Academic literature on the topic 'BF Psychology : RG Gynecology and obstetrics'

Objective: Mastitis is a common and painful condition experienced in up to 33% of breast-feeding women (Cusack & Brennan, 2011; Jahanfar, Ng & Teng, 2009; Scott, Robertson, Fitzpaterick, Knight, & Mulholland, 2008; Spencer, 2008). The period following having a baby may be emotionally and physically demanding due to the physical, hormonal and lifestyle changes a woman undergoes (Cusack & Brennan, 2011). Developing mastitis during this time may therefore be debilitating and has been found to be a common reason for discontinuing breastfeeding. This study aimed to explore women’s experiences of breast-feeding and mastitis, the formal and informal support that was available to them when they had mastitis, and the impact it had on whether they continued or discontinued breastfeeding (Amir, Forster, Lumley & McLachlan, 2007; Cleminson, Oddie, Renfrew & McGuire, 2015). Method: Grounded theory was used to analyse the data. Sixteen women who had experienced mastitis were included in the study. Results: All of the women intended to breast-feed. However, they often experienced problems early on (i.e. engorgement and nipple damage) that were unexpected and left them feeling exhausted and emotional. These problems precipitated mastitis. Mastitis was for most, a very difficult experience sometimes leading to discontinuation of breast-feeding. Delaying help-seeking negatively affected health outcomes. Determination and receiving good advice and support were fundamental factors in breast-feeding continuation. Conclusion: Improved support, communication, and advice with breast-feeding from the outset would reduce the risk of problems occurring and persisting, and potentially reduce the risk of mastitis developing. Early diagnosis and treatment of mastitis once it has developed is very important. Understanding that breast-feeding is a skill that often encompasses both ups and downs may reduce the pressure women put on themselves when they feel like they are failing because it is not going as well as they expected it to. Once mastered, women found breast-feeding to be a lovely bonding experience that exceeded their expectations.

Summary Background: Previous studies report that women are failing to make informed choices with regard to antenatal screening, due to significant deficits in knowledge. However, current definitions dictate that informed choice occurs not merely as a result of sufficient knowledge, but by acting in line with one’s attitudes despite perceived social pressure (Dormandy et al., 2002). Objective: To investigate whether women are making informed choices with regard to Combined Ultrasound & Biochemical (CUB) screening, using more substantial criteria. Design: Prospective non-experimental. Setting: The Queen Mother’s Maternity Hospital in Glasgow. Sample: 63 women due attend their first antenatal appointment. Outcome measures: responses to a questionnaire constructed for the purposes of the study. Methods: A multidimensional questionnaire measure encompassing demographic factors, areas of knowledge recommended by The Royal College of Obstetricians and Gynaecologists (RCOG, 1993) and all aspects of the Theory of Planned Behaviour (TPB; Ajzen, 1985). Results: Women appeared to be well informed, though there were some worrying misconceptions. Women appeared to intend to act in line with their attitudes, although small numbers of women planning to refuse screening limited findings. Attitude was the strongest predictor of behavioural intention. Conclusions: There appears to be moderate support for the hypothesis that women would make ‘informed choices’, though this is limited by a number of factors which require further investigation.

Women commonly complain of cognitive impairment during pregnancy; although some research has confirmed impairments using objective tests, the aetiology of this is uncertain. The relationship between disturbed sleep during pregnancy and cognitive functioning has not been specifically investigated. Using a correlational design, the present study aimed to examine the relationship between disturbed sleep and cognitive functioning during pregnancy. Method: Sixty-four women in the third trimester of pregnancy completed the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. A sub-sample also undertook actigraphic monitoring to obtain objective estimates of sleep quality. Cognitive functioning was measured subjectively using the Cognitive Failures Questionnaire and objectively using the IntegNeuro computer package. Results: Women reported significant sleep disturbance, which was confirmed by actigraphic monitoring in a sub-sample. Poorer subjective and objective sleep quality was related to more self-reported cognitive failures. Subjective sleep quality was also significantly correlated with objective measures of delayed verbal recall, but not to other domains of cognitive functioning. Poorer objectively measured sleep was related to decreased vigilance. Women reporting significant sleep disturbance reported significantly more cognitive failures than good sleepers, although this difference was not reflected by performance on objective cognitive tests. Conclusion: Sleep disturbance during pregnancy is related to subjective cognitive impairment and to some domains of cognitive performance using objective cognitive tests.

