Nichole Fairbrother

Fertility and aging: do reproductive-aged Canadian women know what they need to know?

OBJECTIVE Female fertility declines with age; however, women are increasingly delaying childbearing until later in their reproductive years. One of the factors that may contribute to this trend is a general lack of knowledge about the decline in fertility with age. DESIGN Self-report survey. Questions pertained to participant demographics and childbearing intentions, and knowledge of the decline in fertility and increased risk of pregnancy loss with age. SETTING The University of British Columbia in Vancouver, British Columbia, Canada. PATIENTS Female undergraduate students (N = 360). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Knowledge of fertility over the life span, predictors of age of intended childbearing. RESULT(S) Although most women were aware that fertility declines with age, they significantly overestimated the chance of pregnancy at all ages and were not conscious of the steep rate of fertility decline. Surprisingly, women overestimated the chance of pregnancy loss at all ages, but did not generally identify a womans age as the strongest risk factor for miscarriage. CONCLUSION(S) Education regarding the rate at which reproductive capacity declines with age is necessary to avoid unintended childlessness among female academics and professionals.

Sexual Assault of Women Prevention Efforts and Risk Factors

Most North American universities offer sexual assault prevention programs focusing on attitude change. However, the few program outcome evaluations suggest that these programs may not be effective. This review summarizes the research on sexual assault program evaluation. It is apparent that the most promising avenue for sexual assault prevention may be self-defense training, which is presently not an integral component of typical prevention programs. The substantial body of research on risk factors for sexual assault is also reviewed, and it is concluded that existing rape prevention programs could be improved by focusing on these factors.

Feelings of mental pollution subsequent to sexual assault.

This paper describes an investigation of the phenomenon of mental pollution in a sample of 50 female victims of sexual assault. Feelings of mental pollution were assessed using an interview and a questionnaire. An experimental procedure was employed to determine if feelings of dirtiness and the urge to wash could be provoked by deliberate attention to the assault memory. Thirty (60%) of the 50 participants reported some feelings of mental pollution subsequent to the assault, and feelings of mental pollution were related to post-assault washing behaviour. Deliberate recall of the assault resulted in stronger feelings of dirtiness and the urge to wash than did deliberate attention to a pleasant memory or scene. Nine women reported washing their hands in response to deliberate recall of the assault. These findings suggest that feelings of mental pollution may be prominent in victims of sexual assault.

Relation Between Prenatal Maternal Mood and Anxiety and Neonatal Health

Objective: To examine the relation between the mood and anxiety of pregnant, psychiatrically treated women and neonatal health outcomes after birth. Method: We prospectively assessed 46 women treated with psychotropic medications for anxiety and depression during pregnancy. We compared measures of maternal mental health with infant outcomes, in particular, the outcomes of infants with symptoms of poor neonatal adaptation. Results: The mothers of babies who demonstrated poor neonatal adaptation reported higher levels of anxiety and depression at study entry than did the mothers of healthy babies. This relation was not related to the presence or absence of treatment with clonazepam, an anxiolytic used to treat symptoms of anxiety. Further, increased psychiatric comorbidity in the mother was associated with a greater likelihood of transient symptoms in the newborn. Conclusions: Despite psychiatric treatment, the intensity and degree of comorbid symptoms appear to be related to poor transient neonatal health outcome. Our data suggest that, in addition to the impact of pharmacologic factors, maternal psychiatric status influences infant outcomes.

Sociotropy, Autonomy, and Self-Discrepancy: Status in Depressed, Remitted Depressed, and Control Participants

This study examined the status of sociotropy,autonomy, and self-discrepancy in clinically depressed(N = 28), remitted depressed (N = 20), and controlindividuals (N = 20). Results from the Personal Style Inventory (PSI)and the Selves Questionnaireindicated that depressed, remitted, and controlparticipants differed significantly in their levels ofsociotropy, autonomy, and actual-ideal discrepancy.Results were in the predicted direction with depressedparticipants evidencing the highest levels of thesevariables, remitted participants the next highest, andcontrol participants the lowest. Both sociotropy and autonomy were significantly correlated withactual-ideal discrepancy. Each of the three variablesstudied accounted for unique variance in currentdepression. Together they accounted for 48% of the variance in depression scores. This studyprovides support for the relation of sociotropy,autonomy, and actual-ideal discrepancyto depression, andsuggests a need for greater attention to issues ofavailability and accessibility in the area of depressionresearch.

Fear of childbirth and obstetrical events as predictors of postnatal symptoms of depression and post-traumatic stress disorder

This prospective study examined psychological and obstetrical predictors of enduring postpartum symptoms of depression and post-traumatic stress disorder. Contrary to prediction, prenatal fear of childbirth did not significantly predict symptoms of depression or post-traumatic stress disorder at one month postpartum, but anxiety sensitivity was an unexpected predictor that merits further investigation. Several obstetrical and neonatal variables significantly predicted symptoms of post-traumatic disorder, but not depression.

