To assess pregnancy‐related care and outcomes for women with pre‐gestational, Type 1 diabetes.
The study was a prospective, population‐based, clinical audit in Scotland. A total of 273 and 179 pregnancies in two 12‐month audit periods (during 1998/99 and 2003/04 respectively) were examined.
In both years, antenatal care for women with diabetes was well organised by dedicated multi‐professional teams. Provision of formal pre‐pregnancy clinics increased (1998, four of 22 maternity units; 2003, six of 20 units). Pregnancies documented as “planned” (1998/99, 116/273, or 42.5 per cent; 2003/04, 105/179, or 58.7 per cent; p=0.001) and periconceptual folic acid supplementation, 5 mg daily (1998/99, 40/273, or 14.7 per cent; 2003/04, 71/179, or 39.7 per cent; p<0.0001) increased over time. In both years, women whose pregnancies progressed to delivery attended early for antenatal care (median eight weeks' gestation) and had meticulous monitoring of diabetic control and foetal wellbeing. In the recent year, fewer women had hypoglycaemia during pregnancy (1998/99, 86/212, or 43.9 per cent; 2003/04, 47/160, or 29.4 per cent; p<0.0001). In both years, macrosomia was common (mean z scores: 1.57 in 1998/99 and 1.64 in 2003/04; standard deviations above a reference population mean) and perinatal mortality appeared higher than for the Scottish population (27.9/1,000 in 1998/99 and 24.8/1,000 in 2003/04). There was a (non‐significant) fall in congenital anomaly rate (1998/99: 13/215 births, or 60/1,000; 2003/04, 6/161 births, or 24.8/1,000).
Re‐audit after a five‐year interval showed that periconceptual care and pregnancy planning for Scottish women with Type 1 diabetes has improved. Although pregnancy outcomes remain poorer than for the general Scottish population, the apparent reduction in congenital anomalies is encouraging.
Past research suggests that whether pregnancies are wanted, unwanted, or mistimed may influence breastfeeding behavior. The purpose of this chapter is to develop a more…
Past research suggests that whether pregnancies are wanted, unwanted, or mistimed may influence breastfeeding behavior. The purpose of this chapter is to develop a more precise understanding of this relationship. Specifically, this chapter asks three questions: first, do pregnancy intentions matter most in sustaining breastfeeding for long or for short durations postpartum; second, at what time postpartum are rates of breastfeeding discontinuation most differentiated by pregnancy intentions; and third, how does poverty (measured here by Medicaid receipt) moderate the relationship between pregnancy intentions and breastfeeding duration.
Logistic regression analysis of survey data from a national sample representative of US mothers is used to determine the relationship of pregnancy intentions to whether breastfeeding continues for various durations and through various intervals after birth. Interaction terms between pregnancy intentions and mother’s Medicaid status are used to test for relationships specific to poor or nonpoor mothers between pregnancy intentions and breastfeeding duration.
Results show that pregnancy timing matters most for sustaining breastfeeding for durations past 6 months and that differences in rates of breastfeeding discontinuation between mothers with wanted, unwanted, and mistimed pregnancies are most pronounced in the 3–7 months postpartum period. In addition, findings show that Medicaid recipients (but not nonrecipients) are less likely to exclusively breastfeed for 6 months when their pregnancies are mistimed.
The literature on fundamental causes of health disparities typically suggests that poverty impairs access to resources necessary for effective planning to achieve desirable health outcomes. This study’s results, however, show that planning of pregnancies is more critical for poor mothers to sustain exclusive breastfeeding. Further research is needed to explain this relationship. The results also suggest that policy interventions to help mothers with unplanned pregnancies to sustain breastfeeding should target the period from 3 to 7 months postpartum.
These findings can help shape policies for facilitating the continuation of breastfeeding for durations recommended by health authorities and advance our understanding of the effects of poverty on health behaviors.
