Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.     

Conceived Through Rape/Incest? Adoptive Parents’ Experiences Managing Uncertainty and Disclosure Surrounding their Children's Origins

Adoptive parents may be placed with children conceived under difficult circumstances, such as via rape or incest. At the same time, adoptive parents are generally encouraged to communicate openly with their children about their adoption stories and birth families. No research has examined the experiences of parents who adopt children who were conceived through rape or incest. This exploratory study examines how parents discuss their decision-making when adopting children conceived via rape or incest, how they manage varying levels of uncertainty about their children's origins, and whether and how they plan to disclose this information to children. The researchers used thematic analysis to examine the experiences of 11 couples (22 parents) interviewed at four time points after adopting children who were reportedly conceived via rape or incest. Findings revealed that even soon after adopting, parents discussed the need to eventually talk to their children about their conception circumstances. Parents generally struggled to determine how and when to disclose this information, particularly when they felt uncertain about the veracity of the conception stories they had been told. Some hoped to rely on professionals or birth mothers to guide them in these communications. Findings have implications for supporting adoptive families as they navigate the complexity of managing sensitive information and uncertainty when adopting children conceived through rape or incest. Practitioners should provide ongoing guidance to adoptive parents about how and when to disclose developmentally appropriate information to children about difficult conception circumstances.     

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY

Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.     

Creating mother and baby therapy groups in prison: emotional valuation

Mothers in prison are at high risk of depression and other mental health issues and yet access to therapeutic services is limited. This paper describes the development by the author of two prison therapy groups: one for pregnant women, the other for mothers and their babies. Called the ‘Born Inside’ project, both groups are currently held in Bronzefield Prison, Surrey. The theory and principles behind the project are discussed, as well as the processes and practicalities involved in providing the therapy and specialised support to the women and their vulnerable infants. In addition, principles of forensic psychotherapy in relation to this specific prison population are described, and the situational and emotional challenges faced are illustrated through narratives of group members.     

Stigma and hostility towards pregnant smokers: Does individuating information reduce the effect?

Australia is at the forefront of tobacco control, yet 17% of Australian women smoke during pregnancy. Negative attitudes to smoking are intensified when the smoker is pregnant, consistent with a discourse that encourages surveillance of pregnant women. Such overt anti-smoking attitudes create a context which may make it difficult for pregnant smokers to seek assistance to stop. However, there is little evidence on the extent to which pregnant smokers are stigmatised by community members. We used vignettes to examine the degree of smoking-related stigma expressed by 595 Australian university students who rated a woman, described as a mother who was smoking or not, and pregnant or not. Further, we examined whether provision of individuating information reduced the degree of stigma. Mothers described as smokers were rated more negatively than those not, particularly if they were pregnant: smokers were perceived as unhealthy, and also as bad mothers. Provision of individuating information slightly reduced these effects. These findings support the view that smokers – particularly if pregnant – are subject to negative moral judgement. Our findings contribute to the ethical debate about stigma-inducing tobacco control efforts, and suggest that anti-smoking campaigns that contextualise smoking in pregnancy might reduce stigma and assist cessation.     

Conceptualizing stress to study effects on health: Environmental,perceptual, and emotional components

Abstract

Stress has been operationalized in numerous ways across studies of physical and mental health, raising questions about the appropriate definition of stress and the construct validity of stress measures. The present paper discusses the theoretical and operational strengths of three prominent approaches to stress definition and then attempts to integrate them into a comprehensive and robust multidimensional definition of stress. In a study of socioeconomically disadvantaged pregnant women, structural equation modelling techniques were used to test whether a single latent construct underlies environmental, perceptual, and response-based indicators of stress. Results suggested a two-factor, rather than a single-factor, model of stress. Stress perception and emotion were part of a single underlying latent factor, a phenomenological stress construct, whereas environmental conditions in the form of major life events represented a second and distinct component of stress. Failure to find a single latent stress construct is interpreted as evidence for the importance of individual perception or appraisal as a mediator of response to difficult environmental conditions. The findings suggest that multidimensional models of stress are theoretically justified and that enhancement of stress measurement in this manner may enable researchers to better identify health effects of stress.     

Esther bick (1901 – 1983)

Abstract

Pearl King and Richardo Steiner, Eds. The Freud-Klein Controversies 1941-45. London, Routledge, 1991. λ100 (Hardback).

Alessandra Piontelli. From Fetus to Child. An Observational and Pyschoanalytic Study. New Library of Psychoanalysis 15. 1992. λ14.99 paperback.

Antonino Ferro. La tecnica in psicoanalisi infantile. II bambino e l'analista: dalla relatione al campo emotivo.? Milan: Cortina, 1992, 221 pages

Rolene Szur and Sheila Miller, Editors. Extending Horizons. Psychoanalytic Psychotherapy with Children, Adolescents and Families. Published by Karnac Books, 1991. Paperback λ24.95.     

The Unintended Outcomes of High-Stakes Testing

SUMMARY

Although it is important to evaluate the intended outcomes of high-stakes testing, it is also important to evaluate the unintended outcomes, which might be as important or more important than the intended outcomes. The purpose of this paper is to examine some of the unintended outcomes of high-stakes testing, including those related to: (a) using tests as a means to hold educators accountable, (b) the effects on instruction, (c) the effects on student and teacher motivation, and (d) the effects on students who are at-risk of school failure. In examining the evidence, I conclude that while some unintended outcomes of high-stakes testing have been positive, many of the unintended outcomes have been negative. Hopefully, through a greater awareness of the unintended outcomes, school psychologists can work to minimize the negative effects of testing on students and educators.