Prenatal care: The patient's perspective. A qualitative study
Department of Psychotherapy and Psychoanalysis, Vienna University Hospital, Austria. Prenatal Diagnosis
(Impact Factor: 3.27).
10/2006; 26(10):931-7. DOI: 10.1002/pd.1529
To investigate the subjective experiences and perceptions of the prenatal care system for women following a prenatal diagnosis and to assess the factors related to dissatisfaction with medical treatment.
Data derived from a follow-up investigation in fifty women following a prenatal diagnosis is presented. Women were asked to give written comments concerning their feelings and experiences during their time at the prenatal care unit. A qualitative content analysis was performed in order to examine the patients' perceptions and expectations of the prenatal care management and to seek potential associations of certain attitudes with socio-demographic, clinical, or psychological characteristics. Womens' comments were coded within established categories including 'satisfaction', 'dissatisfaction' and 'communicated emotionality'.
A high proportion of women were found to be dissatisfied with the physicians' attitudes (42%), the amount of information provided (46%), and medical staffs' attitudes (30%). One criticism, in particular, concerned a lack of communication skills in doctors and medical staff members. Forty-eight percent of our study population mentioned that they had benefited from psychological support. 'Nullipara' was the only variable associated with dissatisfaction with the received prenatal care.
The results of the study suggest that the high degree of discontent found in prenatal care patients could at least in some part be alleviated by implementation of communication training and supervision services for prenatal care workers. Moreover, nullipara may constitute a particular vulnerable subgroup that may need special attention and support. However, given the qualitative nature of our study, our results warrant replication in further empirically based research.
Available from: JoAnne M Youngblut
- "The literature lacks empirical data for profiles of common problems women encounter during or following high risk pregnancy from the women's perspectives (Kline, Martin, & Deyo, 1998; Leithner et al., 2006). In addition, other than drug or specific medical treatment, few empirical data exist on provider responses to common problems women encounter. "
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ABSTRACT: To (a) describe women's prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor).
Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women's homes. Patients' problems and APN interventions were classified with the Omaha Classification System.
A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1%). Women with chronic hypertension required significantly more case-management interventions.
The categories of women's problems were largely similar across medical diagnostic groups. Interventions to address women's problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies.
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ABSTRACT: Prenatal procedures have a major impact on a woman’s psychological experience during pregnancy. Generally, women expect a
confirmation of their expectation of a healthy child during ultrasonography. The detection of a fetal abnormality is a considerably
stressful situation. The active decision to terminate a wanted pregnancy following an adverse prenatal diagnosis as well as
any loss of a pregnancy, frequently result in acute feelings of grief, despair, and guilt, and may also cause severe long-term
psychological sequelae. Invasive procedures are often linked with anxiety about losing the baby and may confront women and
their partners with a moral dilemma about terminating the pregnancy. This seems even more evident for multiple pregnancies,
which may expose couples to the question of selective feticide or multifetal pregnancy reduction. Psychological support, from
the first suspicion of a fetal abnormality, and during the prenatal diagnostic process and after the termination of a pregnancy,
is needed to help women and their partners.
Available from: Victoria J Miller
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ABSTRACT: The objective of this study was to examine parent-reported experiences in the health care system after receiving the prenatal diagnosis of trisomy 18 and to identify factors that contribute to satisfaction with care.
Nineteen families who received the diagnosis between 2002 and 2005 were given semistructured telephone interviews. Of the 19 families, 11 continued the pregnancy while the remaining 8 chose induced abortion. Classical content analysis was utilized to identify themes among subject responses.
We identified several specific aspects of care as key in either being highly satisfied or dissatisfied: expressions of empathy from provider, continuity of care, communication, valuing the fetus and participation in medical decision-making.
Aspects of care that were identified as reasons for dissatisfaction are potentially modifiable by training, education or team-based approaches. Further studies are necessary to determine how we can improve the quality of services during prenatal diagnosis.
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