PurposeThis paper first focuses on outlining currently available knowledge throughout the world regarding women who decide to continue with their pregnancy knowing that there will be something abnormal about their child. Secondly, it discusses making information applicable to the existing issues available to midwives who deal with those women. Finally, the paper looks at coming up with a future agenda for improving the care environment for those women, to be worked on in clinical practice. MethodsPublished literature concerning those women who choose to carry on a pregnancy after having been informed of a fetal abnormality was searched for using the following sources: PubMed, PsycINFO, CINAHL, and Ichu-shi WEB. A search was made for English language articles published in any country between 1998 and 2009, using the keywords "prenatal diagnosis" and "fetal abnormality". We considered each article's targets, research method and results in order to analyze how fetal diagnoses and mothers' experiences influence the framing of psychological experiences. ResultIn reviewing twelve domestic and international journal articles, five themes were highlighted that constitute pregnant women's experiences carrying a child with a congenital abnormality, namely: grief, attachment, dilemma, uncertainty and isolation. These themes became clear that the experiences of those women carrying a child with a known congenital abnormality cannot be described in any one way, as there are so many constituent factors to take into account. ConclusionThese themes can be helpful in understanding mothers' experiences. However, more studies need to be done in order to explore how they influence mothers' relationship with, and involvement in society. Understanding mothers' experiences from both psychological and social perspectives can help nurses improve their clinical practice, both in delivering the child and in caring for the mother. Future studies will yield further useful information, to help healthcare professionals assist mothers, children, and families cope with any challenge they may face.
目的:羊水検査を受けるか否かを検討する妊婦はどのようなプロセスを辿って意思決定をするのか,その際の意思決定プロセスには一般的な意思決定プロセスとの差異があるのかを知ることにより,どのような援助が意思決定を行う妊婦の支援となるのかを明らかにすることを目的とする。対象と方法:対象は,研究参加の同意が得られ,今回の妊娠において羊水検査を受けるか否かを検討した体験を持つ妊婦5名。データ収集には半構造化面接法を用い,妊娠26週~30週の時期の1時点で実施した。得られたデータは面接内容を逐語録としてデータ化した後,内容を質的帰納的に分析した。結果:羊水検査を受けるか否かを決定する際の妊婦の意思決定プロセスを構成するカテゴリーは,≪妊娠の継続を自分に問う≫≪人工妊娠中絶に対する思いを自問する≫≪周囲の意見との照らし合わせ≫≪障害児育児を想像する≫の4つのカテゴリーが抽出された。意思決定プロセスの起点は,≪妊娠の継続を自分に問う≫という形で命に関する自己の価値観を明確化し妊娠の継続を検討することであった。このカテゴリーを起点とし≪人工妊娠中絶に対する思いを自問する≫ことによって自分の人工妊娠中絶に対する考え方を確認し,自分の価値観が周囲の身近な社会で受け入れられるのかを≪周囲の意見との照らし合わせ≫で十分に観察し,障害という視点から≪障害児育児を想像する≫し,育児の可能性を測った上で,検査を受けるか否かの最終意思決定を行うというプロセスが見出された。このプロセス中で羊水検査を受けた妊婦には,胎児に感じる愛着と五体満足でなければいけないという価値観との間で「揺れ」を感じ,検査結果がでるまで妊娠継続に関する決定を保留とし,検査を受ける決定を行なう過程が存在した。結論:羊水検査を受けるか否かを検討する妊婦は,検査結果による妊娠の継続に関することを最初に問題認識し検査を受けるか否かの検討を行なっていた。このプロセスの中で妊婦は,妊娠の継続から導き出された命の価値観と,胎児に対する感情や障害児育児に対する感情が相反した場合に「揺れ」を感じていた。特に検査結果で異常が指摘された場合に,人工妊娠中絶を受けることを考えている妊婦は,心理的重圧という問題を抱えており細心の配慮が必要である。Purpose: The purpose of this study is to understand the decision making process of pregnant women who have to consider whether to undergo amniocentesis or not. Methods: The subjects, who all gave their consent to be interviewed, were 5 women in their 26th to 30th week of pregnancy. The women were interviewed in a semi-structured manner and interviews were recorded and transcribed. A qualitative method was used for an in-depth analysis of the interviews. Units of meaningful descriptions were classified into various main categories. The categories were determined by making small changes after each interview. Results: Three of the 5 women refused to undergo amniocentesis and 2 agreed to it. As regards the process of decision making about whether to go through with the birth or have an abortion, four key categories to be pondered by the pregnant women were identified. These are as follows: 1) ask yourself whether to go ahead with the birth or not, 2) confirm your own sense of value about abortion, 3) judge your own opinion by comparing with that of others, 4) envisage what rearing a disabled infant would be like. The starting point of the process is that