The Association Between Unintended Pregnancy and Perinatal Outcomes in Low-Risk Pregnancies: A Retrospective Registry Study in the Netherlands.

INTRODUCTION: People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations. METHOD: This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations. RESULTS: Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 -2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations. DISCUSSION: Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.

Legal age limits in accessing donor information: experiences of donor-conceived people, parents, sperm donors and counsellors.

RESEARCH QUESTION: What are the lived experiences of donor-conceived people, parents, sperm donors and counsellors related to legal age limits on accessing donor information in the Netherlands? DESIGN: A phenomenological study was carried out that included 20 donor-conceived individuals, 15 parents, 6 sperm donors and 5 counsellors. Data were collected through online qualitative in-depth interviews and focus groups. The data were analysed using Dahlberg's Reflective Lifeworld Approach. RESULTS: The results show how: (i) age limits create challenges related to dependency, autonomy and loyalty to parents; (ii) donor information can be important for identity development, which looks different at different ages; (iii) inaccessible information can lead to unfair loss and may be perceived as negative; (iv) relational stability provides a good foundation for dealing with the (in)accessibility of donor information; (v) procedural barriers and age limits increase the inaccessibility of donor information; and (vi) comprehensive counselling is desired for donor-conceived individuals, parents and donors. CONCLUSIONS: This study shows that legal age limits on accessing donor information can lead to several negative consequences. The age limits focus on one individual, which is not appropriate for questions about ancestry that always pertain to a relational network. Counselling should be tailored to the child's needs, and the child's family should be involved. Furthermore, the donor should receive independent counselling.

Women with unwanted pregnancies, their psychosocial problems, and contraceptive use in primary care in Northern Netherlands: insights from a primary care registry database.

INTRODUCTION: Globally an estimated 1 in 16 women per year experience an unwanted pregnancy (UWP). In the Netherlands, general practitioners (GPs) play an important role in providing care for women with UWP; however, it is unknown how many of these women consult their GP about the pregnancy. UWPs are a major life experience with a possible influence on mental health. Data that GPs register about UWPs, psychosocial problems, and contraceptive use could give more insight into care needs. AIMS: To create an overview of (i) the prevalence of UWPs in general practice, (ii) the prevalence of psychosocial problems in women with UWP, and (iii) contraceptive use of women with UWP. METHODS: GP registration data were analysed from 58 general practices located in Northern Netherlands between 2015 and 2019. Patient files were checked for registration of ICPC and ATC codes concerning pregnancy, psychosocial health, and contraceptive use. Chi-square and Fisher's exact test were used to calculate differences between women with a UWP and women with a wanted pregnancy (WP). An analysis of registration dates was conducted to determine when the psychosocial problems were registered in relation to the pregnancy. RESULTS: Of female patients of reproductive age, 1.6% had a UWP and 11.8% had a WP. Women with a UWP reported statistically significantly more psychosocial problems. Furthermore, statistically significantly more contraceptive methods were prescribed to women with UWP compared with both women with WP and women without pregnancy. DISCUSSION AND CONCLUSION: The finding that women with UWP experience more psychosocial problems can be used to improve aftercare and can be incorporated into current guidelines for GPs.

Discovering a pregnancy after 30 weeks: a qualitative study on explanations for unperceived pregnancy.

"Unperceived pregnancy" names the phenomenon when a person becomes pregnant unintentionally and is not aware of being pregnant. Scientific explanations are roughly based on two hypotheses: psychological and physiological. We aim to gain a better understanding of unperceived pregnancy by studying the perspectives of people who experienced an unperceived pregnancy and obstetric professionals. Seventeen semi-structured interviews were conducted: eight with women who had experienced an unperceived pregnancy (≥30 weeks' gestation), six with midwives, and three with gynecologists. Our findings show that women's explanations for not noticing their pregnancy center around the absence of pregnancy symptoms. The failure to recognize more subtle signs of pregnancy was enforced by inattention, physical distractions, and psychological factors. In contrast, psychological explanations are dominant among obstetric professionals. Our study demonstrates a discrepancy in the explanations provided by women who had experienced an unperceived pregnancy and obstetric professionals. Potentially, this could result in people being unheard and misunderstood. We recommend that future research moves beyond a focus on "denial of pregnancy" to consider both psychological and physiological factors, and how these could potentially interrelate. This broadened approach will enhance our understanding of unperceived pregnancy and can contribute to improved counseling by obstetric professionals.

Life after teenage childbearing: A long-term view on teenage mothers' wellbeing.

