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Dahlen HG, Ryan M, Homer CSE, Cooke M. An Australian prospective cohort study of risk factors for severe perineal trauma during childbirth. Midwifery 2007; 23:196-203. [PMID: 17125892 DOI: 10.1016/j.midw.2006.04.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 03/24/2006] [Accepted: 04/04/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE to determine risk factors for the occurrence of severe perineal trauma (third and fourth degree tears) during childbirth. DESIGN a prospective cohort study was conducted using the hospital's computerised obstetric information system. Additional data were gathered on women who sustained severe perineal trauma. Descriptive statistics and logistic regression were used to assess risk factors for severe perineal trauma. Midwives were asked to comment on possible reasons for severe perineal trauma. Written responses made by midwives were analysed using content analysis. Discussion groups with midwives were held to further explore their experiences. SETTING Royal Prince Alfred Hospital, Sydney, Australia. PARTICIPANTS all women having vaginal births (n=6595) in a 2-year period between 1 April 1998 and 31 March 2000, in both the birth centre and the labour ward. MEASUREMENTS AND FINDINGS 2% of women (n=134) experienced severe perineal trauma. One hundred and twenty-two women had third-degree tears and 12 had fourth-degree tears. Primiparity, instrumental delivery, Asian ethnicity and heavier babies were associated with an elevated risk of severe perineal trauma. Midwives identified several factors they believed contributed to severe perineal trauma. These were lack of effective communication with the woman during the birth, different birth positions, delivery technique, ethnicity and obstetric influences. KEY CONCLUSIONS findings support current knowledge that primiparity, instrumental birth, heavier babies and being of Asian ethnicity are associated with increased rates of severe trauma. Specific attention needs to be paid to the strong association found between being of Asian ethnicity and experiencing severe perineal trauma. IMPLICATIONS FOR PRACTICE further identification and validation of the concerns expressed by midwives to reduce severe perineal trauma is warranted so that preventative strategies can be used and researched.
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Williams A, Herron-Marx S, Knibb R. The prevalence of enduring postnatal perineal morbidity and its relationship to type of birth and birth risk factors. J Clin Nurs 2007; 16:549-61. [PMID: 17335531 DOI: 10.1111/j.1365-2702.2006.01593.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate the prevalence of perineal morbidity at 12 months postnatal and its relationship to type of birth and birth risk factors. BACKGROUND It is well documented that women endure short-term postnatal perineal morbidity following childbirth (e.g. incontinence, perineal pain and sexual morbidity). However, to date, very little research has been carried out on the long-term effects of perineal morbidity and its relationship to the type of birth the women experienced and other birth risk factors (e.g. ethnic origin, age, parity, length of labour, epidural anaesthesia). DESIGN A retrospective, cross-sectional community survey of postnatal women within two maternity units in Birmingham. METHODS A total population sample of 2,100 women were surveyed using a self-administered postal questionnaire. The questionnaire included self-assessment of perineal pain, perineal healing, urinary incontinence, flatus incontinence, faecal incontinence, sexual morbidity and dyspareunia. Demographic details, type of birth and birth risk factors were taken from the hospital's computerized maternity information system. RESULTS Four hundred and eighty-two women responded to the questionnaire (23.3%). Overall, a high level of enduring perineal morbidity was reported with 87% complaining of at least one index of morbidity. Instrumental births were associated with higher levels of certain types of perineal morbidity than women following a caesarean section or normal vaginal birth (stress and urge urinary incontinence, flatus incontinence, sexual morbidity and dyspareunia). In particular, women following a forceps birth reported higher levels of morbidity than normal or ventouse birth (continual, stress and urge urinary incontinence and flatus incontinence), even when comparing with the same degree of perineal trauma. Increasing age, increasing birth weight, length of labour and particularly Asian ethnic origin were also identified as risk factors for certain types of perineal morbidity. CONCLUSIONS The study concludes that enduring perineal morbidity in women following childbirth is common, especially with women following a forceps birth and certain birth risk factors (i.e. age, ethnic origin, length of labour and birth weight). RELEVANCE TO CLINICAL PRACTICE These findings highlight the need for further research and provide a number of challenges for health-care services and health-care professionals.