Can one describe the ‘natural’ process of pregnancy as ‘harm’, even when negligently brought about? What does that harm consist of? Offering a contextual analysis of the…
Can one describe the ‘natural’ process of pregnancy as ‘harm’, even when negligently brought about? What does that harm consist of? Offering a contextual analysis of the English judiciary's characterisation of wrongful pregnancy, this paper demonstrates from a feminist perspective that the current construction of pregnancy as a ‘personal injury’ is deeply problematic. Forwarding an alternative account, this paper argues for law to embrace a richer notion of autonomy that will better resonate with women's diverse experiences of reproduction, and articulate the importance of autonomy in the reproductive domain: notably, women gaining control over their moral, relational and social lives.
Turkish mothers’ interactions with medical authorities during pregnancy and childbirth have developed in a context of risk discourses produced by biomedical experts with…
Turkish mothers’ interactions with medical authorities during pregnancy and childbirth have developed in a context of risk discourses produced by biomedical experts with surveillance justified by these discourses. Giving meaning to pregnancy and childbirth through the search for the reduction of risks is a reflexive part of Turkish mothers’ everyday life.
This research paper aims to discuss a study examining how pregnancy and childbirth are socially constructed, how increased medicalization is experienced by Turkish mothers, and how they assign meaning to pregnancy and childbirth. A phenomenological research was designed using depth interviews with 10 Turkish mothers with children aged 0–6 years, living in Istanbul who had high education and welfare levels.
The findings shed light on Turkish mothers’ subjective experiences and how medicine as a profession shapes these experiences. With the medicalization of pregnancy and childbirth, how the trust toward the experts, the knowledge of preparation for maternity in an appropriate and responsible manner have become functional for Turkish mothers to create a sense of ontological security are examined.
Racial/ethnic minority, low-income teens represent a significantly underserved group in terms of reproductive health care including birth control and prenatal care. This…
Racial/ethnic minority, low-income teens represent a significantly underserved group in terms of reproductive health care including birth control and prenatal care. This paper provides patients’ perspectives through analysis of in-depth interviews with 51 African American teen mothers about their reproductive health care and focuses on the influence of gender ideologies and behavior expectations on teens’, and their perceptions of their mothers’, decisions around these issues. The findings suggest that attention to cultural influences of gender on teens’ decisions around sexuality and reproduction is critical to our theoretical and practical approaches to expanding health care services to underserved populations.
In the contemporary US, pregnant women must navigate competing ideas about their bodies, including expectations for weight gain. Given that there are few social spaces…
In the contemporary US, pregnant women must navigate competing ideas about their bodies, including expectations for weight gain. Given that there are few social spaces where women may gain weight without disapproval, pregnancy represents a period when women are allowed to put on weight. However, gaining weight means doing so within the context of the obesity “epidemic” and increased medical surveillance of the body. To explore how women navigate the medicalization of pregnancy weight, I draw on data from in-depth interviews with 40 pregnant and recently pregnant women. Findings indicate that women reframe the meaning of pregnancy weight as “baby weight,” rather than body weight. This allows them to view it as a temporary condition that is “for the baby,” while holding two concurrent body images – a pregnant and a non-pregnant version of themselves. Women also resist the quantification of their maternity weight, either by not keeping track or not looking at scales in the doctor’s office. Doing so prevented baby weight from turning back into body weight – a concrete and meaningful number on the scale. Such resistance to quantification is often accomplished with the help of doctors and healthcare professionals who do not explicitly discuss weight gain with their patients. These findings suggest that women rely on a variety of strategies to navigate the medicalization of pregnancy weight, and provides another lens through which to understand how and why women may make similar choices about other medicalized aspects of their pregnancy (or pregnancy experiences).
Research examining the experiences of women in the workplace has, to a large extent, neglected the unique stressors pregnant employees may experience. Stress during…
Research examining the experiences of women in the workplace has, to a large extent, neglected the unique stressors pregnant employees may experience. Stress during pregnancy has been shown consistently to lead to detrimental consequences for the mother and her baby. Using job stress theories, we develop an expanded theoretical model of experienced stress during pregnancy and the potential detrimental health outcomes for the mother and her baby. Our theoretical model includes factors from multiple levels (i.e., individual, interpersonal, sociocultural, and community) and the role they play on the health and well-being of the pregnant employee and her baby. In order to gain a deeper understanding of job stress during pregnancy, we examine three pregnancy-specific organizational stressors (i.e., perceived pregnancy discrimination, pregnancy disclosure, and identity-role conflict) that are unique to pregnant employees. These stressors are argued to be over and above the normal job stressors experienced and they are proposed to result in elevated levels of experienced stress leading to detrimental health outcomes for the mother and baby. The role of resilience resources and learning in reducing some of the negative outcomes from job stressors is also explored.
