This thesis discusses the experience of Taiwanese pregnant women who undergo prenatal screening and testing (PST), exploring how those experiences affect their relations to the foetuses, medical professionals, PST technologies and their . families. Based on ethnographic observations, interviews with pregnant women and couples, and my participants' drawings of PSI, this thesis argues that PST provokes both pleasure and anxiety for pregnant women. Both sex screening and genetic testing construct women as responsible decision-making subjects. I argue that in Taiwan women's decisions about genetic testing are entangled with the concept of you sheng ('superior birth'), medical practices and the logic of prenatal care. Employing Donna Haraway's and actor-network theory's material-semiotic approaches, I show how women, the foetus, medical practices and PST technologies are brought into this relational web shaping and reshaping the connection between these human and non-humans actors. A central concern of this thesis is to ask: what are the implications of PST for Taiwanese society. It thus contributes to and extends international feminist technoscience studies by bringing Taiwanese women's experiences and an ANT approach to feminist discussions of prenatal screening and testing.

The experience of pregnancy and becoming a mother is largely influenced by socio-cultural background. However, many studies on this transition have been carried out in western populations and knowledge of the experience of pregnancy and motherhood has been conceptualised on the basis of evidence from these studies. The aim of the study was to explore the extent to which culture shapes the experiences of pregnancy in Sunderland and Tashkent women from a woman's perspective. Ten women from Sunderland and ten from Tashkent, aged 18-22 years and in their first pregnancies, were interviewed at 12-14 and 34-36 weeks into their pregnancies. In-depth data analysis was carried out from the perspectives of the participants via Interpretative Phenomenological Analysis. Four themes emerged during the data an'alysis, namely becoming pregnant, becoming a mother, being pregnant and social support. Sunderland women were not yet prepared to become mothers and had difficulty identifying themselves with the motherhood roIEL' The majority of Sunderland women expressed a desire to continue smoking and drinking after becoming pregnant. Worry about labour pain was a major concern, as were fears over loss of jobs and financial worries. Sunderland women were generally satisfied with the support available during pregnancy. Reluctance in obtaining support from professionals was associated with perceiving health professionals as prejudiced against young mothers. Friends were the most valued source of support. Tashkent women were highly motivated towards becoming pregnant. Worries related to their babies' well-being predominated over worries about their own health and undergoing labour. The Uzbek imperative of having at least one male child led to women worrying about their child's gender. The most valued source of support was from their own mothers. The study demonstrated that culture shapes how women identify with the role of a mother and is key in developing attitudes towards pregnancy and unborn babies and plays a major role in influencing well-being and social support throughout pregnancy.

This portfolio was submitted to the University of Surrey for the completion of the Practitioner Doctorate in Psychotherapeutic and Counselling Psychology. It consists of three dossiers, namely the academic, therapeutic and research dossiers. Three essays are included in the academic dossier, starting with an exploration of the concept of projective identification. Social anxiety examined from a cognitive perspective is the second essay of the dossier, followed by a paper on the use of behavioural experiments in CBT and their effect on the therapeutic relationship. The therapeutic dossier offers a description of the four clinical placements I undertook during my training and the competences gained throughout this time. It concludes with the final clinical paper which provides an account of the experiences contributing to my personal and professional development as a counselling psychologist. The last dossier comprises of a literature review on panic disorder and pregnancy, followed by two empirical studies employing qualitative methodologies. The first paper uses interpretative phenomena logical analysis to examine the experience of pre-existing panic disorder among pregnant women, while the second is interested in therapists' experiences of working with such clients. This was achieved through the use of thematic analysis.