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Abstract
OBJECTIVE To construct a substantive theory of postpartum fatigue. DESIGN Grounded theory. SETTING Participants were recruited in the hospital after delivery and interviewed in their homes. PARTICIPANTS Thirteen primiparae (n=5) and multiparae (n=8) women between 2 and 5 weeks postpartum from diverse ethnic, age, obstetric, and financial contexts were theoretically sampled. RESULTS Persevering was the central human process around which the grounded theory emerged. The process of persevering was explained through the relationships of influencing factors, postpartum fatigue, coping techniques, self-transcendence, and caregiving. Participants persevered in caregiving of infants and older children in spite of an overwhelming desire to rest and sleep using self-identified coping techniques in combination with the belief that their children brought purpose and meaning to their lives. CONCLUSIONS The theory "Persevering Through Postpartum Fatigue" contributes a more complete understanding of the complex phenomenon of postpartum fatigue as it is expressed in the everyday lives of women during the postpartum period. The results may be used to develop and implement health-promoting nursing interventions to reduce postpartum fatigue and its health-related consequences.
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Lee SY, Lee KA. Early postpartum sleep and fatigue for mothers after cesarean delivery compared with vaginal delivery: an exploratory study. J Perinat Neonatal Nurs 2007; 21:109-13. [PMID: 17505230 DOI: 10.1097/01.jpn.0000270627.73993.b0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to describe sleep and fatigue during the first week of postpartum recovery, and compare women after cesarean delivery with women after vaginal delivery while their infants were hospitalized in the intensive care unit (ICU). METHODS This cross-sectional descriptive exploratory study involved 21 postpartum Chinese American mothers (6 after cesarean delivery and 15 after vaginal delivery). Three types of data were collected: (1) mothers' demographic data; (2) objective sleep that included total sleep time (TST) and wake after sleep onset (WASO) measured using wrist actigraphy, and (3) subjective sleep quality (General Sleep Disturbance Scale) and fatigue severity (Numerical Rating Scale-Fatigue). RESULTS All of the mothers experienced poor sleep while their 3- to 5-day-old infants were in the ICU. After cesarean birth, mothers averaged only about 4 hours TST with 34% WASO while still hospitalized, compared with 6.5 hours TST with 14% WASO for mothers after vaginal birth monitored in their home after hospital discharge. CONCLUSION Sleep disturbances and fatigue need to be further investigated to better understand the relationship between type of delivery and maternal health outcomes. Despite infant care provided in ICUs, these new mothers could benefit from interventions to promote their own sleep, particularly when also recovering from cesarean delivery.
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105
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Abstract
OBJECTIVES This study describes the patterns of sleep disturbance and depressive symptoms in a sample of childbearing women from the third trimester through the postpartum period. The relationship between sleep and depressive symptoms is also examined. A secondary aim of this study was to examine the relationship between self-report measures of sleep and depressive symptoms between women with depressive symptoms in comparison with women with minimal or no depressive symptoms in the third trimester and in the third month postpartum. METHODS This longitudinal, descriptive study followed 124 primiparous women from their last month of pregnancy through 3 months postpartum. Questionnaires on sleep and depressive symptoms were completed during the third trimester (Time 1), 1 month postpartum (Time 2), 2 months postpartum (Time 3), and during the third month postpartum (Time 4). Sleep measures in a subset of women with depressive symptoms were compared with those of women with minimal or no symptoms at Time 1 and Time 4. RESULTS AND CONCLUSIONS Sleep disturbance and depressive symptoms were associated at Time 1 and Time 4. For new mothers, a complaint of trouble falling asleep (delayed sleep onset latency) may be the most relevant screening question in relation to their risk for postpartum depression.