Most researchers examining educational disparities in unintended pregnancy take a rational-choice perspective, defining pregnancy intention as a fixed state within…
Most researchers examining educational disparities in unintended pregnancy take a rational-choice perspective, defining pregnancy intention as a fixed state within decontextualized individuals. However, evidence suggests that women’s reproductive intentions may be more relational than rational, and that relationship context varies by education. This study investigated if relationship context could explain educational disparities in unintended pregnancy.
Using the 2006–2015 National Survey of Family Growth (n = 4,320 pregnancies), I calculated structural equation models and predicted probabilities to examine if relational stability (marital status) and partner specificity (wanting a baby with a particular man) mediated the association between education and pregnancy intendedness for White, Hispanic, and Black women.
Relational stability and partner specificity mediated the association between education and pregnancy intention for all three groups. Education was rendered insignificant after controlling for race, marital status, partner specificity, and age. Marital status was a better predictor for White women than Hispanic women, and was not statistically significant for Black women. Partner specificity had greater influence on pregnancy intendedness than marital status, and its effect varied only slightly by race. Thus, disparities in marriage and access to desired partners influence educational disparities in unintended pregnancy.
These findings suggest that partner specificity could prove particularly useful in predicting unintended pregnancy as rates of non-marital pregnancies continue to rise. They also indicate that a shift in research and policy focus from decontextualized individuals to relationships between women and men is warranted.
Purpose – In this chapter, I set out to unexcise the messiness of maternalisms and disparities in women's health care by addressing narratives about reproductive trauma. I…
Purpose – In this chapter, I set out to unexcise the messiness of maternalisms and disparities in women's health care by addressing narratives about reproductive trauma. I ask, what might it mean to analyze the interaction between the medical industrial complex and women who experience reproductive trauma as a social practice, one that is constitutive of gender socialization and the medicalization of women's bodies in the American nation-state? I accomplish responding to the question by addressing a vastly underresearched and underaddressed pregnancy complication Hyperemesis Gravidarum (HG).
Methodology/Approach – First, I thread posts from supportive online reproductive trauma forums to weave thematic narratives about and the impacts of HG. Next, I review biomedical literature in order to probe potential etiology. Third, I share my debilitating experiences with HG – reproductive traumas – to interrogate dominant androcentric biomedical discourse of pregnancy culture, maternalisms, maternal ideology, and epistemic violence.
Findings – Our knowledge about HG continues to be murky and unresolved, leaving many pregnant people – namely women – untreated.
Research limitations/implications – I call on the absence of contemporary protective sociocultural structures that provide support and care – gendered health-care disparities – for women during pregnancy, labor and delivery, and postpartum in order to advocate reproductive trauma is a viable and normal expression in the context of misogynist social scripts.
Originality/Value of the Chapter – My hope is to raise the volume on narratives of pregnancy trauma and reproductive experience using HG as a case study and my intention is to argue gender is a salient factor in health-care disparities.
This chapter focuses on the culturally assumed link between femininity and pregnancy. It situates itself using the feminist theories of performativity (Butler, 1990), female masculinity (Halbertstam, 1998) and the queer art of failure (Halberstam, 2011). The chapter is based on ethnographic research with butch lesbians and genderqueer individuals in British Columbia, Canada. It focuses on these individuals’ desires to experience pregnancy, find appropriate clothes to wear when pregnant, and not being simultaneously socially recognized as both pregnant and masculine. It argues that feminism is still needed to broaden how we gender pregnancy, and to challenge the assumptions and social pressures that link individuals with uteruses to female to femininity to pregnancy and motherhood.