Expecting the unexpected:
Authors:   , Schonewille Noralie Nicoline 
Published: October 2024

This project utilized both quantitative and qualitative research approaches to achieve
the following objectives (1) understand the frequency of unintended pregnancies (UPs)
in women with psychiatric vulnerability in the Netherlands, (2) explore the experiences
of current and former mental health patients regarding family and pregnancy
planning, (3) investigate the experiences of patients during UPs, and (4) examine the
perspectives of patients and mental health professionals (MHPs) on discussing family
planning in Dutch mental healthcare settings. Results from a systematic review and
meta-analysis demonstrated that women with psychiatric vulnerability face a higher
likelihood of UPs compared to those without psychiatric vulnerability. A retrospective
cohort study was conducted on 2312 women who delivered at OLVG, the largest
maternity hospital in Amsterdam, between 2015 and 2020. Maternal and neonatal
outcomes were also compared between planned and unplanned pregnancies, with
an exploration of the mediating effect of psychiatric vulnerability. High rates of UPs
amongst women with psychiatric vulnerability were shown (39% versus 29% in
women without psychiatric vulnerability). We found comparable outcomes in all four
groups for all clinically relevant maternal and neonatal outcomes like hypertensive
disorders, gestational diabetes, mode of delivery, low birth weight, premature birth,
Apgar score after birth and admission to a neonatal ward. An exploratory survey with
members of the MIND mental health care panel showed that mental health issues
significantly influenced family planning, pregnancy, sexuality, and parenthood for
patients and their relatives. Focus groups, including women with psychiatric
vulnerability illustrated how shadows of the past (childhood trauma and inadequate
parenting), present (the burden and awareness of psychiatric vulnerability) and future
(fear of motherhood and insecurity) impacted (past) family planning decisions.
Interviews with women with psychiatric vulnerability who experienced UPs, as well as
their partners, showed that UPs had a substantial impact on women and partners, but
they adapted to the new situation, and appropriate support during pregnancy gave
rise to behavioral change and installed a window of opportunity to break the chain of
transgenerational trauma. Two additional surveys were conducted among the MIND
panel and mental healthcare providers, specifically addressing family planning and
pregnancy in mental healthcare. Despite a strong desire for discussions on family
planning in mental healthcare, only one in five patients had the opportunity to engage
in such conversations. We unveiled existing barriers to discussing family planning,
including the fear of broaching the topic, lack of knowledge, and time constraints. The
implementation of the "family check-tool" aims to facilitate more effective conversations
between healthcare providers and patients on these crucial topics. Training
opportunities will be facilitated for MHPs to implement the family check-tool. Also, continued affords are made to incorporate the topic of reproductive health related to
psychiatry in various educational programs in the Netherlands, such as the school of
medicine, psychiatry residency programs and other relevant mental health studies such
as psychiatric nursing. By acknowledging the significance of the reproductive health
themes of family planning, childlessness and UPs for individuals with psychiatric
vulnerability, this thesis underscores the importance of addressing reproductive matters
in psychiatric healthcare and literature.