目的:哪些因素影响父亲关于减少多胎妊娠或维持三胎妊娠的决策过程,以及这些决定如何影响他们的心理健康?
结论:对于父亲,减少多胎妊娠或照顾三胞胎对情绪的影响是广泛的,需要仔细考虑。
背景:减少多胎妊娠是一种医疗程序,目的是减少胎儿数量,以提高剩余胎儿和母亲健康结局的机会,出于医学原因或社会考虑。很少研究是否进行多胎减孕的决定方面,对父亲的影响是未知的。
方法:在2021年10月至2023年2月之间进行半结构化访谈的定性研究。
方法:将多胎妊娠从三胎减少至双胎或单胎妊娠或决定后1-6年持续三胎妊娠的父亲纳入研究。访谈时间表旨在探讨与(i)是否进行多胎妊娠减少的决策过程以及(ii)决定的情感方面和心理影响有关的关键方面。主题分析用于确定父亲数据中的模式和趋势。该过程涉及熟悉数据,定义和命名主题,并制作最终报告。这项研究是地区二级医院(OLVG)和三级保健医院(阿姆斯特丹大学医学中心,阿姆斯特丹UMC),都位于阿姆斯特丹,荷兰。
结果:12次访谈后数据达到饱和。确定了五个主要主题:(i)初始反应和情绪复杂性,(ii)在咨询质量和决策后护理方面存在差异,(iii)个人对决策过程的影响,(iv)导航父母身份:选择,挑战,和情感适应,(五)分享智慧和教训。对于父亲来说,决定是否维持或减少三胎妊娠是复杂的,其中医学,心理因素,但主要是社会因素起着重要作用。就决定后的心理后果而言,这项研究发现,多胎妊娠减胎术后的父亲们常常在艰难的情绪中挣扎着做出决定;一些人表达了怀疑或后悔的感觉,并且仍在处理这些情绪。正在进行的三胞胎后的几个父亲在怀孕后的头几年经历了一段严重的压力,对他们的心理健康有重大影响。在决定或出生后,没有向任何父亲提供情感处理方面的帮助。
结论:虽然我们的研究集中在阿姆斯特丹地区的多胎妊娠减少过程,我们认识到进一步调查这一过程在荷兰和国际不同地区的差异的重要性。我们承认选择偏差的潜力,因为有更积极经验的父亲可能更愿意参与。在解释母亲在招聘过程中的作用时需要谨慎。此外,决定和访谈之间1-6年的时间跨度可能影响了情绪处理,并引入了潜在的报告偏见.
结论:减少多胎妊娠或照顾三胞胎对情绪的影响是显著的,强调护理人员需要意识到父亲面临的情感挑战。引导轨迹可能会优化决策,并主要促进此后提供适当的护理,以优化具有潜在创伤影响的决策结果。
背景:这项研究没有获得资助。作者没有利益冲突要声明。
背景:不适用。
OBJECTIVE: What factors influence the decision-making process of fathers regarding multifetal pregnancy reduction or maintaining a triplet pregnancy, and how do these decisions impact their psychological well-being?
CONCLUSIONS: For fathers, the emotional impact of multifetal pregnancy reduction or caring for triplets is extensive and requires careful consideration.
BACKGROUND: Multifetal pregnancy reduction is a medical procedure with the purpose to reduce the number of fetuses to improve chances of a healthy outcome for both the remaining fetus(es) and the mother, either for medical reasons or social considerations. Aspects of the decision whether to perform multifetal pregnancy reduction have been rarely investigated, and the impact on fathers is unknown.
METHODS: Qualitative study with semi-structured interviews between October 2021 and February 2023.
METHODS: Fathers either after multifetal pregnancy reduction from triplet to twin or singleton pregnancy or ongoing triplet pregnancies 1-6 years after the decision were included. The interview schedule was designed to explore key aspects related to (i) the decision-making process whether to perform multifetal pregnancy reduction and (ii) the emotional aspects and psychological impact of the decision. Thematic analysis was used to identify patterns and trends in the father\'s data. The process involved familiarization with the data, defining and naming themes, and producing a final report. This study was a collaboration between a regional secondary hospital (OLVG) and a tertiary care hospital (Amsterdam University Medical Center, Amsterdam UMC), both situated in Amsterdam, The Netherlands.
RESULTS: Data saturation was achieved after 12 interviews. Five main themes were identified: (i) initial responses and emotional complexity, (ii) experiencing disparities in counselling quality and post-decision care, (iii) personal influences on the decision journey, (iv) navigating parenthood: choices, challenges, and emotional adaptation, and (v) shared wisdom and lessons. For fathers, the decision whether to maintain or reduce a triplet pregnancy is complex, in which medical, psychological but mainly social factors play an important role. In terms of psychological consequences after the decision, this study found that fathers after multifetal pregnancy reduction often struggled with difficult emotions towards the decision; some expressed feelings of doubt or regret and were still processing these emotions. Several fathers after an ongoing triplet had experienced a period of severe stress in the first years after the pregnancy, with major consequences for their mental health. Help in emotional processing was not offered to any of the fathers after the decision or birth.
CONCLUSIONS: While our study focuses on the multifetal pregnancy reduction process in the Amsterdam region, we recognize the importance of further investigation into how this process may vary across different regions in The Netherlands and internationally. We acknowledge the potential of selection bias, as fathers with more positive experiences might have been more willing to participate. Caution is needed in interpreting the role of the mother in the recruitment process. Additionally, the time span of 1-6 years between the decision and the interviews may have influenced emotional processing and introduced potential reporting bias.
CONCLUSIONS: The emotional impact of multifetal pregnancy reduction or caring for triplets is significant, emphasizing the need for awareness among caregivers regarding the emotional challenges faced by fathers. A guided trajectory might optimize the decision-making and primarily facilitate the provision of appropriate care thereafter to optimize outcomes around decisions with potential traumatic implications.
BACKGROUND: This study received no funding. The authors have no conflicts of interest to declare.
BACKGROUND: N/A.