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Beyond "Option B+": Understanding Antiretroviral Therapy (ART) Adherence, Retention in Care and Engagement in ART Services Among Pregnant and Postpartum Women Initiating Therapy in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2017; 75 Suppl 2:S115-S122. [PMID: 28498180 DOI: 10.1097/qai.0000000000001343] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies from sub-Saharan Africa have highlighted significant challenges in providing antiretroviral therapy (ART) to pregnant and postpartum women, with specific concerns around maintaining optimal levels of adherence to ART and/or retaining women in long-term services. However, there are few conceptual frameworks to help understand nonadherence and nonretention, as well as the drivers of these, among HIV-infected women, particularly in the postpartum period. METHODS This review provides an overview of the key issues involved in thinking about ART adherence, retention in care and engagement in ART services among pregnant and postpartum women. RESULTS The related behaviors of adherence and retention may be understood as components of effective engagement of patients in ART services, which share the goal of achieving and maintaining suppressed maternal viral load on ART. Under this framework, the existing literature indicates that disengagement from care is widespread among postpartum women, with strikingly similar data emerging from ART services around the globe and indications that similar challenges may be encountered by postpartum care services outside the context of HIV. However, the drivers of disengagement require further research, and evidence-based intervention strategies are limited. CONCLUSIONS The challenges of engaging women in ART services during pregnancy and the postpartum period seem pervasive, although the determinants of these are poorly understood. Looking forward, a host of innovative intervention approaches are needed to help improve women's engagement, and in turn, promote maternal and child health in the context of HIV.
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Kellie FJ. Postpartum health professional contact for improving maternal and infant health outcomes for healthy women and their infants. Hippokratia 2017. [DOI: 10.1002/14651858.cd010855.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Frances J Kellie
- The University of Liverpool; Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
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Mori E, Iwata H, Sakajo A, Maehara K, Tamakoshi K. Association between physical and depressive symptoms during the first 6 months postpartum. Int J Nurs Pract 2017. [PMID: 28635063 DOI: 10.1111/ijn.12545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the relationship between physical symptoms and depressive symptoms among new mothers during the first 6 months postpartum. METHODS Prospective cohort study design was used in this study. Participants were recruited in 13 Japanese hospitals between 2012 and 2013. A total of 2709 women (response rate of those invited 71.9%) provided longitudinal data using self-report questionnaires at 5 time points: during the hospital stay and at 1, 2, 4, and 6 months postpartum. Depressive symptoms were measured using the Japanese version of the Edinburgh Postnatal Depression Scale. Also, 37 physical symptoms were measured using a yes-or-no checklist. To examine the association between physical symptoms and depressive symptoms, logistic regression analysis was used. RESULTS There was a significant positive association between physical symptoms and depressive symptoms during the first 6 months postpartum. Fifteen physical symptoms were associated with significantly increased odds of depression at 1, 2, 4, and 6 months post-partum. These symptoms included: loss of appetite, tiredness/languor, and palpitation/shortness of breath. CONCLUSION Multiple physical symptoms after childbirth were associated with depressive symptomatology. Health professionals should assess for postpartum depression when puerperal women report multiple physical symptoms as independent complaints.
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Affiliation(s)
- Emi Mori
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Hiroko Iwata
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Akiko Sakajo
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Kunie Maehara
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Koji Tamakoshi
- Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Lowenhoff C, Appleton JV, Davison-Fischer J, Pike N. NICE guideline for antenatal and postnatal mental health: The health visitor role. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/johv.2017.5.6.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine Lowenhoff
- PhD student, Department of Psychology, Social Work and Public Health, Oxford Brookes University
| | - Jane V Appleton
- Professor of primary and community care, Oxford Brookes University
| | | | - Nick Pike
- Research visiting fellow in social work, Oxford Brookes University
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Abstract
Health problems may occur in mothers and can persist during the postpartum. Life event stress (LES) is a risk factor for poor maternal health. We examined the relations of LES and rise in LES over time to maternal health during the first three years postpartum. We used data from 1,364 mothers obtained between 1991 and 2007 in the U.S. National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Information on maternal sociodemographics and early postpartum health was collected 1 month after childbirth. Maternal reports on health status and LES were obtained at 6, 15, 24, and 36 months postpartum. Latent growth curve analyses were performed, with maternal sociodemographics and early postpartum health as covariates for which statistical adjustment was made. Maternal health declined steadily in a linear pattern with marked individual differences, whereas maternal LES increased gradually in a linear pattern. Moreover, faster maternal health decline was associated with poorer early health at 1 month postpartum, greater exposure to LES at 6 months postpartum, and faster rise in LES exposure over time. Decline in maternal health may be explained at least in part by the deleterious effects of exposure to stressful life events.
