The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study.

PROBLEM: Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population. BACKGROUND: Women's experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women. AIM: To examine if pregnant migrant women's experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy. METHODS: A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index. RESULTS: Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability showed a mean score of 4.2 (±2.56). Women's experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p<.001). Five themes emerged from the focus group discussions: "Look beyond who you think I am and see and treat me for who I really am", "Ownership of truth and knowledge", "Don't punish me for being honest", "Projection of fear" and "Coping with labelling". CONCLUSION: Pregnant migrant women's experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.

The effect of Wazzup Mama?! An antenatal intervention to prevent or reduce maternal distress in pregnancy.

We evaluated the effect of the intervention WazzUp Mama?! on antenatal maternal distress in a non-randomized pre-post study including healthy women in 17 Dutch midwifery practices. The control group (n = 215) received antenatal care-as-usual. The experimental group (n = 218) received the intervention. Data were collected at the first and third trimester of pregnancy. Maternal distress (MD) was measured with the Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI), and Pregnancy-Related Anxiety Questionnaire (PRAQ). We used multivariate repeated-measure analysis to examine the across time changes and ANCOVA was used to examine the differences between the two groups. In the control group, mean EDS, STAI, and MD scores significantly increased from first to third trimester of pregnancy, mean PRAQ scores increased, but not significantly, the proportion of scores above cut-off level of EDS, STAI, and PRAQ significantly increased from first to third trimester, and the proportion of MD scores above cut-off level increased, but not significantly. Within the experimental group, the mean STAI, PRAQ, and MD scores significantly decreased from first to third trimester, the EDS mean scores decreased but not significantly, proportions of scores above cut-off level for PRAQ and MD significantly decreased from first to third trimester of pregnancy, the proportions of EDS and STAI scores above cut-off level decreased but not significantly. There was a moderate significant positive effect of WazzUP Mama?! on the MD scores (F(1.43) = 27.05, p < 0.001, d = 0.5). The results provide support for the effectiveness of the intervention WazzUp Mama?!

Dutch midwives' behavioural intentions of antenatal management of maternal distress and factors influencing these intentions: an exploratory survey.

OBJECTIVE: to explore midwives' behavioural intentions and the determinants of these intentions with regard to the management of antenatal care of women with maternal distress. DESIGN: an exploratory survey using a questionnaire. Descriptive statistics calculated expanded TPB constructs, demographic information, personal characteristics and work related details. Multiple linear regression analyses were used to examine which factors influence midwives' intention to provide antenatal care of maternal distress. SETTING: midwives working in Dutch primary care. PARTICIPANTS: 112 midwives completed the survey. RESULTS: midwives did not report a clear intention to screen for maternal distress (3.46 ± 1.8). On average, midwives expressed a positive intention to support women with maternal distress (4.63 ± 1.57) and to collaborate with other health-care professionals (4.63 ± 1.57). Finding maternal distress an interesting topic was a positive predictor for the intention to screen (B=0.383; p=0.005), to support (B=0.637; p=<0.000) and to collaborate (B=0.455; p=0.002). Other positive predictors for the intention to screen for maternal distress were years of work experience (B=0.035; p=0.028), attitude about the value of screening (B=0.326; p=0.002), and self-efficacy (B=0.248; p=0.004). A positive attitude toward support for women with maternal distress (B=0.523; p=0.017) predicted the intention to support these women. Number of years of work experience (B=0.042; p=0.017) was a positive predictor for the intention to collaborate with other health-care professionals. KEY CONCLUSIONS: the intention to screen for maternal distress was less evident than the intention to support women with maternal distress and the intention to collaborate with other health-care professionals. Important factors predicting the midwife's intention to screen, support and collaborate were finding maternal distress an interesting topic, years of work experience, attitude about the value of screening and support and self-efficacy about screening. IMPLICATIONS FOR PRACTICE: to provide care involving all three components of antenatal management of maternal distress implies efforts to influence the factors that predict the intention to screen, to support women with maternal distress and the intention to collaborate with other health-care professionals.