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106
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Abstract
OBJECTIVE The purpose of this qualitative study was to learn from 20 mothers about their experience of sleep during pregnancy and the immediate months of becoming a new mother. The study was part of a larger randomized clinical trial on an intervention to improve sleep and well-being among new mothers. METHODS Semistructured, audiotaped interviews were conducted in which women were asked to describe the continuum of the sleep experience across the pregnancy and early postpartum and to describe strategies they found helpful as they established sleep patterns with their infant. Narrative analysis was used to interpret their stories, and data were managed with Atlas.ti qualitative software. RESULTS AND CONCLUSIONS Sleep disturbances were common to all of the mothers, and sleep became a negotiated behavior as they adjusted to the mothering role. All of the mothers were surprised at the level of disturbance and exhaustion they experienced. Strategies included enlistment of partners to facilitate naps, development of a "sleep consciousness," and bed-sharing. Mercer's stages of becoming a mother are used to describe the process of incorporating sleep changes into their lives.
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Bosch OJ, Müsch W, Bredewold R, Slattery DA, Neumann ID. Prenatal stress increases HPA axis activity and impairs maternal care in lactating female offspring: implications for postpartum mood disorder. Psychoneuroendocrinology 2007; 32:267-78. [PMID: 17337328 DOI: 10.1016/j.psyneuen.2006.12.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 12/15/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
Early life stress is believed to constitute a risk factor for the development of mood disorders later in life. In the present study, we hypothesized that prenatal stress (PS) exerts long-lasting effects in female rat offspring, resulting in impaired adaptations to stress during lactation and, as such, may be a contributory factor to postpartum mood disorders. PS increased anxiety in adult virgin females compared with controls. During lactation, PS dams nursed significantly less and spent less time with pups compared with controls, whereas dams did not differ in pup retrieval or maternal aggression. HPA axis reactivity was elevated in response to a mild stressor in PS dams compared to their controls, but not in virgins, with the delta corticosterone response returning to the higher level seen in virgins. Moreover, corticotropin-releasing hormone (CRH) mRNA expression within the parvocellular region of the paraventricular nucleus (PVN) was increased in both virgins and dams exposed to PS compared with the relative controls, while the attenuation in expression in lactating controls was abolished following PS. In addition, arginine vasopressin (AVP) mRNA was increased in the parvocellular, but not magnocellular part of the PVN, in both PS-exposed virgins and lactating dams compared with their relative controls; although expression was also higher in controls during lactation compared with virgins. Thus, the present study demonstrates that exposure to PS results in long-lasting behavioural and neuroendocrine alterations in the female offspring, which are manifested during the lactation period. Furthermore, it implicates PS as a potential risk factor for the development of postpartum mood disorders, and that alterations in the HPA axis reactivity, at least partially, are involved.
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108
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Nuwagaba-Biribonwoha H, Mayon-White RT, Okong P, Carpenter LM, Jenkinson C. The impact of HIV on maternal quality of life in Uganda. AIDS Care 2007; 18:614-20. [PMID: 16831790 DOI: 10.1080/09540120500359298] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To study the effect of HIV infection on quality of life (QOL) during pregnancy and puerperium, QOL was measured in a cohort study at St. Francis Hospital Nsambya, Kampala, Uganda. Dartmouth COOP charts were administered to 132 HIV-positive and 399 HIV-negative women at 36 weeks of pregnancy and six weeks post-partum. Responses were coded from 0 = best health-status to 4 = worst health-status and scores of 3-4 defined as poor. Odds ratios (OR) (95% confidence intervals(CI)) for poor scores were calculated and independent predictors of poor QOL examined using logistic regression. In pregnancy, HIV-positive women were more likely to have poor scores in feelings: OR = 3.2(1.9-5.3), daily activities: OR = 2.8(1.4-5.5), pain: OR = 2.1(1.3-3.5), overall health: OR = 1.7(1.1-2.7) and QOL: OR = 7.2(3.6-14.7), all p= <or= 0.01. Differences in physical fitness, change in health, social activities and social support were not statistically significant (all p>0.2). HIV infection was independently associated with poor QOL: OR = 8.5(3.8-19). Findings in puerperium were similar to those in pregnancy except more HIV-positive women had poor scores in social activities: OR = 2.5(1.4-4.7) and change in health: OR = 5.4(2-14.5) and infant death also predicted poor QOL: OR = 6.7(2.4-18.5). The findings reflect HIV's adverse impact on maternal QOL and the need for interventions to alleviate this infection's social and emotional effects.