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Affiliation(s)
- Hui-Chin Hsu
- a Department of Human Development and Family Science , University of Georgia , Athens , Georgia , USA
| | - Kandauda A S Wickrama
- a Department of Human Development and Family Science , University of Georgia , Athens , Georgia , USA
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Ghiasvand F, Riazi H, Hajian S, Kazemi E, Firoozi A. The effect of a self-care program based on the teach back method on the postpartum quality of life. Electron Physician 2017; 9:4180-4189. [PMID: 28607653 PMCID: PMC5459290 DOI: 10.19082/4180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background The postpartum period is a critical stage of life with major changes in the quality of life. Therefore, special consideration is needed to this issue. Objective To determine the effect of a self-care program based on the Teach Back method on the postpartum quality of life. Methods This experimental study was conducted on eighty postpartum women who had given birth in health centers across Darreh Shahr County, Ilam Province, Iran in 2016. The control group received only routine postpartum care according to the national guidelines. The trial group received the routine care in addition to two sessions of physical and psychological postpartum self-care based on the Teach Back method. The two groups were assessed in terms of their quality of life before and after the intervention using the Postpartum Quality of Life Questionnaire. The data were analyzed using SPSS version 21. Descriptive statistic tests, Chi squared, independent-samples t-test, paired-samples t-test, Wilcoxon and Mann Whitney’s test was used. Results Before the intervention, the postpartum quality of life score was 106.23±11.866 in the trial group and 107.30±13.197 in the control group; after the intervention, the score was 124.73±10.706 and 115.03±12.687 in the two groups respectively, suggesting a significant inter-group difference after the intervention (p<0.001). Significant differences were also observed between the two groups in terms of the mother’s feelings toward herself, toward her child and toward her spouse and others, and physical health before and after the intervention (p<0.001). Conclusions Using the Teach Back model for a self-care program appears to dramatically improve the postpartum quality of life and is therefore recommended as a useful method for postpartum care. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015012820854N1. Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Affiliation(s)
- Fatemeh Ghiasvand
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedyeh Riazi
- Ph.D., Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Hajian
- Ph.D., Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Kazemi
- Ph.D. Student, Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Firoozi
- MS, Clinical Psychologist, Researcher, Department of Psychology, Khwarizmi University, Karaj, Iran
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Sivertsen B, Petrie KJ, Skogen JC, Hysing M, Eberhard-Gran M. Insomnia before and after childbirth: The risk of developing postpartum pain-A longitudinal population-based study. Eur J Obstet Gynecol Reprod Biol 2017; 210:348-354. [PMID: 28126668 DOI: 10.1016/j.ejogrb.2017.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine if insomnia before and after childbirth predicts the development of postpartum bodily pain. METHODS This study is part of a longitudinal cohort study, the Akershus Birth Cohort Study, which targeted all women giving birth at Akershus University Hospital in Norway. The current sample is comprised of 1480 women who participated at all three time points, yielding a participation rate of 32% of the 4662 women who originally consented to participate. The Bergen Insomnia Scale (BIS) was used to measure insomnia and a latent profile analysis (LPA) was used to identify subsets of women who shared a similar pattern of responses on the BIS-scale across the three time points. Pain was measured using the bodily pain scale, derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and symptoms of depression were measured by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS Using a latent profile analysis a three class model showed the best fit and identified one major group (55.6%) with a low BIS scores across all three time points, one group with intermediate BIS scores (32.9%), and a smaller group (11.5%) with higher BIS scores across all three times. The chronic high insomnia group had a 2.8-fold increased risk of reporting high levels of bodily pain. The chronic intermediate group was associated with a 2.2-fold increased risk of bodily pain at two years postpartum. Adjusting for demographics and lifestyle behaviors did not reduce any of the associations, while adjusting for depression significantly attenuated the associations. Additional adjustment for pain at eight weeks postpartum further reduced the magnitude of the associations, but both chronic intermediate insomnia and chronic high insomnia remained strongly associated with the onset of bodily pain in the fully adjusted models (RR=1.75, 95% CI: 1.37-2.23) and RR=1.63, 95% CI: 1.15-2.32, respectively). CONCLUSIONS The high prevalence of insomnia among women during and after childbirth, in combination with the strong prospective association with impaired physical health, emphasizes the importance of adequately identifying, preventing and treating insomnia for this population.
