'A small person that we made' - Parental conceptualisation of the unborn child: A constructivist grounded theory.

BACKGROUND: The way that expectant parents think and feel about the fetus during pregnancy is thought to be somewhat predictive of their later relationship with the child. However, efforts to identify determinants, correlates and consequences of the parental-fetal tie have had conflicting results. This is likely to be partially attributable to issues in existing conceptualisations of the phenomenon. OBJECTIVE: The purpose of the study was to construct substantive theory of expectant parents' fetal conceptual and relational experiences. METHODS: Constructivist grounded theory was used to explore data generated through individual, semi-structured interviews conducted with nine first-time expectant mothers and their male partners residing in Malta, in early, middle and late pregnancy. Analysis included techniques of coding, constant comparison and memo-writing. FINDINGS: Expectant mothers and fathers conceptualise and connect to the fetus through comparable processes, despite physical disparities in the pregnancy experience. Coming to think of the fetus as a known other and part of the intimate family is vital in achieving a sense of relatedness. An increasingly tangible fetus facilitates such an outlook. However, the extent of accessibility to fetal palpability and reciprocity consistently fail to satisfy parental yearnings. CONCLUSIONS: Given the convoluted and individualised nature of the parental-fetal tie, accurate measurement of this through the use of self-report instruments is likely to remain challenging. Instead, midwives can talk to expectant parents in-depth about their feelings regarding the unborn child and seek to address any concerns. Further longitudinal research spanning the transition to parenthood is needed to understand the postpartum sequelae of the processes observed antenatally.

A narrative review of interventions addressing the parental-fetal relationship.

BACKGROUND: Expectant parents develop varying degrees of emotional affiliation with the unborn child. Interventions supporting this relationship may be beneficial given its link to maternal health behaviour during pregnancy, as well as the parental-infant bond after birth. AIM: To identify and describe the effects of programmes and strategies that have addressed the parental-fetal relationship. METHOD: English-language primary studies, published between 2005-2015, were identified and their methodological quality was assessed. Databases used included CINAHL, Cochrane Library, MEDLINE, PsycINFO and Web of Science. Key search terms included maternal/paternal-fetal attachment, prenatal bond, parental-fetal relationship and intervention. RCTs, non-RCTs, observational and non-comparative studies, before and after studies and case studies were included. FINDINGS: Twenty-seven papers were included. Studies evaluated the effects of various strategies, including ultrasound and screening procedures, fetal awareness interventions, social and psychological support techniques, educational programmes and relaxation strategies. Results are inconsistent due to the diversity of interventions and significant variation in methodological quality. CONCLUSION: There is insufficient evidence to support definitive conclusions regarding the efficacy of any included intervention. A number of limitations, such as non-probability sampling, lack of blinding, and insufficient follow-up weaken the evidence. The inclusion of fathers in only three studies reflects the overall neglect of men in research regarding the prenatal relationship. Further in-depth study of the nature of the maternal/paternal-fetal relationship may be needed in order to allow for the identification of interventions that are consistently beneficial and worthwhile.

A systematic review of midwife-led interventions to address post partum post-traumatic stress.

OBJECTIVE: to systematically identify interventions that midwives could introduce to address post-traumatic stress in women following childbirth. METHODS: a search strategy was developed and relevant papers were identified from databases including Cinahl, Cochrane Library, EMBASE, Maternity and Infant Care, MEDLINE, PsycINFO, and Web of Science. Key search terms used were post-traumatic stress, post partum, intervention, controlled trial and review. Papers eligible for inclusion were primary studies and reviews of research published from 2002-2012, focusing on interventions which could be implemented by midwives for the prevention and/or management of PTSD. For primary studies, RCTs, controlled clinical trials, and cohort studies with a control group were eligible. Eligible reviews were those with a specified search strategy and inclusion/exclusion criteria. Methodological quality was assessed using recognised frameworks. FINDINGS: six primary studies and eight reviews were eligible for inclusion. The majority of included studies or reviews focused on debriefing and/or counselling interventions; however the results were not consistent due to significant variation in methodological quality and use of dissimilar interventions. Two of the reviews considered the general management of post partum PTSD and one broadly covered anxiety during pregnancy and the post partum, incorporating a section on PTSD. The majority of women reported that the opportunity to discuss their childbirth experience was subjectively beneficial. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: no evidence-based midwifery interventions were identified from this systematic review that can be recommended for introduction into practice to address PTSD. It is recommended that future research in this area should incorporate standardised interventions with similar outcome measures to facilitate synthesis of results. Further research on interventions used in non-maternity populations is needed in order to confirm their usefulness in addressing post partum PTSD.