'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.

The dynamics of epidural and opioid analgesia during labour.

PURPOSE: To investigate the association of analgesia, opioids or epidural, or the combination of both with labour duration and spontaneous birth in nulliparous women. METHODS: A secondary data analysis of an existing cohort study was performed and included nulliparous women (n = 2074). Durations of total labour and first and second labour stage were calculated with Kaplan-Meier estimation for the four different study groups: no analgesia (n = 620), opioid analgesia (n = 743), epidural analgesia (n = 482), and combined application (n = 229). Labour duration was compared by Cox regression while adjusting for confounders and censoring for operative births. Logistic regression was used to investigate the association between the administration of different types of analgesia and mode of birth. RESULTS: Most women in the combined application group were first to receive opioid analgesia. Women with no analgesia had the shortest duration of labour (log rank p < 0.001) and highest chance of a spontaneous birth (p < 0.001). If analgesia was administered, women with opioids had a shorter first stage (p = 0.018), compared to women with epidural (p < 0.001) or women with combined application (p < 0.001). Women with opioids had an increased chance to reach full cervical dilatation (p = 0.006). Women with epidural analgesia (p < 0.001) and women with combined application (p < 0.001) had a prolonged second stage and decreased chance of spontaneous birth compared to women without analgesia. CONCLUSIONS: Women with opioids had a prolonged first stage, but increased chance to reach full cervical dilatation. Women with epidural analgesia and women with both opioid and epidural analgesia had a prolonged first and second stage and a decreased chance of a spontaneous birth.

[Evidence-based midwifery practice in Scotland: a discussion of the problems]. / Evidenzbasierte Hebammenpraxis in Schottland: Eine Diskussion der Probleme.

In recent years there has been a drive to base all health care provision upon the most recent, appropriate scientific evidence. This has prompted an interest in research by midwives in clinical practice who want to ensure that they are providing the best possible care. Those midwives who do not use evidenced based practice but instead teach, support and demonstrate ritualistic practices without reference to the substantial research available, are limiting women's choice in maternity care. In a recent trial investigating whether routine suturing of perineal lacerations is required, the trial's outcome was jeopardised because of midwives' beliefs about suturing. The rationale for such ritualistic behaviour is not always easy to understand and using a framework of power and it is examined in this article to determine what concepts are influencing these practices. The article concludes by suggesting that some midwives appear to ignore the results of this trial and other research and demonstrate a paternalistic attitude towards their clients.