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Affiliation(s)
- Børge Sivertsen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway; The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway; Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, N-5504 Haugesund, Norway.
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland 1142, New Zealand
| | - Jens Christoffer Skogen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway; The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway; Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Mari Hysing
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway; Health Services Research Center, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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Brodribb WE, Mitchell BL, Van Driel ML. Postpartum consultations in Australian general practice. Aust J Prim Health 2017; 22:128-132. [PMID: 25586677 DOI: 10.1071/py14082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/25/2014] [Indexed: 11/23/2022]
Abstract
Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants.
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Affiliation(s)
- Wendy E Brodribb
- Discipline of General Practice, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
| | - Benjamin L Mitchell
- Discipline of General Practice, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
| | - Mieke L Van Driel
- Discipline of General Practice, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
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Abstract
OBJECTIVES To date, little is known regarding the impact of maternal depression on participation in public benefit programs. This study examines whether maternal depression is predictive of lower WIC participation in early childhood. METHODS This was a secondary data analysis using weighted data from the Early Childhood Longitudinal Study, Birth Cohort. Maternal data collected when children were 9 and 24 months of age were used. 9 months was considered baseline, and 24 months was considered follow-up. The study cohort consisted of 3841 low income mothers, defined as <185 % federal poverty level, who reported WIC participation at baseline. Baseline maternal depressive symptoms were measured by a 12-item abbreviated version of the Center for Epidemiologic Studies Depression Scale. WIC participation was assessed by maternal self-report. RESULTS At baseline, 24.5 % of mothers were depressed (raw score >9). The majority of mothers were white, unemployed, and born in the US. Most received Medicaid (74 %) and almost half received SNAP (47 %). At follow-up, 80.1 % of mothers reported WIC participation. In multivariable analysis, maternal depression at baseline was significantly associated with decreased WIC participation at follow-up (aOR 0.74; 95 % CI 0.55-0.99). CONCLUSIONS Our results suggest that maternal depression is an independent risk factor for decreased WIC participation in low-income families with young children. Primary and secondary prevention strategies aimed at maternal depression may positively impact low-income families' participation in public benefit programs. Further longitudinal and interventional studies are needed in order to inform clinical practice and public health policy.