This study explores the experiences of a group of midwives when caring for women who are having obstetric emergencies in labour. The study aimed to investigate the experiences of midwives to answer the research question 'What is the lived experience of caring for women during obstetric emergencies in labour, as perceived through the experiences of midwives?' The study utilised a descriptive phenomenological approach in which midwives were asked to recount their experiences during a non-directed interview. The data were analysed using a modified version of Colaizzi's (1978) framework. The study was conducted in two maternity units within National Health Service Trusts in the East of England. The participants comprised a convenience sample of eleven midwives with between six months and twenty-five years experience, all of whom had given care during obstetric emergencies in labour - in either acute or midwifery led units, or in the community setting. Four theme categories and twelve associated theme clusters were identified. The four theme categories were: learning to care; involvement; coping; and valuing and respecting. The study suggests that caring in obstetric emergencies is a demanding and, at times, exhausting reciprocal partnership between the midwife and the woman. The midwife-mother relationship is characterised by varying degrees of involvement. Caring is initiated in response to actual or perceived needs or wants, and is communicated through physical presence and an intense emotional connection. The woman and her family are valued and respected, which facilitates the connection. The ability to care and to cope in these difficult clinical situations is influenced by a number of factors, including the level of perceived support from colleagues and events in the midwife's' personal life. Caring is enhanced by an extended experiential knowledge base and can be ii ~~---------- extended beyond personally determined boundaries if either of these two factors is enhanced. The study offers insight into a previously unexplored aspect of midwifery practice, and has ramifications for both undergraduate preparation of student midwives, and the support and continuing professional development of qualified staff.

No description available.

There is some evidence from both animal literature and human studies to suggest that maternal emotional well-being during pregnancy, as well as maternal behaviour during early childhood, can have important implications for the development of child temperament and children's distress reactivity and recovery (Albers, Riksen-Walraven, Sweep & de Weerth, 2008 Huizink, Mulder & Buitelaar, 2004 Leerkes, Blakson, and O'Brien, 2009). This thesis consists of two parts. The first part explored what measures of prenatal stress and anxiety are related to infant birth outcomes, temperament and cognition. The second part explored the role of maternal sensitivity and intrusiveness in child behavioural and endocrinological coping with stress across the first three years of life, concurrently and longitudinally. It was found that even relatively small fluctuations in prenatal stress and pregnancy- related anxiety in a normal sample of healthy women can still have an impact on infant birth outcomes and temperament in the first six months postnatally. In addition, maternal and amniotic fluid Cortisol levels during early pregnancy were positively associated, suggesting that increases in maternal Cortisol can influence Cortisol concentrations in the amniotic fluid and the foetus. In the studies on early postnatal maternal behaviour and child coping with stress, maternal sensitivity had different effects on child behavioural and Cortisol reactivity in response to stress across early childhood. For example, maternal behaviour had a direct influence on child behavioural and Cortisol reactivity to separation and novelty as well as recovery from distress however these effects were only observed children were two years old, and not when they were aged one or three years. Nevertheless, the results of the longitudinal study revealed that early maternal sensitivity can influence child behavioural and Cortisol distress reactivity when children are three years old. Children of more sensitive mothers were more reactive to separation and novelty. In addition, the longitudinal results revealed that maternal sensitivity and intrusiveness are not fixed and stable traits, but are behaviours that change over time and across different emotional states of the child during the course of early childhood. Collectively, the findings of this thesis demonstrate that small variations in prenatal stress and postnatal maternal behaviour in a normal low-risk sample can influence child temperament and coping with separation and novelty in early childhood. These findings indicate that a multi-method approach to studying maternal prenatal stress is necessary in order to obtain a better understanding of what aspects of prenatal stress are more important for child outcomes. In addition, the findings on the instability of maternal behaviour during early childhood highlight the importance of multiple assessments of sensitivity and intrusiveness in order to better capture maternal caregiving behaviour across time and its influence on child coping with stress.

Three lines of research focus on the influence of positive psychological factors and processes on psychological and physical well-being. In Part I, the unique and shared predictive power of dispositional optimism on women's biological (ovarian) response to fertility treatment was examined. The results suggested that rather than dispositional optimism having direct benefits on ovarian response, this construct shared variance with a broader psychological dimension, and that this dimension compromised biological response. In Part II, a self-administered positive reappraisal coping intervention (PRCI) was developed, and then used by women waiting for an IVF pregnancy test. The effects of the PRCI on psychological well-being and pregnancy rates, compared to controls were examined. The results suggested that the PRCI helped to sustain positive reappraisal coping efforts and other coping efforts, but had no effect on mood or impact on pregnancy rates compared to routine care. In Part III, an experimental paradigm emulating an unresolved period of persistent stress in a medical context was developed (the USP). Reactions became, and remained, persistently negative in response to the USP. The USP was then employed in a test of the "goodness-of-fit" hypothesis, where the influence of dispositional and situational factors on situational coping was examined. The results showed that a manipulation of situational factors had a transient influence on escapism coping and emotional well-being whereas dispositional factors had a more pervasive influence. Overall, this thesis demonstrates that both dispositional and situational influences have important effects on emotional well-being and physical outcomes and that it is important that neither should be completely overlooked in favour of the other.