“It's All the Rage These Days”: University Students' Attitudes Toward Vaginal and Cesarean Birth

BACKGROUND At 30 percent, British Columbia has the highest cesarean section rate in Canada. Little is known about the childbirth views and birthing preferences of college-aged women and men. The objectives of this study were to document (a) the prevalence of cesarean versus vaginal delivery as the preferred mode of delivery among nonpregnant university students without a history of childbirth, (b) the reasons for reported childbirth preferences, and (c) confidence in vaginal birth as a predictor of childbirth preference. METHODS A cohort of 3,680 male and female university students without a history of childbirth participated in an online survey of childbirth preferences. The study used a mixed methods approach (quantitative thematic analysis and logistic regression modeling). Prevalence of, and reasons for, preferred mode of delivery were analyzed separately for male and female respondents. RESULTS Most men and women responded that they preferred vaginal delivery, with 9 percent stating a preference for cesarean delivery. Reasons for preferred mode of delivery were similar for men and women. For women, confidence in vaginal birth emerged as a significant predictor of childbirth preference. CONCLUSIONS Results indicate that a preference for cesarean section is linked to fear of childbirth and driven by low confidence in vaginal birth. Educational strategies targeting university-aged men and women may be helpful in alleviating fears of vaginal birth and providing evidence-based information about different birth options.

Perinatal anxiety disorder prevalence and incidence

BACKGROUND Anxiety and related disorders (AD) disproportionately affect women, and are the most prevalent of all mental health conditions. The current research represents the first study of maternal postpartum AD prevalence in which all of the AD are assessed, and one of few studies of this type in which maternal prenatal AD incidence is assessed. METHODS A Canadian sample of pregnant women (N=310) was recruited from a defined geographical area between November 2007 and November 2010. Participants were first administered postnatal mood and anxiety screening measures. Those who scored at or above cutoff on one or more of these measures were administered a diagnostic interview for depression and anxiety at approximately three months postpartum (n=115). Findings from the diagnostic interview were used to estimate the prevalence and incidence of mood and AD in pregnancy, as well as at and during the first three months postpartum. Period prevalence and incidence estimates were obtained retrospectively from interview data collected postnatally. RESULTS The prevalence of AD during pregnancy and the early postpartum period (15.8% and 17.1% respectively) exceeded that of depression (3.9% and 4.8% respectively). The prevalence of OCD in our sample exceeded that of OCD among adults aged 18-64. Parity was unrelated to AD prevalence. Slightly less than 5% of participants were comorbid for both AD, and depression. LIMITATIONS This study is limited by a relatively small sample size for a prevalence study, and non-random sample selection. As only women who scored above cutoff on one or more screening measures were interviewed, prevalence estimates are conservative. Finally, prenatal prevalence estimates are based on retrospective report provided postpartum. CONCLUSIONS This study provides evidence that, as a group, anxiety and related conditions affect a significant proportion of postpartum women, and are more prevalent than is postpartum depression.

Psychometric Evaluation of the Multidimensional Assessment of Fatigue Scale for Use with Pregnant and Postpartum Women.

Although fatigue is a common experience for pregnant women and new mothers, few measures of fatigue have been validated for use with this population. To address this gap, the authors assessed psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale, which was used in 2 independent samples of pregnant women. Results indicated that the psychometric properties of the scale were very similar across samples and time points. The scale possesses a high level of internal consistency, has good convergent validity with measures of sleep quality and depression, and discriminates well from a measure of social support. Contrary to previous evaluations of the MAF, data strongly suggest that the scale represents a unidimensional construct best represented by a single factor. Results indicate that the MAF is a useful measure of fatigue among pregnant and postpartum women.

Reproductive-Aged Women’s Knowledge and Attitudes Regarding Infant-Feeding Practices: An Experimental Evaluation

Using an experimental design, this study assessed knowledge, attitudes, and intentions regarding infant feeding practices among Canadian female university undergraduates (N = 285). Participants completed a survey of knowledge, attitudes, and intentions with respect to infant-feeding practices. Two versions of the survey were randomly distributed to participants: one containing a photograph of a woman breastfeeding her infant (n = 131) and the other containing a photograph of the same women bottle-feeding her infant (n = 154). Findings indicated that the majority of the sample had been breastfed (84%) and intend to breastfeed their own offspring (97%). The intention to breastfeed future offspring was predicted by knowledge, attitudes, and perceptions of social norms. Participants reported more positive attitudes toward visual depictions of breastfeeding compared with bottle-feeding but less positive views of breastfeeding in public compared with bottle-feeding in public. Participants also significantly underestimated the health benefits and optimal duration of breastfeeding. The findings highlight gaps in knowledge that may contribute to premature cessation of breastfeeding among Canadian women and suggest the need for breastfeeding education.