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Moura MRS, Araújo CGA, Prado MM, Paro HBMS, Pinto RMC, Abdallah VOS, Mendonça TMS, Silva CHM. Factors associated with the quality of life of mothers of preterm infants with very low birth weight: a 3-year follow-up study. Qual Life Res 2016; 26:1349-1360. [DOI: 10.1007/s11136-016-1456-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
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Semasaka JPS, Krantz G, Nzayirambaho M, Munyanshongore C, Edvardsson K, Mogren I. Self-reported pregnancy-related health problems and self-rated health status in Rwandan women postpartum: a population-based cross-sectional study. BMC Pregnancy Childbirth 2016; 16:340. [PMID: 27821082 PMCID: PMC5100328 DOI: 10.1186/s12884-016-1138-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/30/2016] [Indexed: 11/28/2022] Open
Abstract
Background Self-rated health status (SRH) can be used as a predictor of morbidity and mortality. Postpartum self-rated health has been used to estimate maternal morbidity and postpartum problems. Reproductive history factors are associated with poor self-rated health postpartum. This study investigated prevalence of self-reported health problems during first, second, and third trimesters of pregnancy, delivery, and postpartum. In addition, this study investigated SRH in Rwandan women up to 13 months from partus. Methods This population-based, cross-sectional study collected data in 2014 using structured interviews (N = 921). Univariable analysis was used to identify variables that were associated with poor self-rated health status (poor-SRH). Logistic regression analyses were performed to identify factors associated with poor-SRH at one day, one week, and one month postpartum and at the time of the interview. Results Mean time between latest delivery and the time of interview was 7.1 months. Prevalence of anaemia, hypertension, diabetes mellitus during pregnancy, and severe bleeding during pregnancy and labour were 15.0, 4.9, 2.4, and 3.7 %, respectively. The prevalence of poor-SRH was 32.2 % at one day postpartum, 7.8 % at one month, and 11.7 % at time of the interview. Hypertension during pregnancy and significant postpartum haemorrhage were associated with poor-SRH at one day and one week postpartum. Severe bleeding during pregnancy and labour were associated with poor-SRH at one week and one month postpartum. Infection and anaemia during pregnancy were associated with poor-SRH at one month postpartum and at the time of interview. The Kaplan-Meier curves illustrate restitution of health for most women during the study period. Conclusions This population-based study reports a high prevalence of poor SRH status among Rwandan women in the early postpartum period. Identified factors associated with poor-SRH were severe bleeding, hypertension, infection, and anaemia during pregnancy and postpartum haemorrhage. These factors may be prevented or reduced by providing more frequent and specific attention during pregnancy and by providing timely measures that address complications during delivery, including adequate postpartum care.
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Affiliation(s)
- Jean Paul S Semasaka
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden. .,University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda.
| | - Gunilla Krantz
- Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Manasse Nzayirambaho
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
| | - Cyprien Munyanshongore
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.,Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Verbiest S, McClain E, Stuebe A, Menard MK. Postpartum Health Services Requested by Mothers with Newborns Receiving Intensive Care. Matern Child Health J 2016; 20:125-131. [PMID: 27357697 PMCID: PMC5118385 DOI: 10.1007/s10995-016-2045-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Our pilot study aimed to build knowledge of the postpartum health needs of mothers with infants in a newborn intensive care unit (NICU). Methods Between May 2008 and December 2009, a Certified Nurse Midwife was available during workday hours to provide health care services to mothers visiting their infants in the NICU at a large tertiary care center. Results A total of 424 health service encounters were recorded. Maternal requests for services covered a wide variety of needs, with primary care being the most common. Key health concerns included blood pressure monitoring, colds, coughs, sore throats, insomnia and migraines. Mothers also expressed a need for mental health assessment and support, obstetric care, treatment for sexually transmitted infections, tobacco cessation, breastfeeding assistance, postpartum visits, and provision of contraception. Conclusions Our study suggests that mothers with babies in the NICU have a host of health needs. We also found that women were receptive to receiving health services in a critical care pediatric setting. Intensive care nurseries could feasibly partner with in-patient mother-baby units and/or on-site obstetric clinics to increase access to health care for the mothers of the high-risk newborns in their units. Modifications should be made within health care systems that serve high-risk infants to better address the many needs of the mother/baby dyad in the postpartum period.
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Affiliation(s)
- Sarah Verbiest
- Center for Maternal and Infant Health, University of North Carolina at Chapel Hill, Campus Box 7181, Room 3018 Old Clinic Building, Chapel Hill, NC, 27599-7181, USA.
- School of Social Work, University of North Carolina at Chapel Hill, Campus Box 3550, 325 Pittsboro Street, Chapel Hill, NC, 27599-3550, USA.