BACKGROUND: This study aims to address the lack of information about the long-term wellbeing of (former) teenage mothers in the Netherlands. It provides data which policymakers can use to ensure that support programmesmeet the needs of teenage mothers. METHODS: Women who had given birth before the age of twenty were recruited online by Fiom, expertise centre on unintended pregnancy (December 2018-February 2019; N = 248). Survey data were obtained to assess how they perceived their wellbeing, employment, education, housing, and social support. Respondents were divided into three groups: 0-3 years after teenage childbearing (short term), 4-12 years (medium term), >12 years (long term). Results were analysed using univariate and bivariate descriptions in SPSS. RESULTS: Almost 80% of respondents reported that they were doing well and were satisfied with their lives, 63% had a job, and 17% were students. Short-term mothers worked fewer hours per week, received more benefits, and were less satisfied with their living conditions compared to medium- and long-term mothers. 36% Of the respondents smoked cigarettes. Most support was given by family (83%), mainly by female relatives. About 24% received formal support from social workers or institutions. CONCLUSIONS: Respondents, on average, reported they were doing well and were satisfied with their lives, in both the short and long term. These results suggest that as the years pass, teenage mothers overcome difficulties. Regarding income and housing, however, short-term mothers were in a less favourable position. Tailored interventions are recommended to address smoking among (former) teenage mothers.

Meeting multiple same-donor offspring: psychosocial challenges.

Debates regarding donor-conceived people's rights to genetic information have caused some jurisdictions to abolish donor anonymity. Moreover, voluntary services have been established whose primary focus is providing possibilities to find information about the donor. A less discussed consequence is that donor-conceived people also find information about donor half-siblings: people conceived through the same donor. In the recent climate of openness and online DNA tests, there is an increased chance of finding multiple donor half-siblings. This study explored how donor-conceived people experience meeting multiple same-donor offspring in a group setting. Second, the study investigated donor-conceived people's need for support when meeting multiple donor half-siblings. A qualitative approach was used. Nineteen donor-conceived offspring who participated in donor half-sibling network meetings were interviewed. Using a grounded theory approach three themes were identified regarding group aspects: (i) defining group membership; (ii) regulating closeness and distance; and (iii) managing group dynamics. Professional support needs in relation to these themes were also analysed. While establishing relationships between donor half-siblings are viewed as generally more beneficial than connecting with a donor, this study showed that these new relationships also come with their challenges, and counselling may need to be refined towards a more specific same donor-offspring relationships' framework.

Anonymous Dutch sperm donors releasing their identity.

This study examined the motivations of anonymous Dutch sperm donors to release their identity. It aimed to increase knowledge and encourage donors to become identifiable through a more informed decision, allowing more donor-conceived persons to contact their donors. Since 2010, anonymous sperm donors in the Netherlands can register in the Fiom KID-DNA Database developed by Fiom and Canisius Wilhelmina Hospital (CWZ). An online survey was sent to donors who registered in the database (May 2015-August 2017). A total of 179 male respondents participated in this study. The motives of most donors to register in the database were child-oriented: donors believe that their offspring are entitled to their physical and social details and/or they want to give their offspring the chance to contact them. Other motives are donor-oriented, such as the curiosity about the number of offspring, their well-being and the desire to establish contact. This research showed that, to encourage anonymous donors to release their identity, one should focus on providing information about the existence of DNA databases. As well as increasing the donor's awareness of problems donor-conceived persons can experience by the lack of knowledge about their descent, answering questions and concerns from donors, and exploring the curiosity about their offspring.

Restless Feelings: Desiring Direct Contact After Postmortem Organ Donation.

This article investigates the emergence of a growing demand in the Netherlands: the wish of organ donor families and organ recipients to establish contact. Such direct contact transgresses both the anonymity and privacy long considered by many to be fundamental to organ donation. Legislation prescribes that privacy should be safeguarded, but the parties involved increasingly manage to find each other. Research is needed to provide insight into the ramifications of direct contact, which may inform mourning counseling and psychosocial support. Drawing on qualitative interviews with donor's relatives, we analyze the reasons for the desire to have direct contact. We seek to understand how meanings are constructed and contested through organs at the margins of life and death in the individualized and secularized society of the Netherlands. We find that relatives struggle with persistent restless feelings after postmortem organ donation and may develop a level of personal attachment and assign inalienability to human body parts.

Over my dead body: body donation and the rise in donor registrations in The Netherlands.

In The Netherlands, the number of body donor registrations has been increasing for several years. Body donors are people who register at an anatomical institute to donate their entire body, after death, for scientific education and research. Although only 0.1% of the Dutch population is registered as a body donor, this is sufficient to realize the anatomical demand of about 650 bodies annually. Due to the recent rise of registrations many anatomical institutes have (temporarily) stopped registering new donors to prevent a surplus of bodies. Based on a large body donor survey (n=759) and in-depth anthropological interviews with 20 body donors, we try to give an explanation for the rising registration numbers. We argue that the choice for body donation in contemporary, individualized Dutch society is an autonomous way to give meaning and sense to life and death outside the framework of institutionalized religion.

