Mette Juhl

Pregnant women with a history of mental disorders, neglect, or low social support are at increased risk of mental health problems. It is crucial to identify psychosocial risk factors in early pregnancy to reduce the risk of short- and long-term health consequences for mother and child. The Antenatal Risk Questionnaire has been found acceptable as a psychosocial screening tool among pregnant women in Australia, but it has not been tested in a Scandinavian context. The aim of this study was to explore the experiences of pregnant women when using the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale as part of a model to identify psychosocial vulnerabilities in pregnancy in Denmark. We conducted individual interviews (n = 18) and used thematic analysis. We identified two main themes: (1) Feeling heard and (2) An occasion for self-reflection. Overall, the pregnant women deemed the online ANRQ/EPDS acceptable as a screening tool. The screening model provided a feeling of being heard and provided an occasion for self-reflection about mental health challenges related to pregnancy and motherhood. However, some women expressed that the screening raised concerns and fear of the consequences of answering honestly. A non-judgmental, open, emphatic, and reassuring approach by clinicians may help reduce stigma.

A traumatic upbringing increases the risks of antenatal health problems, unfavourable pregnancy outcomes, and mental disorders. Such childhood experiences may affect women’s pa-renting skills and the social–emotional functioning of their children. Research on screening for adverse childhood experiences in antenatal care is limited. The objective of this study was to explore pregnant women’s attitudes towards and experiences of an adverse childhood experiences questionnaire, and to assess the relevance of the questionnaire among a population of pregnant women referred to antenatal care levels one and two, targeting women who are generally not perceived to be vulnerable. Data were collected at three maternity wards and consisted of quantitative data on 1352 women’s adverse childhood experience scores, structured observations of 18 midwifery visits, and in-depth interviews with 15 pregnant women. Quantitative data were analysed by descriptive statistics, and qualitative data were analysed using systematic text condensation. The qualitative analysis revealed two main categories: “Being screened for childhood adversities” and “Having adverse childhood experiences”. In the study population, the prevalence of adverse childhood experiences was high. The women assessed the adverse childhood experiences questionnaire to be a relevant and acceptable screening method. Furthermore, women’s perceptions of their relationship with their midwife greatly impacted their attitudes towards and experiences of the questionnaire.

Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; “Relevance of the adverse childhood experiences questionnaire”, “Challenges related to use of the adverse childhood experiences questionnaire” and “Apprehensions, emotional strain, and professional support”. The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives’ acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women’s boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.

The adult children of alcoholic parents are at increased risk of having health problems compared to the adult children of nonalcoholic parents. Little is known about how growing up with alcoholic parents affects women’s experiences when pregnant. The objectives of this study were to explore how adverse childhood experiences related to parental alcohol abuse affect women during their pregnancy and to assess the potential implications of women’s experiences for antenatal care provision. Twelve in-depth interviews were performed with women who were brought up by an alcoholic mother and/or father. Systematic text condensation was used to analyse the data. Two main categories were identified: ‘establishing relationships and having social support’ and ‘antenatal care encounters and concerns during pregnancy’. Women’s trust in others in adult life was impacted by their upbringing. Strained relationships with their parents and few friends meant that the women primarily relied on their partners for support. Neither antenatal care providers nor women talked about women’s childhood experiences at the visits. The women described concerns related to the baby’s health, lack of predictability and control during the pregnancy, as well as apprehensiveness regarding birth and motherhood. The potential implications for practice include systematic screening for adverse childhood experiences, antenatal preparation classes, parenting courses, and post-graduate training.

Background: In Denmark, 13% of all children are born by non-Western immigrant women. The public antenatal care has not adapted to this increased diversity of women. Compared to women coming from Western countries, non-Western immigrant women have an increased prevalence of severe maternal morbidity and higher risks of maternal death, stillbirth and infant death. Suboptimal care is a contributing factor to these ethnic disparities, and thus the provision of appropriate antenatal care services is pivotal to reducing these disparities and challenges to public health. Yet, little is known about the targeted interventions which have been developed to reduce these inequities in reproductive health. The MAMAACT intervention, which included a training course for midwives, a leaflet and a mobile application, as well as additional visit time, was developed and tested at a maternity ward to increase responses to pregnancy warning signs among midwives and non-Western immigrant women. Aim: To explore the feasibility and acceptability of the MAMAACT intervention among midwives and identify factors affecting midwives’ delivery of the intervention. Methods: Eight mini-group interviews with midwives (n = 18) were undertaken. Systematic text condensation was used to analyse data. Results: Three main categories were identified, which were ‘Challenges of working with non-Western immigrant women’, ‘Attitudes towards and use of the leaflet and mobile application’, and ‘Organisational factors affecting the use of the MAMAACT intervention’. Conclusions: The MAMAACT intervention was found to be feasible as well as acceptable among midwives. Women turning to relatives for pregnancy-related advice, time constraints during midwifery visits, incomplete clinical records and lack of professional interpreter assistance impacted midwives’ delivery of the MAMAACT intervention. Midwives displayed a readiness for the MAMAACT intervention; however, there is a need to further examine how contextual factors may impact the use of the intervention in antenatal care. Trial registration: ClinicalTrials.gov, Retrospective Registration (07/2/2020), registration number NCT04261400.

In western countries, immigrant women have an increased risk of negative birth outcomes. Immigrant women’s and maternity care system’s delayed response to pregnancy complications contribute to ethnic inequities in reproductive health. The MAMAACT intervention was developed to improve midwives’ and women’s response to pregnancy complications in Denmark. The study examines the context of the implementation of the MAMAACT intervention and investigates how the intended intervention mechanisms regarding response to pregnancy complications were affected by barriers in non-Western immigrant women’s everyday life situations. Twenty-one interviews with non-Western immigrant women were undertaken. Systematic text condensation and the situational-adaptation framework by Alonzo were used to analyze data. Four main categories were identified: ‘Sources of knowledge during pregnancy’, ‘Containment of pregnancy warning signs’, ‘Barriers during the onset of acute illness’ and ‘Previous situations with maternity care providers’. Attention to potential pregnancy complications may conflict with immigrant women’s everyday life situations and result in the containment of symptoms as well as causing delays in seeking medical assistance. It is probable that barriers in women’s everyday life will impact the intended intervention mechanisms and thus the full potential of the intervention may not be reached.