Chapter one systematically reviews the literature on the psychological impact of breastfeeding on mothers. Whilst breastfeeding is indicated as the superior feeding choice for infants, the full impact on mothers is under-reported. Results show that breastfeeding and weaning have a varied psychological impact on maternal wellbeing, identity and perceptions of role. Where incompatibilities between mothers‟ expectations and lived experiences occur, or where disagreement between self and others is perceived, dissonance, distress and division result. Discussion is made of the implications of these findings for clinical service provision, training and research. Chapter two presents a grounded theory analysis of fathers‟ experiences of attending traumatic childbirth. Despite an increasing trend over recent decades for fathers to attend their children‟s births, relatively little is still known about the potential impact of having been present during a traumatic labour or delivery upon them. In response to this gap in the literature, the current study reports theoretical concepts generated from interviews with fathers. A model of the experiences recounted is also presented, showing that, within the context of their past experiences, antenatal preparation and confidence in the care provided, fathers cycled between seeking control, passive observing, and helplessness. Findings are discussed in relation to the existing literature and the implications of this novel contribution to the subject area for future research and service provision are highlighted. Chapter three discusses the candidate‟s personal observations and reflections on the research process. The impact of parenthood and gender upon research into the perinatal period is considered and effects are noted on the researcher, participants and the research itself. Reflections are discussed with reference to previous research into gender and motherhood in qualitative research, and a call is made for researchers to acknowledge their epistemological positions within their subject fields as a matter of routine.

This thesis was focused on parent’s mental health during the perinatal period. Fear related to childbirth is common in mothers. Chapter one provides a meta-ethnographic synthesis of literature exploring mothers’ experiences of fear related to childbirth. Three meta-themes were identified which showed what it was like for women to experience fear related to childbirth, external factors than influenced their fear (e.g. the media) and internal factors (e.g. coping strategies). This study illustrated the complexity of mothers’ experiences and how fear related to childbirth can impact quality of life. The implications of these findings, and clinical recommendations, are discussed. There is increasing recognition that fathers may experience low mood in the postnatal period. Chapter two explores how fathers talk about paternal postnatal depression (PND). Six fathers who considered themselves to have had paternal PND took part in semi-structured interviews, which were analysed using discourse analysis. The results showed that PND was constructed as something that happens to women rather than men. They highlighted the difficulties men have talking about PND and how masculine identities were used to account for this difficulty. Finally, men constructed themselves as being deficient fathers when they had paternal PND. This study has significant implications for how PND is talked about with men. Chapter three presents a reflective account of conducting the research, which was written from the perspective of a parent. The focus was on the impact that the researcher may have had on the study and the effect that the study had on the researcher. It encompassed the whole process from developing ideas to potential areas of future study. The importance of terminology in mental health was discussed as well as what it is like conducting research on parents as a parent. The chapter ends with reflections on the researcher’s epistemological position.

Obesity is associated with an increased risk of developing some gynaecological cancers, and delayed help-seeking. The thesis aims were to identify factors predictive of delayed help-seeking for women seeking help for potential symptoms of gynaecological cancers, particularly looking at the role of obesity on time to help-seeking. Qualitative and exploratory research further investigated health beliefs and help-seeking attitudes of women experiencing gynaecological cancer symptoms and built a framework for understanding women’s complex journeys toward medical help-seeking. Additionally, the research assessed for differences in time to help-seeking and cancer awareness across groups with varying body mass indexes (BMIs) and different ethnic groups. Findings suggested that women have a limited awareness of gynaecological cancers, nevertheless, low awareness of gynaecological cancers was not associated with help-seeking delay. Thesis studies showed that obese women were not more likely to delay help-seeking when compared to non-obese women, and that attendance at preventative screenings was a predictor of delayed help-seeking. In conclusion the thesis provided an understanding of the often-complex transition through the menopause and challenged assumptions in the literature about the association between obesity, help-seeking and preventative screenings. Future research should further explore the complex relationship between BMI and help-seeking for gynaecological cancer symptoms.

