AIMS/BACKGROUND:Research has shown that children born through surrogacy to heterosexual and gay couples are often told about this at an early age. However, to our knowledge no studies have explored how single fathers approach telling and talking about their route to parenthood with their children conceived via surrogacy and egg donation. DESIGN/METHODS:The current sample comprises twenty-one fathers of children aged 4 months to 6-years-old who were born using surrogacy and egg donation. In-depth semi-structured interviews were conducted with fathers about their experiences of telling their child about their surrogacy birth. Data were analysed using thematic analysis. RESULTS:All the fathers had disclosed or intended to disclose. Two overarching themes were identified: personal considerations and practical considerations. Within each overarching theme, fathers' narratives centred around motivations to disclose, their approach, and the content of disclosure conversations. Nine further subthemes were identified. CONCLUSION:This study provides new insight into single fathers' approaches to disclosure. Fathers felt strongly about disclosing, and many had begun to reflect on how to approach disclosure. Fathers considered at what age to disclose, they deliberated about their choice of terminology, and felt resources, such as books, were helpful aids for disclosure. The findings have relevance for fertility and parenting counsellors working with single fathers.
BACKGROUND:Outcomes of first episode postpartum psychosis and their distinction from outcomes of non-postpartum psychosis are poorly characterised. AIMS:To characterise the disease course and outcomes of first episode postpartum psychosis, compared with first episode non-postpartum psychosis. METHODS:This is a retrospective cohort study. Group demographics and subsequent outcomes were compared between groups unadjusted and adjusted for prior psychiatric illness. Outcome trajectories within the postpartum psychosis group were analysed via k-means clustering, and multivariable outcome prediction models calculated. RESULTS:Women in the postpartum group (n = 408) had lower parity (0.4 vs 0.6, t = -4.3, p < 0,001) and more prior psychiatric admissions (0.8 vs 0.1, t = 12.8, p < 0.001) than those experiencing non-postpartum psychosis (n = 1011). During follow-up, women with postpartum psychosis had fewer subsequent births and an increased risk of readmission during subsequent postpartum periods (0.55 admissions/delivery). Mortality in the postpartum group (871/100,000/year) was c. 11.3x local population norm. Clustering identified two distinct clinical trajectories following first episode postpartum psychosis, one of higher future morbidity and one of lower future morbidity. CONCLUSIONS:Small but significant differences in baseline characteristics and later prognosis were observed between individuals experiencing first episode postpartum psychosis and first episode non-postpartum psychosis in this single centre sample. Excess mortality was observed in both groups.
OBJECTIVE:This study adapted and evaluated the psychometric properties of the Attitudes Towards Surrogacy Scale (ATSS) for use in Portugal. METHODS:A total of 443 adults residing in Portugal completed the Portuguese version of the scale, hereafter referred to as the ATSS-PT, along with measures of psychological distress, attitudes towards assisted reproductive technologies, populist attitudes, and sociodemographic variables. The adaptation process included translation, back-translation, expert review, and pilot testing. Exploratory and confirmatory factor analyses were conducted to examine the scale's factorial structure, reliability, validity evidence, measurement invariance, group differences, and predictors. RESULTS:Exploratory and confirmatory factor analyses supported a three-factor structure comprising Surrogacy Ethical Context, Acceptance of Surrogacy, and Financing and Legalising Surrogacy, although bifactor results indicated the predominance of a general attitudes factor. The model showed acceptable fit, and the total scale and subscales demonstrated adequate to high internal consistency. Convergent validity was supported by the association with attitudes towards assisted reproductive technologies, whereas discriminant validity among the subscales was only partially supported, particularly due to the strong correlation between Acceptance and Financing/Legalising. LGBTQIA+ participants reported more favourable attitudes than heterosexual participants. Political ideology emerged as the only significant predictor, although the regression model explained a modest proportion of variance. CONCLUSION:The ATSS-PT appears to be a promising research instrument for assessing attitudes towards surrogacy in Portugal. However, the total score should be prioritised, and subscale-level interpretations should be made cautiously. Further validation in more representative samples is recommended.