| | - Erin McClain
- Center for Maternal and Infant Health, University of North Carolina at Chapel Hill, Campus Box 7181, Room 3018 Old Clinic Building, Chapel Hill, NC, 27599-7181, USA
| | - Alison Stuebe
- Center for Maternal and Infant Health, University of North Carolina at Chapel Hill, Campus Box 7181, Room 3018 Old Clinic Building, Chapel Hill, NC, 27599-7181, USA
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology Department, University of North Carolina at Chapel Hill School of Medicine, Campus Box 7516, Chapel Hill, NC, 27599-7516, USA
| | - M Kathryn Menard
- Center for Maternal and Infant Health, University of North Carolina at Chapel Hill, Campus Box 7181, Room 3018 Old Clinic Building, Chapel Hill, NC, 27599-7181, USA
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology Department, University of North Carolina at Chapel Hill School of Medicine, Campus Box 7516, Chapel Hill, NC, 27599-7516, USA
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The impact of postpartum hemoglobin levels on maternal quality of life after delivery: a prospective exploratory study. Ann Hematol 2016; 95:2049-2055. [PMID: 27623626 DOI: 10.1007/s00277-016-2817-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
Postpartum anemia has been associated with postpartum morbidities, such as depression and poor cognition. However, it is unclear whether postpartum anemia is associated with reduced health-related quality of life. We performed a prospective study to examine the relations between postpartum Hb levels with postpartum health-related quality of life (HRQoL). We collected data from 60 women intending vaginal delivery and assessed HRQoL and maternal fatigue on admission and on the first postpartum day using the RAND 36-Item Short-Form Health Survey (SF-36) and the Multidimensional Fatigue Inventory (MFI), respectively. Maternal Hb levels were measured on admission and on the first postpartum day. We also assessed patients for postpartum depression using the Edinburgh Postpartum Depression Scale (EPDS). We performed unadjusted and multivariate linear regression (adjusting for maternal age, parity, mode of delivery, and race) to assess the associations between postdelivery Hb with each subscale of the SF-36 and MFI. The mean predelivery and postpartum Hb levels were 12.3 (1.2) and 10.8 (1.4) g/dl, respectively. In our unadjusted and adjusted regression analyses, we observed no statistically significant associations between postpartum Hb levels with any SF-36 or MFI subscale (P > 0.05). Based on the EPDS, only one patient was depressed; her postpartum Hb was 11.2 g/dl. Our findings suggest that postpartum Hb levels may not influence HRQoL or fatigue. However, our findings may only apply to women without predelivery anemia, severe blood loss or moderate-to-severe anemia after delivery. Future studies are needed to determine whether postpartum Hb influences HRQoL among women with moderate or severe postpartum anemia.
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Norhayati MN, Nik Hazlina NH, Aniza AA. Immediate and long-term relationship between severe maternal morbidity and health-related quality of life: a prospective double cohort comparison study. BMC Public Health 2016; 16:818. [PMID: 27538506 PMCID: PMC4990872 DOI: 10.1186/s12889-016-3524-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/15/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Given the growing interest in severe maternal morbidity (SMM), the need to assess its effects on quality of life is pressing. The objective of this study was to compare the quality of life scores between women with and without SMM at 1-month and 6-month postpartum in Kelantan, Malaysia. METHODS A prospective double cohort study design was applied at two tertiary referral hospitals over a 6-month period. The study population included all postpartum women who delivered in 2014. Postpartum women with and without SMM were selected as the exposed and non-exposed groups, respectively. For each exposed case identified, a non-exposed case with a similar mode of delivery was selected. The main outcome measures used were scores from the Short Form-12 Health Survey (SF-12). RESULTS The study measured 145 exposed and 187 non-exposed women. The group-time interaction of the repeated measure analysis of variance (RM ANOVA) showed no significant difference in the mean overall SF-12 physical component summary score changes (P = 0.534) between women with and without SMM. Similarly, the group-time interaction of the RM ANOVA showed no significant difference in the mean overall SF-12 mental component summary score changes (P = 0.674) between women with and without SMM. However, women with SMM scored significantly lower on a general health perceptions subscale at 1-month (P = 0.031), role limitations due to physical health subscale at 6-month (P = 0.019), vitality subscale at 1-month (P = 0.007) and 6-month (P = 0.008), and role limitations due to emotional problems subscales at 6-month (P = 0.008). CONCLUSIONS Women with severe maternal morbidity demonstrated comparable quality of life during the 6-month postpartum period compared to women without severe maternal morbidity.
