Caroline Lafarge

Women’s Experiences of Coping With Pregnancy Termination for Fetal Abnormality:

Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women’s coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study’s findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.

Termination of Pregnancy for Fetal Abnormality: A Meta-Ethnography of Women's Experiences

Abstract Due to technological advances in antenatal diagnosis of fetal abnormalities, more women face the prospect of terminating pregnancies on these grounds. Much existing research focuses on women’s psychological adaptation to this event. However, there is a lack of holistic understanding of women’s experiences. This article reports a systematic review of qualitative studies into women’s experiences of pregnancy termination for fetal abnormality. Eight databases were searched up to April 2014 for peer-reviewed studies, written in English, that reported primary or secondary data, used identifiable and interpretative qualitative methods, and offered a valuable contribution to the synthesis. Altogether, 4,281 records were screened; 14 met the inclusion criteria. The data were synthesised using meta-ethnography. Four themes were identified: a shattered world, losing and regaining control, the role of health professionals and the power of cultures. Pregnancy termination for fetal abnormality can be considered as a traumatic event that women experience as individuals, in their contact with the health professional community, and in the context of their politico-socio-legal environment. The range of emotions and experiences that pregnancy termination for fetal abnormality generates goes beyond the abortion paradigm and encompasses a bereavement model. Coordinated care pathways are needed that enable women to make their own decisions and receive supportive care. Résumé En raison des progrès technologiques du diagnostic prénatal, davantage de femmes risquent de devoir interrompre leur grossesse pour une anomalie fłtale. La plupart des recherches portent sur l’adaptation psychologique des femmes à cet événement. Néanmoins, on manque de vision globale de l’expérience des femmes. Cet article rend compte de l’examen systématique d’études qualitatives sur l’expérience de femmes ayant interrompu leur grossesse pour anomalie fłtale. Dans huit bases de données, on a recherché jusqu’en avril 2014 des études révisées par les pairs, rédigées en anglais, fournissant des données primaires ou secondaires, qui utilisaient des méthodes qualitatives identifiables et interprétatives, et offraient une contribution utile à la synthèse. Au total, 4281 fichiers ont été examinés ; 14 réunissaient les critères d’inclusion. Les données ont été synthétisées en utilisant la méta-ethnographie. Quatre thèmes ont été identifiés : un monde brisé, le contrôle perdu et retrouvé, le rôle des professionnels de santé et le pouvoir des cultures. L’interruption de grossesse pour anomalie fłtale peut être considérée comme un événement traumatique auquel les femmes doivent faire face en tant qu’individus, dans leur contact avec la communauté des professionnels de santé et dans le contexte de leur environnement politico-socio-juridique. L’éventail des émotions et des expériences que suscite l’interruption de grossesse pour anomalie fłtale va au-delà du paradigme de l’avortement et englobe un modèle de deuil. Des filières coordonnées de soins sont nécessaires pour permettre aux femmes de prendre leurs propres décisions et de recevoir des soins d’accompagnement. Resumen Debido a los avances tecnológicos en el diagnóstico prenatal de anormalidades fetales, más mujeres contemplan la opción de interrumpir un embarazo por este motivo. Gran parte de los estudios disponibles se enfocan en la adaptación psicológica de la mujer a este suceso. Sin embargo, se carece de un entendimiento holista de las experiencias de las mujeres. Este artículo reporta una revisión sistemática de estudios cualitativos de las experiencias de las mujeres con la interrupción del embarazo por anormalidad fetal. En ocho bases de datos, se realizó una búsqueda hasta abril de 2014 de estudios revisados por pares, redactados en inglés, que reportaron datos primarios o secundarios, utilizaron métodos cualitativos identificables e interpretativos, y ofrecían una contribución valiosa a la síntesis. En total, se examinaron 4281 estudios; 14 reunían los criterios de inclusión. Los datos fueron sintetizados utilizando meta-etnografía. Se identificaron cuatro temáticas: un mundo destrozado, perdiendo y volviendo a ganar control, el role de profesionales de la salud y el poder de culturas. La interrupción del embarazo por anormalidad fetal puede considerarse un suceso traumático que las mujeres experimentan como personas individuales, en su contacto con la comunidad de profesionales de la salud, y en el contexto del ambiente político-socio-jurídico. La variedad de emociones y experiencias que genera la interrupción del embarazo por anormalidad fetal va más allá del paradigma de aborto y abarca un modelo de pesar. Se necesitan opciones de servicios coordinados que les permitan a las mujeres tomar sus propias decisiones y recibir atención con apoyo.

Perinatal grief following a termination of pregnancy for foetal abnormality: the impact of coping strategies

Pregnancy termination for foetal abnormality (TFA) can have significant psychological repercussions, but little is known about the coping strategies involved in dealing with TFA. This study examined the relationships between womens coping strategies and perinatal grief.

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

ABSTRACT Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG. Design: An online, retrospective survey was conducted with 161 women. Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses. Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high. Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.

Termination for fetal anomaly: Are women in England given a choice of method?

Abstract Choice of a medical or surgical method of termination for fetal anomaly (TFA) is advocated in national guidelines based on a similar risk profile. We investigated whether women are offered a choice of method, by surveying members of a UK parent support organisation. An online questionnaire was designed to examine respondents’ experience of TFA. A total of 351 responses were included in the final analysis. TFAs after 24 weeks’ gestation and selective reductions were excluded. Mean gestational age at TFA was 17 weeks; 14% (n = 50) were offered a choice of method, falling to 8% (n = 19) after 14 weeks’ gestation. Overall, 78% (n = 275) underwent medical TFA with 88% stating they chose it because it was the only method offered; 60% (n = 30) of those offered a choice had a surgical TFA. Our survey suggests that women having TFA are not offered a choice of method. Service delivery should be improved to meet national guidance and womens needs.

Pregnancy termination for fetal abnormality: are health professionals’ perceptions of women’s coping congruent with women’s accounts?

BackgroundPregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts.MethodsFifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences.ResultsHealth professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women.ConclusionsHealth professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.

P056: The patient experience of the mrsa screening process and the impact of a MRSA positive result: a qualitative study

Universal screening for methicillin resistant Staphylococcus aureus (MRSA) of admissions to hospital became mandatory in England in 2010 . However, there is little data about the patient experience of MRSA screening, the impact of receiving a positive result and the confidence patients have in the care they receive.