Background and Objectives: Extensive research has shown that chronic pelvic pain (CPP) can have a detrimental impact on a woman’s quality of life (QoL). QoL is a subjective, multidimensional concept that refers to an individuals’ perception of their social, emotional, physical and psychological wellbeing. There is currently very little literature exploring the possible psychological predictors of QoL in this patient group. Therefore the purpose of this report was to provide a systematic review of the literature concerning predictors of QoL in women who experience CPP. Design: Systematic review. Method: Relevant papers were obtained through scanning five electronic databases and searching references and bibliographic lists. Studies were selected if they included women who had a diagnosis of CPP, included a standardised QoL measurement tool and predictors (psychological, social or clinical features), used a quantitative design and were available in English. A total of 12 studies were eligible for the review. All 12 papers were assessed for their quality using the 16 item Quality Assessment Tool for Studies with Diverse Designs (QATSDD; Sirriyeh, Lawton, Gardner & Armitage, 2011). Results: Similarly to other studies investigating QoL, income, number of years of education, the effect of CPP on a woman’s job and having a partner present were found to be statistically significantly associated with improved QoL. The frequency and intensity of pain, sexual dysfunction, comorbid physical health conditions, higher BMI, higher number of physician visits and surgical procedures were statistically related to a lower QoL. Dyspareunia and intermenstrual pelvic pain were both found to be statistically significantly related to a poorer QoL. Having a diagnoses of endometriosis or deep infiltrating endometriosis (DIE) or fibromyalgia were also found statistically to be significant predictors of a poorer QoL. Psychological factors found to be statistically associated with a poorer QoL included increased catastrophizing, depression, anxiety, perception of poorer pain control and a history of sexual and physical abuse and other lifetime trauma. Conclusions: This review has demonstrated that there are a number of possible predictors of poorer QoL in women with CPP. Interventions to target these predictors, may be worthy of further investigation.

Background: Female Genital Mutilation (FGM) may put women at additional physical risks during pregnancy, which may leave them psychologically vulnerable. Pregnancy and childbirth research with women with FGM has focused on the physical risks and the outcomes of pregnancy for mother and child (Paliwal, Ali, Bradshaw, Hughes & Jolly, 2013; Small et al., 2008; Zenner, Liao, Richens & Creighton, 2013; WHO, 2006). The psychological needs of pregnant women with FGM are under researched in the UK, or have relied on retrospective accounts given many years after pregnancy. Aims: To explore the psychological and emotional needs of pregnant women with FGM and their experience of FGM, pregnancy and pregnancy-related care. Methods: Seven pregnant women were interviewed using semi-structured interviews, which were recorded and transcribed verbatim. Transcripts were analysed using Thematic Analysis (Braun & Clarke, 2006). Results: Five main themes emerged, which related to how women made sense of their FGM procedure (The shame of FGM) and how this impacted on their experience of pregnancy (Suffering), as well as their experience of care during their pregnancy (women with FGM need to feel cared for, information sharing, and specialised/individual care). The study highlighted the profound suffering of pregnant women with FGM, in particular their fear of labour and birth. The study was limited as recruitment was from specialist FGM services; however, in doing so the need for specialist services, with professionals who are knowledgeable and experienced with FGM-related pregnancy care, was emphasised. Conclusions: The study added to the understanding of how pregnant women with FGM experience their pregnancy and their maternity care, identifying the crucial aspects of specialist FGM.

Background: With increasing numbers of people with a learning disability (LD) choosing to become parents (Booth and Booth, 1994) it is important the right support is provided to enable them to parent effectively (Macintyre and Stewart, 2011). Materials and Methods: This study used semi-structured interviews with four women with a LD who received doula support prenatally, during labour and postnatally. The women were interviewed during prenatal and postnatal support periods. The doulas were interviewed about their experience of supporting a woman with a LD towards the end of the postnatal support period. Results: Interview transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Themes were identified from each of the ten interviews, before analysis of themes for the same support phase were analysed together for mothers and doulas, allowing discussion of similarities and differences. Conclusions: The findings show that prenatally the women considered the doula to be a reliable source of information about pregnancy and birth. Each mother perceived doula support as a means of keeping her child in her care. Postnatally, mothers described a trusting relationship with their doula, which enabled them to make informed choices. Doulas described the need to adapt their work to meet the needs of parents with LD. The experience of working alongside statutory agencies was perceived as potentially challenging, and an important area for supervision.