Exploring UP journeys among women with psychiatric vulnerability using interpretative phenomenological analysis 159 Conception by misconception Several participants actively tried to avoid pregnancy and took precautionary measures by using contraception, while others who did not want to become pregnant did not use contraceptives or alternative methods. For example, participant 7 used a copper intrauterine device for contraception to prevent pregnancy. Despite the use of this long-acting contraceptive, she became pregnant. Participant 8 used a birth control app that tracked her cycle using body temperature and predicted fertile days. She was under the assumption that this would help her avoid pregnancy. "I was not on any hormonal type of birth control. After my second baby I was for some time on the pill. But I didn’t like being on hormonal birth control, so I decided to try a, it’s like a natural, it’s, I think it’s called [name application]. Which is like subscriptionbased hormone free tracking app where you track your basal body temperature every morning. Uhm, so I’ve been doing that in order to avoid fertile days. And I’ve been doing that successfully for a few months. But then my period was supposed to come and then a week went by and there was no period. And then I thought, uhm, maybe time to check? [speaks with sarcasm]. And uh, sure enough it was positive. So that’s how I found out." (Participant 8) Participant 2 commented that she considered herself to be less fertile due to her previous eating disorder. This misconception about her own fertility made her feel less at risk of becoming pregnant and resulted in her not using contraceptives. "[…] with that eating disorder, I didn't know because I got my period so late, whether I was even fertile." (Participant 2) No other participant indicated that her psychiatric vulnerability was (indirectly) related to the UP. Some participants assumed that they were using a form of contraceptive at the time of conception, such as participant 1, who explained that despite the use of condoms, she became pregnant. Her astonishment after she became pregnant illustrated how she was not aware of her risk of becoming pregnant. "It's not like we had unsafe sex, we just used condoms in the meantime, but still, somehow, I got pregnant. We were on vacation in [country], and I was supposed to have my period that week, and I was a bit bloated, and then I thought; well, how is that possible?" (Participant 1)
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