Abstract
Objective Periviable birth accounts for a very small percentage of preterm deliveries but a large proportion of perinatal and neonatal morbidity. Understanding parental experiences during and after periviable deliveries may help healthcare providers determine how to best support women during these medically complex, emotionally charged clinical encounters. Methods This is a qualitative study with a voluntary sample of women who delivered between 22 and 25 weeks gestation at an academic medical center from 2014 to 2016. Women’s narratives of each periviable birth experience were transcribed and analyzed using consensus coding and a grounded theory approach to identify key themes that describe parental experiences. Results A total of 10 women were interviewed. Four emergent temporal themes: (1) the time preceding admission: feeling dismissed; (2) transfer or admission to a tertiary care center: anxiety and doubt; (3) the birth itself: fear of the outcome; and (4) the postpartum period: reflection and communication. Conclusions for practice Women that experience a periviable birth may benefit from continuous support and clear communication. Overall, care for these patients should be expanded to address the specific psychosocial needs identified during the distinctive, periviable temporal themes that emerged during interviews. Continuous longitudinal support in the form of a designated person or team should be provided to women experiencing a potential periviable birth in order to help mitigate the fear and anxiety associated with these complex birth experiences.
This is a preview of subscription content, log in via an institution to check access.
Source Authors
Similar content being viewed by others
References
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub6.
Burcher, P., Cheyney, M. J., Li, K. N., Hushmendy, S., & Kiley, K. C. (2016). Cesarean birth regret and dissatisfaction: A qualitative approach. Birth. https://doi.org/10.1111/birt.12240.
Caeymaex, L., Speranza, M., Vasilescu, C., Danan, C., Bourrat, M. M., Garel, M., et al. (2011). Living with a crucial decision: A qualitative study of parental narratives three years after the loss of their newborn in the NICU. PLoS ONE, 6(12), e28633. https://doi.org/10.1371/journal.pone.0028633.
Callister, L. C. (2004). Making meaning: Women’s birth narratives. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33(4), 508–518.
Callister, L. C. (2006). Perinatal loss: A family perspective. Journal of Perinatal and Neonatal Nursing, 20(3), 227–234. quiz 235 – 226.
Campo-Engelstein, L. (2012). Competing social norms: Why women are responsible for but not trusted with contraception. International Journal of Applied Philosophy, 26(1), 66–84.
Charmaz, K. (2014). Constructing grounded theory. Introducing qualitative methods series (2nd ed.). London: Sage.
Cohen, D., & Crabtree, B. (July 2006). Qualitative Research Guidelines Project. Retrieved from http://www.qualres.org/HomeLinc-3684.html.
Greene, M. M., Rossman, B., Patra, K., Kratovil, A. L., Janes, J. E., & Meier, P. P. (2015). Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit. Journal of Developmental & Behavioral Pediatrics, 36(5), 362–370. https://doi.org/10.1097/dbp.0000000000000174.
Grobman, W. A., Kavanaugh, K., Moro, T., DeRegnier, R. A., & Savage, T. (2010). Providing advice to parents for women at acutely high risk of periviable delivery. Obstetrics & Gynecology, 115(5), 904–909. https://doi.org/10.1097/AOG.0b013e3181da93a7.
Holloway, I. (1997). Basic concepts for qualitative research. London: Blackwell.
Horwitz, S. M., Leibovitz, A., Lilo, E., Jo, B., Debattista, A., St John, N., et al. (2015). Does an intervention to reduce maternal anxiety, depression and trauma also improve mothers’ perceptions of their preterm infants’ vulnerability? The Infant Mental Health Journal, 36(1), 42–52. https://doi.org/10.1002/imhj.21484.
Jubinville, J., Newburn-Cook, C., Hegadoren, K., & Lacaze-Masmonteil, T. (2012). Symptoms of acute stress disorder in mothers of premature infants. Advances in Neonatal Care, 12(4), 246–253. https://doi.org/10.1097/ANC.0b013e31826090ac.
Lau, C., Ambalavanan, N., Chakraborty, H., Wingate, M. S., & Carlo, W. A. (2013). Extremely low birth weight and infant mortality rates in the United States. Pediatrics, 131(5), 855–860. https://doi.org/10.1542/peds.2012-2471.
Lynch, T., & Burcher, P. (2016). Periviability: Translating informed assent and non-dissent to obstetrics. Ethics and Medicine, 31(1), 31–38.
Martin, J. A., Hamilton, B. E., & Osterman, M. J. (2016). Births in the United States, 2015. NCHS Data Brief, 258, 1–8.
Misund, A. R., Nerdrum, P., Braten, S., Pripp, A. H., & Diseth, T. H. (2013). Long-term risk of mental health problems in women experiencing preterm birth: A longitudinal study of 29 mothers. Annals of General Psychiatry, 12(1), 33. https://doi.org/10.1186/1744-859x-12-33.
Peters, M. D., Lisy, K., Riitano, D., Jordan, Z., & Aromataris, E. (2016). Providing meaningful care for families experiencing stillbirth: A meta-synthesis of qualitative evidence. Journal of Perinatology, 36(1), 3–9. https://doi.org/10.1038/jp.2015.97.
Raymond, J. G. (1990). Reproductive gifts and gift giving: The altruistic woman. Hastings Center Report, 20(6), 7–11.
Rothman, B. K. (1993). The tentative pregnancy: Then and now. Fetal Diagnosis and Therapy, 8(Suppl 1), 60–63.
Sawyer, A., Rabe, H., Abbott, J., Gyte, G., Duley, L., & Ayers, S. (2013). Parents’ experiences and satisfaction with care during the birth of their very preterm baby: A qualitative study. BJOG, 120(5), 637–643. https://doi.org/10.1111/1471-0528.12104.
Shaw, E., Levitt, C., Wong, S., & Kaczorowski, J. (2006). Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth, 33(3), 210–220. https://doi.org/10.1111/j.1523-536X.2006.00106.x.
Tucker Edmonds, B., Savage, T. A., Kimura, R. E., Kilpatrick, S. J., Kuppermann, M., Grobman, W., et al. (2017). Prospective parents’ perspectives on antenatal decision making for the anticipated birth of a periviable infant. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2017.1393066.
Vigod, S. N., Villegas, L., Dennis, C. L., & Ross, L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG, 117(5), 540–550. https://doi.org/10.1111/j.1471-0528.2009.02493.x.
Younge, N., Goldstein, R. F., Bann, C. M., Hintz, S. R., Patel, R. M., Smith, P. B., … Cotten, C. M. (2017). Survival and neurodevelopmental outcomes among periviable infants. New England Journal of Medicine, 376(7), 617–628. https://doi.org/10.1056/NEJMoa1605566.
Acknowledgements
We would like to thank the women who so generously shared their stories with us even in a time of great familial and personal crisis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflict of interest or financial support. This study was approved by the Institutional Review Board prior to initiation.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lynch, T.A., Cheyney, M., Chan, M. et al. Temporal Themes in Periviable Birth: A Qualitative Analysis of Patient Experiences. Matern Child Health J 23, 422–430 (2019). https://doi.org/10.1007/s10995-018-02727-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-018-02727-8