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Affiliation(s)
- Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
| | - Nik Hussain Nik Hazlina
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Abd Aziz Aniza
- Faculty of Medicine, Universiti Sultan Zainal Abidin, 20400, Kuala Terengganu, Terengganu, Malaysia
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Nikan F, Asghari Jafarabadi M, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Montazeri A, Asadi S. Psychometric Properties of the Iranian Version of a Postpartum Women's Quality of Life Questionnaire (PQOL): A Methodological Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e35460. [PMID: 27703799 PMCID: PMC5027672 DOI: 10.5812/ircmj.35460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/19/2016] [Accepted: 02/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are some specific measures for the evaluation of postpartum quality of life, and each have some limitations. OBJECTIVES This study investigated the validity and reliability of the Persian version of a postpartum women's quality of life (PQOL) questionnaire at the eighth week of postpartum. PATIENTS AND METHODS This was a methodological research, and subjects were 500 women, ages 18 - 42, eight weeks postpartum, randomly selected from half of the public centers in Tabriz, Iran, who completed questionnaires in a self-administered manner. Data was collected during a two-month period during 2014 - 2015. A standard forward - backward translation procedure was used to translate the English version of the PQOL into Persian. Content, construct, discriminant, and criterion validity was assessed. The reliability was evaluated by internal consistency and test-retest reliability. RESULTS The PQOL showed good content validity; content validity ratio (CVR) ranged from 0.67 to 1.00 and content validity index (CVI) ranged from 0.78 to 1.00. Construct validity evaluation by exploratory factor analysis (EFA) led to extraction of six factors from the data. Due to the lack of theoretical justification for items' relocation in the extracted factors and poor-fitting indices obtained by confirmatory factor analysis (CFA), the exploratory model was eliminated, and the original model was presented and incorporated into the CFA, indicating an acceptable fit for the model (root mean square error of approximation [RMSEA] = 0.038 [0.034; 0.042]; comparative fit index [CFI] = 0.90; normed fit index [NFI] = 0.80; non-normed fit index [NNFI] = 0.90; incremental fit index [IFI] = 0.90). The intergroup differences in total and all dimensions of the PQOL, except for social support, indicated the discrimination ability of the questionnaire. The questionnaire indicated a medium correlation with the short form health survey (SF-12) questionnaire (r ≥ 0.50). Cronbach's alpha coefficient (0.70 - 0.88) indicated a good internal consistency, and the intraclass correlation coefficients (0.87 - 0.92) showed good test - retest reliability. CONCLUSIONS The findings of this study confirmed the validity and reliability of the Iranian version of the PQOL questionnaire in Iranian women as a specific measure to evaluate the women's quality of life.
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Affiliation(s)
- Fariba Nikan
- Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Mohammad Asghari Jafarabadi, Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9124390958, E-mail:
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mojgan Mirghafourvand
- Assistant Professor, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Ali Montazeri
- Professor of Public Health and Epidemiology, Institute for Health Sciences Research, Tarbiat Modares University, Tehran, IR Iran
| | - Sonia Asadi
- Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Functional status of women with and without severe maternal morbidity: A prospective cohort study. Women Birth 2016; 29:443-449. [PMID: 26972285 DOI: 10.1016/j.wombi.2016.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known regarding the impact on maternal functional status in women who have survived severe obstetric complications. OBJECTIVE To compare the maternal functional status score between women with and without severe morbidity at one month and six months postpartum in Kelantan, Malaysia. METHODS A prospective cohort study design was applied at two tertiary referral hospitals over a six-month period. The study population included all postpartum women who gave birth in 2014. Postpartum women with severe maternal morbidity and without severe maternal morbidity were selected as the exposed and non-exposed group, respectively. Functional ability based on the Inventory of Functional Status after Childbirth was used as the main outcome measure. Repeated measure analysis of variance was performed. RESULTS A total of 145 and 187 women with and without severe maternal morbidity, respectively, were measured. There were significant differences in Inventory of Functional Status after Childbirth score changes (P<0.001) between women with and without severe maternal morbidity at one month and at six months. Functional ability score of women with severe maternal morbidity was lower at one month postpartum (P=0.001). The most affected domain was infant care (P=0.002). CONCLUSIONS Healthcare providers are recommended to assess the short-term functional ability of severe morbid mother in addition to existing routine physical examination. Provision of physical support from spouse and family of the high risk mothers particularly on infant care during their early postpartum period is crucial to optimise health and minimise the negative health outcomes.