Dead bodies matter: gift giving and the unveiling of body donor monuments in the Netherlands.

Body donors are people who voluntarily donate their entire body, after death, to anatomical science. Based on anthropological fieldwork in the Netherlands this article explores the construction of body donor monuments since 2007. These developments are analyzed by means of gift-giving theories. Body donation is a practice in which the medical and scientific value of the donor bodies has always been praised. Increasingly the fact that the bodies represent real human beings who have mourning relatives has also been acknowledged. This change in attitude has resulted in a desire on the part of anatomical professionals to give back a monument, not only for the donors themselves but also, in particular, for the donors' relatives. The great public interest in the monuments has revealed that many of the bereaved, in the absence of having the physical body of the donor, need a symbolic final resting place for their loved ones.

Anatomist on the dissecting table? Dutch anatomical professionals' views on body donation.

Anatomical professionals know better than anyone else that donated bodies are a valuable asset to anatomical science and medical education. They highly value voluntary donations, since a dearth of bodies negatively affects their profession. With this in mind, we conducted a survey (n = 54) at the 171st scientific meeting of the Dutch Anatomical Society in 2009 to see to what extent anatomical professionals are willing to donate their own body. The results reveal that none of the survey participants are registered as a whole body donor and that only a quarter of them would consider the possibility of body donation. We argue that the two main constraints preventing Dutch anatomical professionals from donating their own body are their professional and their social environments. In contrast to the absence of registered body donors, half of the anatomical professionals are registered as an organ donor. This figure far exceeds the proportion of registered organ donors among the general Dutch population.

Personality and motivation for body donation.

BACKGROUND: This study examines the relationship between motivation for body donation to science and personality characteristics using a body donor survey (N=759) conducted by the University Medical Centre Groningen (UMCG) in The Netherlands. The survey expands on anthropological studies that suggest an association between donor motivation and personality. METHODS: A structural equation model was used to investigate the relationship between personality and motivation for body donation. FINDINGS: The results show that, compared to society at large, body donors have a similar spectrum of personality characteristics. However, we found statistically significant positive relationships between donor motivation and Big Five personality traits. Together the personality traits explain between 5% and 15% of the variance in motivation for body donation. CONCLUSIONS: We argue that donor campaigns should not focus solely on altruistic motives, but should include the aspect of possible personal achievement by the donor. This is a fruitful starting point for approaching potential donors and anticipating their needs.

An altar in honor of the anatomical gift.

On All Saints Day 2009 a monument for body donors was unveiled by the Department of Anatomy, at the Radboud University Nijmegen Medical Centre (RUNMC). Although body donation to medical science contributes substantially to the quality of medical education, the ceremony was only the first time that the RUNMC publicly reciprocated the anatomical gift. By means of the monument the department of Anatomy endeavors to express gratitude for the gift of body donors and raise awareness among students to value the gift and treat donor bodies with the proper respect. Furthermore, the large attendance of bereaved at the unveiling ceremony, revealed another equally important meaning of the monument, which is the significance of the monument to the donor kin. The wish of a body donor has large implications for the way bereaved can take leave of the donor; there is limited time to bade the deceased farewell, the body will not be available for a funeral, and the donor kin stay behind empty handed without even a grave or ashes. Therefore the monument can be meaningful by facilitating the bereaved with a place of commemoration. The design of the monument anticipates on these multiple meanings and symbolisms by placing an old marble dissection table in the shape of an altar and fixing a bronze sculpture of a phoenix as symbol of imperishableness.

Motivation for body donation to science: more than an altruistic act.

BACKGROUND: In recent years the Netherlands has witnessed a steep increase in the number of bodies donated for medical research and training. To explore this upward trend and motives for donation, a survey was conducted among registered body donors in the database of the Department of Anatomy at the University Medical Center of Groningen (UMCG). METHODS: In November 2008, postal questionnaires were sent to 996 people enrolled at the UMCG body donor database. The present study focuses on motives for donation and social background characteristics of the body donors. FINDINGS: Registered donors responded quickly and the survey response rate was high (76%). The mean age of respondents was 69 years and the majority described themselves as Dutch (98%) and non-church affiliated (79%). One quarter (25%) of the respondents are/were health care professionals and 11% involved in education. Principal factor analysis revealed three dimensions underlying ten different motivations for body donation: a desire to be useful after death, a negative attitude towards funerals and expression of gratitude. Despite the current economic recession only 8% of respondents are prompted by money motives to bequeath their bodies. CONCLUSIONS: The majority of motives for body donation stem from the wish to be useful after death. However, the present survey suggests that body donation is more than an altruistic act; people are also motivated by personal benefit. Results of our survey contradict the notion that body donation stems from loneliness. Many donors have a supportive social network and meaningful social relationships. People moreover propagate body donation within their social networks.