AIMS/BACKGROUND:The first two years postpartum involve substantial physiological change, increasing vulnerability to distress. Body dissatisfaction may be intensified by gestational weight gain, sociocultural 'bounce-back' pressure, and hormonal changes linked to resumed menstruation, which typically returns within 6-8 weeks postpartum for non-breastfeeding women and 6-18 months for breastfeeding women. Despite this, lived experiences of body image and resumed menstruation remain understudied. The current pilot study aimed to address this literature gap. DESIGN/METHODS:A total of eleven UK mothers participated in semi-structured interviews. Reflexive thematic analysis was applied to interview transcripts. RESULTS:Two major themes were identified: Mind-body feedback (sub-themes: A stranger to myself, Menstrual return - a measure of wholeness) and Depletion as a positive feedback loop (sub-themes: Diet and exercise: stuck between a rock and a hard place; Finding your tribe). Body dissatisfaction and declining self-care often co-existed as women struggled to navigate new infant care responsibilities and grieved their pre‑pregnancy identities. Distress was also felt in relation to gestational weight gain and hair loss. Resumed menstruation was viewed both as an important marker of health and bodily 'wholeness', and as a source of stress when symptoms were severe. Finally, participants reported inadequate healthcare guidance and a desire for more support around menstruation, body changes, and self-care postpartum. CONCLUSION:Reframing attitudes towards one's body from its appearance to its functionality supported self-compassion and empowerment. Findings highlight the potential value of self-compassion and cognitive-behavioural interventions, menstrual self-monitoring, and improved healthcare and community support to enhance postpartum wellbeing and body confidence.
AIMS/BACKGROUND:Pregnant adolescents face adversities that heighten perinatal complications in mental (e.g. depression) and physical (e.g. excess gestational weight gain [GWG]) health. Depression may affect excess GWG through stress-related behaviours. We sought to pilot feasibility/acceptability of integrating a brief mental health intervention within prenatal care to address depression and stress-related behaviours contributing to excess GWG. DESIGN/METHODS:The current study reports recruitment/retention, feasibility, and intervention/protocol acceptability of a pilot randomised controlled trial with N = 37 pregnant 13-19-year-olds receiving multidisciplinary prenatal care (NCT03086161). Participants were randomised to 6 × 1-hour individual interpersonal psychotherapy sessions plus usual multidisciplinary prenatal care (IPT+UC) or usual care only (UC). Feasibility was tracked using CONSORT flow. Adolescents completed acceptability ratings at post-program. Within-condition and between-group changes in social functioning, depression, stress-related behaviours, and GWG were assessed from baseline to mid-programme and post-programme. RESULTS:88% of potentially eligible patients enrolled. At mid-programme, 43% were retained in IPT+UC versus 38% in UC; at post-program 38% were retained in IPT+UC versus 35% in UC. Within IPT+UC, 47% received ≥ 80% IPT dosage. Adolescents rated IPT acceptability above-average. Within-group, IPT+UC showed decreased mother-adolescent negative interactions at mid-programme (r = .76, p = .01) and post-programme (r = .63, p = .04). There was no difference in gestational weight gain between arms (ε2 = .02, p = .87). CONCLUSION:Brief, integrated mental health therapy in multidisciplinary prenatal care for adolescents has feasible enrolment and may offer an acceptable approach for mental-physical health. Dosage and retention require refinement. Incorporating dissemination/implementation science principles is warranted in future tests of IPT to support the mental-physical health of pregnant adolescents.