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67
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Walker LO, Murphey CL, Nichols F. The Broken Thread of Health Promotion and Disease Prevention for Women During the Postpartum Period. J Perinat Educ 2016; 24:81-92. [PMID: 26957891 DOI: 10.1891/1058-1243.24.2.81] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Postpartum maternal health affects maternal functional status, future pregnancy outcomes, maternal chronic disease development, and infant health. After pregnancy, however, many mothers may find that they face gaps in care related to their health and caregiving roles. Research shows that they were unprepared, uninformed, and unsupported during the postpartum period as they struggle with physical and emotional symptoms, infant caregiving, breastfeeding concerns, and lifestyle adjustments. Limited follow-up after a diagnosis of gestational hypertension or gestational diabetes and screening for postpartum depression are additional gaps in preventive and supportive care. Integrative reviews revealed modest efficacy and limitations of recent postpartum health promotion and disease prevention interventions. System, clinical, and community strategies are identified to address these gaps in women's postpartum health services.
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68
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Kim JH, Shin HS, Kim SY, Lee HK, Lim SH. Patterns and Factors associated with Complementary and Alternative Medicine Use among Korean Postpartum Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2016; 22:1-10. [PMID: 37684838 DOI: 10.4069/kjwhn.2016.22.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/23/2015] [Accepted: 02/12/2016] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study was conducted to identify the pattern and factors associated with women's use of complementary and alternative medicine (CAM) during postpartum in Korea. METHODS With a descriptive survey design, data of 423 postpartum women were collected via online and offline surveys. RESULTS A total of 251 women (59.3%) reported CAM use during postpartum. Eating animal-based foods (65.3%), plant-based health foods (52.2%), and using oriental medicine (31.8%) were commonly used in postpartum women. The reason for using CAM were physical recovery (39.1%), breastfeeding (29.7%), weight loss (24.8%), prevention of postpartum complications (5.1%), and others (1.3%). People who recommended CAM use was mainly family (41.3%), and expense of using CAM was 751,188 Korea won. Most women discussed CAM use with doctor (44.9%), and 29.3% of women didn't even consult CAM use with health care providers. Most of (72.3%) women were satisfied with CAM use. Higher level of education and monthly income, being employed, primipara, normal range of gestational weight gain, no abortion experience, and no maternal complication were significantly associated with CAM use in postpartum women. CONCLUSION Results of this study were somewhat different from those of western research. Findings offer baseline data of CAM use in postpartum women, and health care providers need to understand it when they care for them.
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Affiliation(s)
- Ju Hee Kim
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Hye Sook Shin
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - So Young Kim
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Hye Kyung Lee
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - So Hee Lim
- College of Nursing Science, Kyung Hee University, Seoul, Korea
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McBean AL, Kinsey SG, Montgomery-Downs HE. Effects of a single night of postpartum sleep on childless women's daytime functioning. Physiol Behav 2016; 156:137-47. [PMID: 26776447 DOI: 10.1016/j.physbeh.2016.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/16/2015] [Accepted: 01/12/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVES The maternal postpartum period is characterized by sleep fragmentation, which is associated with daytime impairment, mental health disturbances, and changes in melatonin patterns. In addition to sleep fragmentation, women undergo a complex set of physiological and environmental changes upon entering the postpartum period, confounding our understanding of effects of postpartum sleep disturbance. The primary study aim was to understand the basic impact of a single night of postpartum-like sleep fragmentation on sleep architecture, nocturnal melatonin levels, mood, daytime sleepiness, and neurobehavioral performance. MEASUREMENTS AND RESULTS For one week prior to entry into the laboratory, eleven healthy nulliparous women kept a stable sleep-wake schedule (verified via actigraphy). Participants contributed three consecutive nights of laboratory overnight polysomnography: (1) a habituation/sleep disorder screening night; (2) a baseline night; and (3) a sleep fragmentation night, when participants were awakened three times for ~30min each. Self-reported sleep quality and mood (Profile of Mood States survey) both decreased significantly after sleep fragmentation compared to baseline measurements. Unexpectedly, daytime sleepiness (Multiple Sleep Latency Test) decreased significantly after sleep fragmentation. Experimental fragmentation had no significant effect on time spent in nocturnal sleep stages, urinary 6-sulfatoxymelatonin concentration, or psychomotor vigilance test performance. Participants continued to provide actigraphy data, and daily PVTs and self-reported sleep quality assessments at home for one week following sleep fragmentation; these assessments did not differ from baseline values. CONCLUSIONS While there were no changes in measured physiological components of a single night of postpartum-like experimental sleep fragmentation, there were decreases in self-reported measures of mood and sleep quality. Future research should examine the effects of multiple nights of modeling postpartum-like sleep fragmentation on objective measures of sleep and daytime functioning.
