General discussion and future directions 237 In Chapter 7, a qualitative study is presented that explored pregnancy journeys of women with UPs and psychiatric vulnerability. The narratives yield four primary themes. Firstly, the theme ‘Ascribing meaning to an unintended pregnancy’ describes how unintended pregnancies occurred, what shaped pregnancy intentions, and the discovery and decision-making process of maintaining the pregnancy. The ‘Impact on mental health’ theme follows with a description of how psychiatric symptoms evolved and changed because of the unintended pregnancy. The ‘Coping’ theme illustrates what coping mechanisms were adopted and how a wish for a safety net emerged. The ‘Parenthood’ theme links the imaginations and expectations during pregnancy with the postpartum experiences. This chapter illustrates how ongoing UPs in women with psychiatric vulnerability could prompt personal growth through behavioral changes, while also highlighting the initial shock and emotional complexities associated with UPs. Finally, Chapter 8 demonstrates results from a mixed-methods study on how discussions about family planning and a desire for children can be held within mental healthcare. Findings reveal novel perspectives on how family planning conversations could be facilitated in psychiatric healthcare. Obstacles that hinder successful conversations are fear of judgment and time constraints, which limits the opportunity for in-depth exploration of important life themes. The study suggests that mental health professionals proactively engage patients in family planning conversations during their reproductive years and prioritize these talks before contraceptive care. Contraceptive care should be discussed according to patients but should be preceded by discussing the desire to have children, the effect of medication on pregnancy, the impact of pregnancy on mental health of parents, the impact of heredity, and the (grief over) not having children and not becoming parents. Discussion of key findings Estimating UP rates: are we comparing apples and oranges? It is safe to say that UPs are prevalent amongst both women with and without psychiatric vulnerability (Chapter 2, Chapter 3, Chapter 4,1). Amongst women with psychiatric vulnerability, UPs mark on average 65% of the pregnancies, according to our meta-analysis (Chapter 2). It is more difficult to ascertain if UPs are more prevalent amongst women with psychiatric vulnerability compared to controls. Three main concerns with regards to measurements of UPs are discussed below.
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