BACKGROUND:Miscarriage is a traumatic event for women and their families. Australian healthcare is fragmented, with evidence that healthcare approaches may adversely impact women's care during a miscarriage. There is limited evidence that describes women's psychological needs to support post-miscarriage recovery. AIM:The aim of this review was to explore the reported psychological support needs of women receiving care after miscarriage in Australia, as understood through their experiences of health care provision. METHODS:Five databases (CINAHL, MEDLINE, Scopus, Web of Science, PubMed) were searched in January 2024 for key terms related to women's experiences of psychological follow-up post-miscarriage in Australia. The review followed the JBI framework and was reported in line with PRISMA-ScR. RESULTS:Of 101 articles retrieved, 28 duplicates were removed. Seventy-three were screened by title and abstract, 39 underwent full-text review, and 8 were included. Eight studies with data on 1,581 Australian women were analysed. Women frequently reported an absence of structured or routine psychological follow-up, despite reporting significant anguish, sadness, and grief post-miscarriage. The thematic synthesis identified 3 themes on psychological follow-up for post-miscarriage care: (1) the necessity for clear, accessible information about miscarriage; (2) the importance of emotionally sensitive care; and (3) the need for effective follow-up care. CONCLUSIONS:The absence of structured psychological follow-up care after miscarriage often leaves women unsupported in their grief. Further research is needed to address women's needs within an integrated care model for psychological care.
INTRODUCTION:Earlier studies focusing on global self-esteem in pregnant women have identified a number of risk factors for low global self-esteem and have compared global self-esteem during pregnancy and after childbirth. However, there is a lack of research on the specific self-esteem components except for body image. This study compared global self-esteem, specific self-esteem components, and identity integration in pregnant and non-pregnant women, and examined selected correlates of these variables. METHODS:The study included 394 women: 285 non-pregnant women aged 18-65 (M = 34.93; SD = 9.23), and 109 pregnant women aged 22-41 (M = 30.49; SD = 3.50). The assessments were performed using the Multidimensional Self-Esteem Inventory developed by O'Brien and Epstein, and enabling measurement of global self-esteem, eight specific self-esteem components, and identity integration. Independent-samples t tests and correlational analyses were used, with supplementary ANCOVAs adjusting for age, BMI, and motherhood history. RESULTS:Pregnant women scored higher than non-pregnant women on global self-esteem, identity integration, and several specific self-esteem components. After adjustment, pregnancy status remained significant for global self-esteem, competence, lovability, likeability, moral self-approval, and identity integration, but not for body appearance, body functioning, or self-control. In the pregnant group, higher pre-pregnancy BMI was associated with less favourable body-related self-evaluations, self-control, and defensiveness. Pre-pregnancy physical activity was associated with higher body appearance, self-control, likeability, and body functioning. DISCUSSION:The present study suggests there are significant differences in self-esteem and identity integration between pregnant and non-pregnant women and highlights the importance of multidimensional measurement of self-esteem in pregnant women.
AIMS:To explore mechanisms that lead mothers with perinatal mental health difficulties to take up an offer of face-to-face peer support from trained volunteers, and contextual factors triggering those mechanisms. METHODS:Realist evaluation methods were used to identify context-mechanism-outcome configurations for take-up in a community-based, third sector programme offering one-to-one and group peer support in the UK. Data were from semi-structured interviews with mothers (n = 20), peer support volunteers (n = 27), and staff (n = 9), and baseline quantitative and open-text data about mothers at referral (n = 260). RESULTS:182/260 mothers (70%) took up peer support, varying between sites with different populations. Twenty context-mechanism-outcome configurations explained take-up, which depended on complex contextual factors. Mechanisms clustered around mothers' expectations of psychological safety; desire for a meaningful reference group for social comparison; beliefs about what they may gain; expectations about how it might compare to professional mental health support; and practical issues such as mode of delivery. The purpose of peer support can be misunderstood. Not all communities see value in talking about emotional distress with peers, and not all mothers trust peers to be non-judgemental. One-to-one and group support may feel safe to different mothers. CONCLUSION:Programmes should work with mothers, third sector organisations, and community leaders, to identify how perinatal mental health peer support can be locally offered most appealingly. Accessibility may be increased by offering a choice of group or one-to-one support, and a blend of face-to-face, telephone, and video-conferencing. Publicity material should clearly explain what peer support is and how it can help.
