothers, whether conceiving through ART or spontaneously, do not show increased vulnerability to postnatal depression.