pregnant women ask yourself whether to go ahead with the birth or not. The process is not one-way to the determination. While the women are wavering mentally about whether or not to continue the pregnancy, they consider the ramifications of these four categories. Conclusion: The results suggest that this process of mental reflection and wavering over a period of time before the final decision is made is extremely important as it alleviates the pregnant woman's emotional conflict. The pregnant women feel wavering when they have the clash of their sense of values and their emotion. And an important matter is affirms the pregnant woman's emotional conflict and their sense of values
This study aimed to clarify the lived experiences of pregnant women diagnosed with a fetal abnormality by examining their everyday lives. Taking Merleau-Ponty s Phenomenology as the study s philosophical base, data was analyzed according to Pollio s Phenomenological Approach, the framework previously used by Thomas. The results showed four themes in women s experience a feeling of safety derived from carrying a child, a sense of burden in meeting public expectations, a sense of connection/disconnection with other people, and feeling a separate sense of time with a child. Pregnant women experienced a sense of safety by feeling a child s existence within, and a sense of comfort in being with other children. Also, through daily interactions, mothers learned about differences between their own and other people s values this gave them a dual sense of loneliness and belonging. Their everyday experience while pregnant taught them about the society norms to which they have to adapt after going through the positive and negative aspects of their pregnancy.
ObjectivesThe purpose of this study was to examine the experiences of midwifery students with puerperants during delivery through birth reviews at the beginning (number of times assisting labor: 1-3) and completion (10) of a labor assistance practicum. The results were analyzed to gain educational insight into care related to childbirth experiences of postpartum women. MethodsParticipants were seven senior nursing major students at A University who chose an elective course in midwifery. These students were divided into two groups of 3 and 4. Focus group interviews were conducted at the completion of the first and second half of the practicum. Results were analyzed using the methods described by Vaughn et al. ResultsThree themes were raised by students as topics in the practicum. In performing birth reviews and self-evaluations, the topics were "care related to reflecting on the childbirth experience," "difficulty of performing birth reviews," and "understanding one's task for the next delivery" in the first half of the practicum, and "care related to integrating the childbirth experience" and "one's current inexperience" in the second half of the practicum. With respect to what one noticed/realized during birth reviews, the topics were "an understanding of puerperants through assumptions" and "the reason and need for birth reviews" in the first half of the practicum, and "lack of a big picture understanding of the delivery process," "midwifery care and puerperant diversity," and "the need to meet individual needs" in the second half of the practicum. Regarding impressions of performing birth reviews, students felt both "uncomfortable with favorable evaluations and a sense of accomplishment" in the first half of the practicum, and "enthusiasm due to favorable evaluations" in the second half of the practicum. ConclusionsBirth reviews began with reflecting on the childbirth experience and, by the end of the practicum, carrying out care by integrating experiences. Birth reviews also provided opportunities for students to realize the effects brought about by such reviews, and made them aware of the diversity in midwifery care. It is important that teaching staff recognize the degree of student understanding of the objective and significance of birth reviews and understanding of their patients, and provide support for clarifying and supplementing deficiencies in tasks.
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