AIM:This study evaluates and compares the effectiveness of various digital psychological interventions for perinatal depression (PND) through a network meta-analysis. METHODS:The network meta-analysis adhered to the PRISMA guidelines,with its protocol registered on PROSPERO (CRD42024609951). Literature search was conducted in electronic databases: Cochrane Central Register of Controlled Trials, PsyclNFO, EMBASE, and MEDLINE. Randomised studies of digital psychological interventions for PND are identified. PND symptoms, as measured by the Edinburgh Postnatal Depression Scale, are the primary outcomes. The mean effect size and its 95% confidence interval (CI) are calculated by combining the standardised mean differences (SMDs) between interventions at post-intervention and follow-up. The ranking probabilities of all interventions are estimated using the surface under the cumulative ranking curve (SUCRA). Study quality is assessed via Cochrane RoB 2. RESULTS:A total of 8577 participants from 32 studies are included. Mindfulness-Based Interventions (MBI) were significantly more effective than control groups at post-intervention. MBI and interpersonal therapy (IPT) also demonstrated sustained effectiveness at follow-up. Overall, MBI ranked as the most effective intervention. Subgroup analyses stratified by delivery mode, country income level, and perinatal status revealed no significant findings in these three subgroups. CONCLUSION:The findings suggest that MBI may be the most effective approach for alleviating depressive symptoms in the overall perinatal population at both post-intervention and follow-up.
INTRODUCTION:Millions of people and couples worldwide are impacted by the complex and emotionally taxing medical issue of infertility. Infertility describes a person's or a couple's inability to conceive a child or carry a pregnancy, leading to profound emotional, psychological, and social effects on them. There search into the mental health of infertile women is crucial in the managementof outcomes of infertility. AIM:Against this background, this study aims to discover mental health challenges that impact fertility in women and further help in the field to improve the overall outlook on the condition. METHODS:In adherence with Prisma Guidelines, a systematic search was carried out of the literature published from 1 January 2010, to 3 March 2023, in PubMed, Cochrane, Web of Science, Google Scholar, and Open Alex. All the synonyms of keywords or MeSH terms for mental health, infertile women, infertile females, and infertility were used. 1234 articles related to mental health and infertility in women were found, and after following the inclusion and exclusion criteria,47 studies were retained. RESULTS:Infertile women experience mental health threats like anxiety, depression, stress, marital dissatisfaction, and lower quality of life. In addition to the psychological and emotional burden of infertility, they often struggle with alack of social support and different types of abuse and violence in the irrelationships. CONCLUSION:With support from loved ones, support groups, and healthcare experts, timely, evidence-based, low-cost infertility interventions can provide great assistance and successfully navigate the emotional difficulties experienced by infertilewomen.
BACKGROUND:Previous research established the key role of caregiver responsiveness in favourable infant development. This study examined psychological determinants of caregiver responsiveness in a non-clinical sample of mothers of infants in the first year of life. METHOD:We conducted an online survey including two self-report measures of caregiver responsiveness (Maternal Responsiveness Questionnaire, MRQ, and Parental Responsiveness Scale, PRS), as well as measures of parental stress (Parental Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and Big-Five personality traits (International Personality Item Pool - Big Five Markers, 20-item version). The sample included 184 mothers, most of whom had higher education. RESULTS:Parental stress was significantly directly associated with lower caregiver responsiveness. Additionally, depressive symptoms partially mediated the relationship (for MRQ, but not PRS) between parental stress and responsiveness. The effects of personality traits were not statistically significant. CONCLUSIONS:Parental stress emerged as the most consistent predictor of caregiver responsiveness, underscoring its central role in relation to parental behaviour. The results were consistent across the two different measures of caregiver responsiveness.