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109
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Jones I, Craddock N. Searching for the puerperal trigger: molecular genetic studies of bipolar affective puerperal psychosis. PSYCHOPHARMACOLOGY BULLETIN 2007; 40:115-28. [PMID: 17514190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The available evidence suggests that the puerperium is a period of increased risk for acute episodes of illness in bipolar (BP) women and points to genetic factors as influencing vulnerability to postpartum triggering of such episodes. We have previously reported compelling evidence of familiarity of vulnerability to puerperal episodes in female sibs with BP disorder and find similar familial clustering for episodes of narrowly defined postpartum episodes in siblings with major depression. Molecular genetic approaches hold out the promise of uncovering the nature of the puerperal trigger leading to important improvements in the prevention and treatment of postpartum affective episodes. A research strategy focusing on positional and candidate gene approaches may prove fruitful in the search for susceptibility genes for both postpartum triggering in particular and for the affective disorder diathesis in general. We have identified the subset of families in the Wellcome Trust UK-Irish BP sib-pair molecular genetic linkage genome screen that include at least one female who has suffered an episode of puerperal psychosis. Analysis of this more homogeneous subgroup of families resulted in a genome-wide significant linkage signal (LOD = 4.07) on chromosome 16p13 and genome wide suggestive linkage on chromosome 8q24. We are undertaking association studies in women with postpartum psychosis at a number of candidate genes of interest in BP disorder with an emphasis on those for which the expression is influenced by steroid hormones.
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110
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Abstract
OBJECTIVE (a) To describe fatigue levels in military active-duty women, (b) to describe the relationship among selected predictor variables of fatigue, and (c) to examine the relationship between predictor variables, fatigue levels, and performance (as measured by functional status) after childbirth. DESIGN Based on the Theory of Unpleasant Symptoms, a longitudinal, prospective design. SETTING A large military medical facility in the southwest United States. PATIENTS/PARTICIPANTS A convenience sample of 109 military active-duty women. MAIN OUTCOME MEASURE Postpartum fatigue. RESULTS Women were found to be moderately fatigued across time, with no change in fatigue levels from 2 to 6 weeks after delivery. All variables correlated with fatigue during hospitalization and at 2 weeks after delivery, and depression, anxiety, maternal sleep, and functional status correlated with fatigue at 6 weeks after delivery. Regression analyses indicated that maternal anxiety predicted fatigue at 6 weeks after delivery. Over half the women had not regained full functional status when they returned to work, and 40% still displayed symptoms of postpartum depression and anxiety. CONCLUSIONS Military women continue to experiencing postpartum fatigue when they return to the workplace. Future research is needed to examine issues surrounding fatigue and its associated variables during the first year after delivery.
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111
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Jansen AJG, Duvekot JJ, Hop WCJ, Essink-Bot ML, Beckers EAM, Karsdorp VHM, Scherjon SA, Steegers EAP, van Rhenen DJ. New insights into fatigue and health-related quality of life after delivery. Acta Obstet Gynecol Scand 2007; 86:579-84. [PMID: 17464587 DOI: 10.1080/00016340701275424] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A delivery has a major impact on the health-related quality of life (HRQoL) of the new mother, especially on fatigue. A common complication during delivery that might have a relationship with maternal morbidity is blood loss. The objectives were to investigate fatigue and HRQoL in women after vaginal delivery (VD), elective caesarean section (CS) and emergency CS, and its relationship with postpartum hemoglobin (Hb) levels during the first 6 weeks postpartum. METHODS Some 141 patients (71 after VD, 36 after elective CS and 34 after emergency CS) completed the HRQoL questionnaires MFI and EQ-5D between 12 and 24 h after VD and 24-48 h after CS (t=0). At 1, 3 and 6 weeks postpartum these questionnaires were repeated, together with the SF36. RESULTS Patients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and >6 weeks after emergency CS. Mean mental HRQoL scores of the study groups were similar or even better compared to reference values. The significant correlation between Hb level and mean physical HRQoL scores found at t=0 had disappeared at 1 week postpartum. CONCLUSIONS Results of this study provided insights into the natural course of fatigue and HRQoL postpartum. Important differences in fatigue and HRQoL scores were observed between the 3 modes of delivery. These HRQoL measures can be used in future clinical trials to assess the effects of interventions postpartum.