Background: There is growing evidence that the numbers of babies being removed at birth, here in the UK is increasing and that the presence of domestic violence, drug misuse and mental ill-health are all contributory factors. Evidence is however lacking regarding the mothers experience and the impact of such removal. There also lacks evidence regarding the midwifery profession involvement, practitioners experience and possible strategies of amelioration for women and professional education needs of midwives, for this challenging aspect of contemporary midwifery practice. Methods: Four mothers and eight midwives were recruited to the study. Narrative inquiry incorporating oral and photo-elicitation was used to collect the data, with mothers being interviewed face to face and midwives taking part via focus groups. Pre-existing analytical frameworks did not fit the study ambition and objectives leading to the creation of one to identify patterns, commonalities, as well as the contrasts and relationships across the data. Results: The outcome of the analytical process enabled the reframing of the data to be shared via two composite narratives, one for the mothers and one for the midwives, each presenting the participant’s experiences in a coherent and meaningful way. It also enabled analysis across the mothers’ and midwives’ narratives and the reporting of interconnected themes. Included in the results is emergent consideration of a model of grief for women who have their babies removed at birth. Reflection on midwifery care models and the educational needs and support for midwives. Plus the recognition that mothers whose babies may be removed at birth are vulnerable themselves and currently may have unmet safeguarding needs, which needs addressing. Conclusions: This study has contributed to our collective understanding of mothers’ and midwives’ experience of babies being removed at birth. This narrative understanding provides valuable insight into a topic that has previously received minimal research attention within a changing social landscape, and evidence to guide and inform midwifery practice. This evidence has potential to inform and educate midwives in preparation for and in their continuing professional practice. It also provides a platform for further research and development in three areas. The process of grief for women who have their babies removed and how this may inform further life choices, care needs requires further exploration to enable understanding and guide services and practice. Midwifery models of care that enable midwives to focus on the dyad of mother and baby who are both vulnerable, may have safeguarding needs, rather than privileging one at the detriment of the other. Thirdly the dissemination of the creative analytical process of reviewing verbal and visual data linked to the use of narrative methodology.

No description available.

Current techniques to identify growth-restricted fetuses, at risk of health complications, have limited accuracy. Placental insufficiency is a key pathological process in fetal growth restriction (FGR). I investigated the potential clinical benefit of placental biomarkers to identify pregnancies delivering small for gestational age (SGA) infants in pregnancies with suspected pre-eclampsia and in those with reduced symphysis-fundal height measurement using delivery of an SGA infant as a surrogate measure of FGR. Suspected pre-eclampsia (PELICAN-PE study) In a large multicentre prospective cohort study investigating diagnostic accuracy of placental growth factor (PlGF) in women with suspected pre-eclampsia, I assessed test performance of 47 biomarkers and ultrasound parameters to identify women delivering an SGA infant. PlGF measurement outperformed all other biomarkers and currently used tests in predicting delivery of an SGA infant. Combinations of biomarkers added minimal value. Reduced symphysis-fundal height measurement (PELICAN-FGR study) I assessed the ability of PlGF and ultrasound parameters to predict delivery of an SGA infant in women with reduced symphysis-fundal height (current UK standard to identify pregnancies at risk of SGA) in a second multinational prospective cohort study. Test performance statistics were calculated for all parameters in isolation and combination. Ultrasound parameters had modest test performance for predicting delivery of an SGA infant. PlGF performed no better. Incorporating PlGF with ultrasound parameters provided modest improvements. In women presenting with suspected pre-eclampsia, PlGF measurement is a potentially useful adjunct to current practice in identifying those at risk of SGA. The findings of the PELICAN-FGR study cannot support the use of PlGF to risk stratify women referred with reduced symphysis-fundal height. The prevalence of FGR in the two studies differed, with a high number of normal pregnancies in those presenting with reduced symphysis-fundal height. The pathological process in normotensive versus hypertensive SGA may differ, potentially explaining these findings.