AIM:This study aimed to explore healthcare professionals' perceptions of selective versus routine episiotomy practices, identify factors influencing their decision- making, and gather challenges and recommendations for implementing selective episiotomy. METHOD:A qualitative descriptive exploratory design was used, employing purposive sampling to enrol 15 participants (five obstetricians, five nurses, five midwives), each with at least one year of clinical experience in labour and obstetric units. Data collection included in-depth interviews conducted in-person or via Zoom, lasting 30-45 minutes, and audio-recorded. Thematic analysis was conducted to extract key themes and sub-themes. RESULTS:Participants were unaware of international episiotomy guidelines and relied on personal clinical judgement for decision-making. The primary reason for performing an episiotomy was to prevent severe perineal tears, with minimal involvement of mothers in the process. Despite preferring selective episiotomy, routine episiotomy was commonly practiced due to barriers like inadequate training, institutional norms, and outdated practices. This discrepancy highlights the need for improvement in practice. The study recommends better training, updated clinical guidelines, and enhanced patient counselling to promote evidence-based episiotomy practice. CONCLUSIONS:The study highlights a gap between healthcare providers' preferences for selective episiotomy and their routine practices, driven by institutional norms and inadequate training. Enhancing training, incorporating evidence-based episiotomy practices into curricula, updating guidelines, and improving patient involvement are essential for better clinical outcomes.
BACKGROUND:Professional motivation and identity development in midwifery students are crucial for their education. However, hearing mostly negative birth stories from their environment can adversely affect their perceptions of birth and their professional role. A positive perception of birth is essential not only for pregnant women but also for midwifery students. This positive view can enhance their professional identity and motivation, significantly influencing their future practice. This study aimed to examine midwifery students' views on the effect of a positive birth stories workshop on their professional motivation. METHODS:This qualitative descriptive research was conducted in two stages. First, a workshop was held with midwifery students and women who had experienced positive births. Then, online interviews were conducted with 12 students who participated in the workshop. The data were analysed using content analysis in MAXQDA 2022 software. RESULTS:All students, aged 20-23, reported mainly hearing negative birth stories previously. Three themes emerged regarding the workshop's effect on professional motivation: (1) Shaping Perceptions - The Influence of Birth Stories, (2) Discovering the Power of Midwifery through Positive Birth Stories, (3) Integration of Birth Stories with Education. DISCUSSIONS:This study shows that positive birth stories enhance maternity care students' professional motivation and perceptions of childbirth. The workshop shifted students' views, portraying midwives as heroes, increasing respect for the profession. Integrating experiential storytelling into education fosters professional responsibility, belonging, and motivation, positively impacting students' development.
BACKGROUND:Stillbirth is a profound and often under-recognised form of perinatal loss that can result in enduring grief. Despite numerous interventions, there is limited synthesis of evidence across the grief trajectory. OBJECTIVE:This umbrella review synthesised evidence from systematic reviews to identify bereavement support strategies for parents after stillbirth, structured by stages of grief. METHODS:Six databases and grey literature were searched for qualitative, quantitative, or mixed-methods systematic reviews. Two reviewers independently conducted screening, critical appraisal (JBI tools), and data extraction. A thematic synthesis and corrected covered area matrix addressed overlapping data. RESULTS:Eleven reviews met the inclusion criteria. Strategies were mapped to three stages: (1) acute grief - empathetic presence, validation of loss, and immediate containment; (2) adjustment - relational support, memory-making, and peer-based programmes; and (3) long-term integration - structured follow-up, meaning-making, and anticipatory guidance for future pregnancies. Approaches differed in scope, intensity, and cultural framing. CONCLUSIONS:This review proposes a stage-based framework to inform interdisciplinary, grief-informed bereavement care. Synthesised strategies may enhance the emotional recovery and long-term adaptation of bereaved parents following stillbirth. REGISTRATION:PROSPERO: CRD420251035521 (registered 18 April 2025).