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112
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Navarro P, Ascaso C, Garcia-Esteve L, Aguado J, Torres A, Martín-Santos R. Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools. Gen Hosp Psychiatry 2007; 29:1-7. [PMID: 17189737 DOI: 10.1016/j.genhosppsych.2006.10.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the validity of the 12-Item General Health Questionnaire (GHQ-12) and the Edinburgh Postnatal Depression Scale (EPDS) in screening for the most common postnatal psychiatric morbidities (mood, anxiety and adjustment disorders). METHOD A two-phase cross-sectional study was designed. First, a sample of 1453 women visiting at 6 weeks postpartum completed the GHQ-12 and the EPDS questionnaires. Second, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation [Structured Clinical Interview for DSM-IV (SCID)]. Receiver operating characteristic (ROC) analysis was used. RESULTS The concurrent validity was satisfactory (0.80). At optimum cut-off scores, both GHQ-12 and EPDS yielded very good sensitivity (80; 85.5) and specificity (80.4; 85.3), respectively. ROC curves showed that the performance of the EPDS (AUC=0.933) is slightly superior to that of GHQ-12 (AUC=0.904). CONCLUSION Both GHQ-12 and EPDS are valid instruments to detect postnatal depression as well as postnatal anxiety and adjustment disorders.
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113
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Yaeger D, Smith HG, Altshuler LL. Atypical antipsychotics in the treatment of schizophrenia during pregnancy and the postpartum. Am J Psychiatry 2006; 163:2064-70. [PMID: 17151155 DOI: 10.1176/ajp.2006.163.12.2064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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114
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Fairbrother N, Abramowitz JS. New parenthood as a risk factor for the development of obsessional problems. Behav Res Ther 2006; 45:2155-63. [PMID: 17084810 DOI: 10.1016/j.brat.2006.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Revised: 09/15/2006] [Accepted: 09/26/2006] [Indexed: 11/21/2022]
Abstract
Research on emotional disturbance during pregnancy and the postpartum period has focused primarily on mood disorders and psychosis, yet preliminary evidence suggests that early parenthood is also associated with an increased risk for the development and exacerbation of obsessional problems. In this article we describe the nature of "postpartum obsessive-compulsive disorder" (ppOCD) and present a cognitive-behavioural model to account for these signs and symptoms. The model outlines features of early parenthood that might increase vulnerability to ppOCD and proposes a conceptual framework similar to that described in cognitive-behavioural models of OCD in general. The empirical status of the model described herein is discussed, along with suggestions for future research and implications for treatment.
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115
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Fowles ER, Walker LO. Correlates of dietary quality and weight retention in postpartum women. J Community Health Nurs 2006; 23:183-97. [PMID: 16863403 DOI: 10.1207/s15327655jchn2303_5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The purpose of this study(1) was to identify correlates of dietary quality and postpartum weight retention in women and to examine the association of dietary quality and weight retention. A secondary analysis was conducted of data from 100 women who delivered singleton babies and were over 18 years of age. In sum, 44 women had adequate dietary quality. Most women had adequate intake of meat (79%), milk (66%), and fruit (51%) but not bread (14%) or vegetables (24%). Dietary quality was significantly associated with breast-feeding (rs = .378, p < .000). Dietary quality was not associated with postpartum weight retention. In all, 43% of the variance in postpartum retained weight was explained by weight gained during pregnancy and weight-related distress. A gap exists in the nutrition education and weight management of women after childbirth that allows for a reversal of the healthy eating patterns adopted during pregnancy and throughout the ensuing postpartum life transition.
