Sylvia Murphy Tighe

An exploration of the attitudes of attenders and non-attenders towards antenatal education

OBJECTIVE to explore the attitudes of first-time mothers towards antenatal education from the perspective of attenders and non-attenders. DESIGN a qualitative approach was utilised using focus group interviews to collect the data. SETTING the study was conducted in one local health office area of the Health Service Executive-South East, Ireland. PARTICIPANTS a purposive sample of first-time mothers was interviewed to explore the area of antenatal education. These women included both attenders and non-attenders at antenatal education. KEY CONCLUSIONS the findings suggest there are many strengths, weaknesses, opportunities and barriers to antenatal education. Strengths of antenatal education included the facilitator of antenatal classes, the information and preparation received, and the social aspect of meeting other expectant mothers. Barriers to attendance at antenatal education included working night shifts, no interest, transport difficulties, inflexible employer, and partner not attending. A move away from didactic teaching methods and greater participation and involvement of parents was identified as necessary. IMPLICATIONS FOR PRACTICE fundamental issues related to the provision and of antenatal education were identified. A need for promotion and advertising of antenatal education was identified by the participants. Mothers identified specific needs such as the provision of postnatal classes and peer mentoring, flexible availability of classes, and facilitators utilising the principles of adult learning to guide classes. The mothers alluded to the importance of fathers attendance and inclusion at classes. In view of the poor uptake of antenatal classes in Ireland, it is imperative that an approach to antenatal education is parent centred and needs driven.

Concealed Pregnancy: A Concept Analysis

AIM/DESIGN A concept analysis of concealed pregnancy was undertaken using Walker and Avants framework to examine the attributes, characteristics and uses of the concept in maternity care. BACKGROUND Understanding the concept of concealed pregnancy is critical as failing to do so adds the risk of maternal and neonatal morbidity and mortality. Reviewing the literature and selected empirical referents indicated that concealed pregnancy has been predominantly viewed through a biomedical lens. Confusion exists around the definitions of denied and concealed pregnancy. DATA SOURCES A systematic search of five bibliographic databases using keywords from the years 1960-2014. METHODS Walker and Avants framework was used to guide the concept analysis. A thematic analysis of reviewed papers identified the main characteristics of concealed pregnancy. RESULTS Concealed pregnancy was conceptualized as a process and the critical attributes are secrecy, hiding, daytime story, staying away and avoidance. This process involves avoidance and if this includes failing to access healthcare can lead to catastrophic outcomes such as maternal and neonatal death. Antecedents, attributes and consequences of concealed pregnancy are also identified. CONCLUSIONS Understanding the concept of concealed pregnancy and its antecedents, attributes and consequences may assist in risk identification of women who conceal a pregnancy. This concept analysis has identified a need for further exploration of the coping styles and psychosocial processes involved in women concealing and revealing a pregnancy.

Regaining Agency & Autonomy: A Grounded Typology of Concealed Pregnancy

AIM To explore and understand the experience of concealed pregnancy and develop a framework for practitioners. BACKGROUND Numerous cases of concealed pregnancy resulting in serious outcomes including maternal and perinatal death, newborn abandonment, and neonaticide are reported internationally. Historically concealed pregnancy is associated with oppressive religious cultures where premarital pregnancy was shunned. Concealed pregnancy has traditionally been viewed through a biomedical lens and associated with mental illness but this assertion remains unsubstantiated by robust evidence. DESIGN A Glaserian grounded theory study was undertaken. DATA SOURCES Thirty women were interviewed, between 2014 - 2016, on up to three occasions (46 interviews) and 22 cases of public interest were included as data. METHODS The constant comparative method and theoretical sampling which are the analytical strategies of grounded theory were used to analyse the data and generate the typology. RESULTS Concealed pregnancy is a fearful, life-altering, and traumatic experience. Women with a history of controlling and oppressive relationships characterized by fear respond to a crisis pregnancy by keeping it secret. Many womens relationships were characterized by emotional, mental, sexual, or physical violence. Fear for ones survival is common, may render women unable to access care or support and can be so extreme that a woman may end her own life or give birth alone. CONCLUSIONS This typology of concealed pregnancy is intended to aid understanding the fear, trauma, and complexities associated with concealed pregnancy which is vital if practitioners are to provide sensitive, responsive and non-judgemental care.