AIM:Individuals with mental health concerns face additional risks in reproductive health. The responsibility of mental healthcare professionals (MHPs) in discussing reproductive health themes - including sexuality, contraception, family planning, pregnancy and parenthood (SCUFPP) - remains underexplored. This study aimed to assess MHPs' opinions, practices, perceived competence and collaboration in discussing SCUFPP with patients. METHODS:Data from 236 Dutch MHPs who completed a 22-item questionnaire on SCUFPP between January 2023 and August 2024 (survey A) were combined with data from 139 Dutch MHPs who completed a nationwide previous survey in May 2022 (survey B) on family planning, to deepen the exploration. Subgroup analyses included gender, age and experience. RESULTS:In total, 55.5% of MHPs agree that family planning should be discussed with every patient of reproductive age, while 44.5% did not explicitly agree. Sexuality and parenthood were discussed more often than family planning, pregnancy and contraception. Older and more experienced MHPs initiated conversations more often. Most MHPs felt competent to discuss SCUFPP, while a minority (27.3%) was familiar with methods or conversation techniques. Female MHPs more often felt competent and expressed a greater need for education on pregnancy. Most MHPs valued collaboration with integrated and preconception care in mental healthcare. CONCLUSION:These findings point to a gap between MHPs' perceived responsibility and their ability to implement these conversations in practice. Enhanced training and collaboration with expert consultations in SCUFPP may improve MHPs' responsibility in informed reproductive choices, enhancing mental health outcomes for patients.
BACKGROUND:Childbirth fear and traumatic birth perceptions negatively affect maternal well-being and labour outcomes. The aim of this study was to evaluate the effectiveness of a transformative learning-based antenatal education programme on childbirth fear, traumatic birth perception, and childbirth preparedness in primigravida women. METHODS:In this parallel-group randomised controlled trial, 54 primigravida women were randomly assigned to an experimental group (n = 27), receiving a three-session transformative learning-based programme over three weeks, or a control group (n = 27) receiving standard antenatal education. Outcomes were assessed using the W-DEQ A, Traumatic Birth Perception Scale, and the Labour Preparation subscale of the PSES. Data were analysed using MANOVA and mixed-design ANOVAs. RESULTS:Significant group ×time interactions were observed for all outcomes. Childbirth fear decreased significantly in the experimental group (63.5 ± 8.1 to 46.3 ± 9.5) compared with the control group (60.3 ± 7.8 to 59.7 ± 8.6; p < .001, ηp2 = .300). Traumatic birth perception also decreased significantly in the experimental group (80.1 ± 6.9 to 70.3 ± 8.1) compared to the control group (82.3 ± 7.3 to 76.1 ± 7.9; p = .001, ηp2 = .193). Furthermore, childbirth preparedness improved significantly in the experimental group (24.0 ± 3.2 to 17.0 ± 2.8) versus the control group (21.0 ± 3.5 to 19.0 ± 3.3; p < .001, ηp2 = .264). CONCLUSION:The transformative learning-based antenatal education programme significantly reduced childbirth fear and traumatic birth perception while enhancing childbirth preparedness among primigravida women compared with standard antenatal education.
BACKGROUND:Tanzania has among the highest rates of stillbirth and neonatal death globally, yet little is known about the mental health impact of such loss on mothers. Cultural stigma, silence around grief, and limited access to psychosocial support compound these challenges. This study explores the experiences of bereaved Tanzanian mothers, focusing on mental health symptoms, social support, and preferred forms of post-loss care. METHODS:We conducted a qualitative descriptive study at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Fifty women (25 with stillbirth, 25 with neonatal death) were enrolled. At 8 weeks post-loss, 40 women completed in-depth interviews. Interviews were transcribed, translated, and thematically coded via a directed content analysis combining deductive and inductive coding. A brief intake questionnaire captured demographic data and perceptions of immediate support. RESULTS:Four organizing themes emerged: (1) identified sources of support included partners, communities, and providers; (2) women experienced negative responses from these loci of support such as blame, gossip, and abandonment; (3) stigma surrounding childlessness disrupted maternal identity; and (4) women expressed a strong desire for structured mental health support, including peer groups and counseling. These organizing themes coalesced into a single ground theme: following perinatal loss, women experienced mental health challenges while expressing needs for greater psychological and psychosocial support. CONCLUSIONS:Perinatal loss deeply impacts maternal mental health in Tanzania. Interventions must address cultural stigma and include formal peer support and provider-led bereavement care to support healing and resilience in bereaved mothers.