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116
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Abstract
OBJECTIVE To enhance the clinical utility of the Perinatal Post-Traumatic Stress Disorder (PTSD) Questionnaire (PPQ), the current study sought to refine the measure by changing the item response options from dichotomous choices to a likert scale format. STUDY DESIGN Using a convergent/divergent validity design and two data sources (traditional survey and World Wide Web), 58 high-risk and 86 low-risk mothers answered four questionnaires. RESULTS Principal components analysis of items on the modified PPQ revealed three components conceptually similar to the diagnostic criterion associated with PTSD. In addition, convergent and divergent validity of the modified measure was supported. The clinical utility of the modified PPQ was established with a strong positive likelihood ratio. CONCLUSION The modified PPQ is a useful clinical tool for identifying mothers experiencing significant emotional distress during the postnatal period so they may be referred for mental health services.
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117
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Abramowitz JS, Khandker M, Nelson CA, Deacon BJ, Rygwall R. The role of cognitive factors in the pathogenesis of obsessive–compulsive symptoms: A prospective study. Behav Res Ther 2006; 44:1361-74. [PMID: 16352291 DOI: 10.1016/j.brat.2005.09.011] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 08/09/2005] [Accepted: 09/01/2005] [Indexed: 10/25/2022]
Abstract
Cognitive models of obsessive-compulsive disorder (OCD) posit that specific kinds of dysfunctional beliefs (e.g., pertaining to responsibility and the significance of intrusive thoughts) underlie the development of this disorder. The present study was designed to prospectively evaluate whether dysfunctional beliefs thought to underlie OCD act as a specific vulnerability factor in the pathogenesis of obsessive-compulsive symptomatology. Eighty-five individuals were prospectively followed over a period of time thought to be associated with an increased onset of OCD symptoms -- childbirth and the postpartum. The majority of these new mothers and fathers experienced intrusive infant-related thoughts and performed neutralizing behaviors similar to, but less severe than, those observed in OCD. Scores on a measure of dysfunctional beliefs thought to underlie OCD predicted the development of obsessive-compulsive symptoms after controlling for pre-existing OCD symptoms, anxiety, and depression. Dysfunctional beliefs also predicted the severity of checking, washing, and obsessional OCD symptom dimensions, but not neutralizing, ordering, or hoarding symptom dimensions. These data provide evidence for specific dysfunctional beliefs as risk factors in the development of some types of OCD symptoms.
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118
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Strahle A, Stainton MC. Women's experience of revealing perinatal bladder function--implications for midwifery care. Women Birth 2006; 19:17-21. [PMID: 16792000 DOI: 10.1016/j.wombi.2006.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Comments of women engaged in a longitudinal study of urinary leaking from first trimester to 12 months following birth provide the data for this paper. Useful insights into the factors contributing to the maintenance of silence and ways to break the barriers to discussion of urinary incontinence before, during and following pregnancy were revealed. Given the prevalence of 30% of Australian women experiencing urinary leaking following pregnancy, it is imperative that midwives engage in discussion and support prevention of this unwelcome outcome of childbirth.
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119
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Kearney MH, Simonelli MC. Intervention fidelity: Lessons learned from an unsuccessful pilot study. Appl Nurs Res 2006; 19:163-6. [PMID: 16877196 DOI: 10.1016/j.apnr.2005.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
Although the design of the study we undertook was randomized, the groups were statistically similar, the intervention was based on evidence of previous efficacy, and the treatment was delivered exactly as planned, this pilot study on an intervention to promote motivation for weight loss in new mothers failed to produce an effect. A closer examination using criteria for intervention fidelity revealed a number of weaknesses. Both treatment integrity and differentiation merit careful consideration in intervention design.
