Women, families and systems of care

The areas covered by the journal are in essence psychological ones. Fundamental issues to do with reproduction, pregnancy, childbirth, early parenting, and infant development are key to the Journal of Reproductive and Infant Psychology. At the same time, the ways in which individuals interface with the systems of healthcare, particularly maternity services, have also been an integral element in many of the research studies and reviews that have been published. Specifically, the issue of expectations in relation to both primary and secondary care and the realities of the care experienced, choice and control are constructs that have been at the core of papers in the journal.

Women's access to and participation in the services provided in relation to fertility and infertility treatment, miscarriage and abortion, pregnancy care, antenatal screening, and a range of childbirth and postnatal interventions can be affected by factors intrinsic to the individual, the way that care is organised and the behaviour of the health professionals involved. Individual differences, including age, physical health and fitness, mental health and emotional well‐being during and outside the perinatal period, temperament or personality, identity and self‐esteem, their own parenting experience and upbringing and couple relationships are all factors that may interact and influence interactions with health services.

Understanding these relationships and investigating where there is a possibility of improving on what is provided are among the broad goals of many of the researchers working in this area. Identifying need is critical; however, needs may differ between individuals, between different reproductive stages or phases and between groups. In such research studies it is important to use quantitative methods, and where possible to collect data prospectively, with large numbers of participants and multivariate analysis in order to test hypotheses adequately and to tease out possible relationships and confounders. While they may stand alone, qualitative methods, although time‐consuming, can be really valuable as starting points in hearing from participants about their own perspective and about their experience directly in their own words. These data often allow a more effective formulation of hypotheses concerning the issues in relation to clinical interventions, the services provided and women's expectations of these, often focusing on the match–mismatch between what is expected and what is experienced.

Medical and midwifery staff, both managers and those providing clinical care, have the potential to make a difference. By using the evidence base and enlightened innovation, as well as being more aware of the power of their day‐to‐day interactions with women, couples and families, care is sometimes organised differently and more effectively and inventions are introduced to support parents, would‐be parents and those who have not been able to become parents. In conjunction with appropriate design, the question of adequate measures of outcomes as a way of understanding which of these interventions actually make a difference is also critical. Only with well‐designed studies will we ask better questions and begin to think about the possible mechanisms at work in changing behaviour, organising service provision and improving outcomes, especially for more vulnerable groups. Longer‐term follow‐up and cohort studies in particular are likely to help, although they are not without difficulties in terms of scale, cost and time frame.

Within country variation and between country comparisons have been a valuable way of reflecting on maternity services and statistics and highlighting patterns of interventions and service organisation that do not appear to be reflecting need (Healthcare Commission, 2008; MacDorman, Menacker & Declercq, 2008) and by inference questioning the ways in which care is organised and provided. The recent special issue of the journal (Cross‐national comparisons of psychosocial aspects of childbirth, edited by Jo Green) provides evidence of this kind (Declercq & Chalmers, 2008; Schytt, Green, Baston & Waldenström, 2008).

Among the papers published in this issue are several that directly reflect on services: one by Rowlands and Lee on the limited social and health service support after miscarriage and another by Séjourné Callahan and chabrol about a psychological intervention that could be used to help with coping at this time. Others, such as the papers by Fleury, Parpinelly and Makuch on the consequences of pre‐eclampsia and that by Gaudet and collegues on pregnancy after perinatal loss, both looking at early parental behaviour and reactions, enable us to gain a better understanding of the issues associated with these particular circumstances. More broadly, the papers by Holton, Fisher and Rowe, Wilkinson and Mulcahy, Gunning and colleagues and Hayes and colleagues, focusing as they do on maternal mental health, both antenatal and postnatal, and the transition to parenthood, provide insights and challenges to the biological and social interpretation of childbirth and its impact.

The abstracts of the 2010 conference, published and available online, describing a wide range of studies also illustrate many of the same points in relation to women's lived experience of maternity care, including clinical and psychosocial interventions and the care received at a critical time in their lives.