Women's experiences of induction of labour: qualitative systematic review and thematic synthesis.

BackgroundWomen can experience a range of psychological problems after birth, including anxiety, depression and adjustment disorders. However, research has predominantly focused on depression. Qualitative work on women’s experiences of postnatal mental health problems has sampled women within particular diagnostic categories so not looked at the range of potential psychological problems. The aims of this study were to explore how women experienced and made sense of the range of emotional distress states in the first postnatal year.MethodsA qualitative study of 17 women who experienced psychological problems in the first year after having a baby. Semi-structured interviews took place in person (n =15) or on the telephone (n =2). Topics included women’s experiences of becoming distressed and their recovery. Data were analysed using Interpretative Phenomenological Analysis (IPA). Themes were developed within each interview before identifying similar themes for multiple participants across interviews, in order to retain an idiographic approach.ResultsPsychological processes such as guilt, avoidance and adjustment difficulties were experienced across different types of distress. Women placed these in the context of defining moments of becoming a mother; giving birth and breastfeeding. Four superordinate themes were identified. Two concerned women’s unwanted negative emotions and difficulties adjusting to their new role. “Living with an unwelcome beginning” describes the way mothers’ new lives with their babies started out with unwelcome emotions, often in the context of birth and breastfeeding difficulties. All women spoke about the importance of their postnatal healthcare experiences in “Relationships in the healthcare system”. “The shock of the new” describes women’s difficulties adjusting to the demands of motherhood and women emphasised the importance of social support in “Meeting new support needs”.ConclusionsThese findings emphasise the need for exploration of psychological processes such as distancing, guilt and self-blame across different types of emotional difficulties, as these may be viable targets for therapeutic intervention. Breastfeeding and birth trauma were key areas with which women felt they needed support with but which was not easily available.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Copyright and reuse: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. City Research Online: http://openaccess.city.ac.uk/ publications@city.ac.uk Permanent repository link: City Research OnlineRunning head: FACTOR STRUCTURE OF THE EPDS Factor structure of the Edinburgh Postnatal Depression Scale in a population-based sample FACTOR STRUCTURE OF THE EPDS 2 AbstractTo demonstrate validity, questionnaires should measure the same construct in different groups and across time. The Edinburgh Postnatal Depression Scale (EPDS) was designed as a unidimensional scale, but factor analyses of the EPDS have been equivocal, and demonstrate other structures: this may be due to sample characteristics and timing of administration. We aimed to examine the factor structure of the EPDS in pregnancy and postpartum at four time-points in a large population-based sample. We carried out exploratory and confirmatory factor analysis on the Avon Longitudinal Study of Parents and Children sample (n = 11,195 -12,166) randomly split in two. We used data from 18and 32 weeks pregnancy gestation; and 8 weeks and 8 months postpartum. A three-factor solution was optimal at all time-points, showing the clearest factor structure and best model fit: Depression (four items) accounted for 43.5 -47.2% of the variance; anhedonia (two items) 10.5 -11.1%; and anxiety (three items) 8.3 -9.4% of the variance. Internal reliability of subscales was good at all time points (Cronbach's alphas: .73 -.78). The EPDS appears to measure three related factors of depression, anhedonia and anxiety and has a stable structure in pregnancy and the first postnatal year.Keywords: ALSPAC, depression, anxiety, postnatal, pregnancy, factor analysis FACTOR STRUCTURE OF THE EPDS 3Factor structure of the Edinburgh Postnatal Depression Scale in a population-based sampleIn pregnancy and the first postnatal year 10-20% of women experience mental illness (Bauer et al., 2014) with detrimental effects on the whole family (Gavin et al., 2005). Interventions can ease symptoms and improve wellbeing of mothers (Dennis & Hodnett, 2007), however effective treatment is hampered by low levels of identification of perinatal mental illness with 50% of women with depression and anxiety not identified (Hewitt et al., 2009) evidence that the EPDS also measures anxiety with three items and that the summed score of these items can differentiate between anxiety and depressive disorders (Bowen, Bowen, Maslany, & Muhajarina, 2008;Matthey, Fisher, & Rowe, 2012; Ross, Evans, Seller, & Romach, 2003) although further research is needed to determine its acceptability, validity and reliability and psychometric properties as a measure of anxiety (Milgrom & Gemmill, 2014). A re...

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link Methods:In-depth interviews with 17 women in southeast England with a baby under one year old who experienced a postnatal mental health problem. Data were analysed using inductive thematic analysis.Results: Women described a lack of identification with the concept of postnatal depression and felt that other forms of emotional distress were not recognised by the healthcare system. Women felt that support seeking for postnatal mental health problems needed to be normalised and that support should be available whether or not women were diagnosed. . Assessment needs to be well timed and caringly implemented.Discussion: Identification and recognition of symptoms and disorders other than postnatal depression needs to be improved. Awareness of multiple types of distress needs to be raised both for women experiencing such distress, and for healthcare professionals, to enable them to support women at this time. Different approaches to assessment that include the range of symptoms reported should be piloted.