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120
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Lemire L. [Maternal lactation in mothers undergoing treatment with methadone substitution]. SOINS. PEDIATRIE, PUERICULTURE 2006:27-9. [PMID: 17017645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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121
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Arons J. "In a black hole": the (negative) space between longing and dread: Home-based psychotherapy with a traumatized mother and her infant son. PSYCHOANALYTIC STUDY OF THE CHILD 2006; 60:101-27. [PMID: 16649677 DOI: 10.1080/00797308.2005.11800748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper offers fragments from the first year of a home-based mother-baby psychotherapy, in which I attempted to help a traumatized and dissociated mother to emotionally engage with her infant son. The treatment was organized in part around certain developmental objectives common to both attachment and psychoanalytic theory. These include: The ability to name and metabolize feelings, to evoke a soothing maternal introject, and to relate to the partner's mind as a separate, understandable center of initiative and intention. In addition, attachment theory, with its emphasis on the critical psychobiological role of containing fear and distress in infancy, was a useful guide in formulating the treatment. The paper reviews research findings on mother-infant pairs described as frightened-disorganized, discusses some of the challenges encountered in home-based mother-infant psychotherapy and then discusses the case of Mary and John. The case illustrates how mother-infant psychotherapy may interrupt the intergenerational transmission of disorganized attachment by working within the couple to name, metabolize and flexibly respond to painful, dissociated or frightening experiences.
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122
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Keller C, Allan J, Tinkle MB. Stages of change, processes of change, and social support for exercise and weight gain in postpartum women. J Obstet Gynecol Neonatal Nurs 2006; 35:232-40. [PMID: 16620249 DOI: 10.1111/j.1552-6909.2006.00030.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To test the extent to which social support and variables included in the Transtheoretical Model were explanatory for exercise initiation and weight maintenance in postpartum women. DESIGN A cross-sectional descriptive design. SETTING Data were collected in the participant's homes. PARTICIPANTS Postpartum women who had normal pregnancies were interviewed and measured on body fat, physical activity, and psychosocial scales. MAIN OUTCOME MEASURE (a) Stages of exercise change measure, (b) Seven Day Recall, (c) Friend and Family Support for Exercise Scale, (d) Processes of Change Questionnaire, and (e) body fat measures including body mass index and percent body fat. RESULTS Forty percent reported engaging in vigorous activity less than 1 hour daily, 55% walked less than four city blocks daily, and 52% engaged in less than 2 hours of vigorous weekend activity. Multilinear regression showed that the processes of change contributed 36% to the body mass index, and 21% of the variance in waist-thigh ratio. Of the processes of change, environmental reevaluation correlated significantly with body mass index. CONCLUSION The impact of a woman's weight on others as well as information concerning the health effects of obesity and physical activity could enhance the initiation of exercise in the postpartum woman.
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Pletsch PK. A model for postpartum smoking resumption prevention for women who stop smoking while pregnant. J Obstet Gynecol Neonatal Nurs 2006; 35:215-22. [PMID: 16620247 DOI: 10.1111/j.1552-6909.2006.00036.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Behavior change models and theories have been useful in our efforts to help people stop smoking. However, models that were developed for the general population do not always fit special populations such as pregnant women. Many women stop smoking while pregnant, but most resume smoking after giving birth. To help women who stop smoking while pregnant to stay smoke-free, a model for tailoring a smoking resumption-prevention intervention to the special needs of pregnant and postpartum women is proposed. The intervention begins during pregnancy, continues postpartum, and addresses pregnancy and parenting contextual factors in women's lives. The model is based on motivational theory and includes conducting patient assessments, developing risk profiles, triaging women to different levels of intervention intensity, and matching intervention strategies to women's risk profiles.
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Abstract
PURPOSE To propose an innovative, theoretically-derived conceptual framework for studies of postpartum smoking relapse including concepts of smoking abstinence self-efficacy and becoming a mother. METHODS Presentation of an existing research paradigm followed by evidence from intervention research and studies of factors associated with postpartum smoking behavior, leading to a new approach to postpartum smoking relapse. FINDINGS Effectiveness of current interventions to prevent relapse is limited. Variables associated with becoming a mother are missing from studies of postpartum smoking relapse. CONCLUSIONS Context-specific variables that influence a woman's progression through the stages of becoming a mother might include protective or risk factors that should be incorporated into the design of postpartum smoking relapse studies.
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