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Affiliation(s)
- Amanda L McBean
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Steven G Kinsey
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Rosen NO, Pukall C. Comparing the Prevalence, Risk Factors, and Repercussions of Postpartum Genito-Pelvic Pain and Dyspareunia. Sex Med Rev 2016; 4:126-135. [PMID: 27872022 DOI: 10.1016/j.sxmr.2015.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Childbirth is a risk factor for developing genito-pelvic pain and/or dyspareunia during the postpartum period and potentially in the longer term. These two types of pain can occur simultaneously or sequentially and could be affected by different risk factors and have a range of repercussions to women's lives, including their sexual functioning. AIM This study reviewed the available evidence to compare and contrast the prevalence, risk factors, and repercussions of postpartum genito-pelvic pain vs dyspareunia. METHODS All available data related to postpartum genito-pelvic pain and dyspareunia were reviewed. MAIN OUTCOME MEASURES A description of the prevalence, risk factors, and sexual and psychological consequences of postpartum genito-pelvic pain and dyspareunia and the methodologic limitations of previous studies. RESULTS The prevalence of postpartum genito-pelvic pain is much lower than that of postpartum dyspareunia. There is evidence of converging and differential risk factors for acute and persistent experiences of these two types of pain. Postpartum genito-pelvic pain and dyspareunia are associated with impaired sexual functioning. Rarely are these pain experiences examined together to make direct comparisons. CONCLUSION There has been a critical lack of studies examining postpartum genito-pelvic pain and dyspareunia together and integrating biomedical and psychosocial risk factors. This approach should be spearheaded by a multidisciplinary group of researchers of diverse and relevant expertise, including obstetricians, gynecologists, anesthesiologists, and psychologists.
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Affiliation(s)
- Natalie O Rosen
- Departments of Psychology and Neuroscience and Psychiatry, Dalhousie University, Halifax, NS, Canada; Department of Obstetrics and Gynecology, IWK Health Centre, Halifax, NS, Canada.
| | - Caroline Pukall
- Department of Psychology, Centre for Neuroscience Studies, and School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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71
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Sundaram S, Harman JS, Cook RL. Maternal morbidities and postpartum depression: an analysis using the 2007 and 2008 Pregnancy Risk Assessment Monitoring System. Womens Health Issues 2015; 24:e381-8. [PMID: 24981397 DOI: 10.1016/j.whi.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Postpartum depression (PPD) is common and associated with significant health outcomes and other consequences. Identifying persons at risk may improve screening and detection of PPD. This exploratory study sought to identify the morbidities that associate with 1) PPD symptoms and 2) PPD diagnosis. METHODS Data from the 2007 and 2008 Pregnancy Risk Assessment Monitoring System were analyzed from 23 states and 1 city (n = 61,733 pregnancies); 13 antenatal morbidities were included. To determine whether antenatal morbidity predictors of PPD would differ based on PPD symptoms versus a diagnosis, each of the 13 antenatal morbidities were examined in separate logistic regression models with each PPD outcome. For each objective, two samples were examined: 1) Women from all states and 2) women from Alaska and Maine, the two states that included both PPD symptoms and PPD diagnosis measures in their questionnaires. Control variables included demographic and sociodemographic variables, pregnancy variables, antenatal and postpartum health behaviors, and birth outcomes. MAIN FINDINGS Having vaginal bleeding (odds ratio [OR], 1.42; OR, 1.76), kidney/bladder infection (OR, 1.59; OR, 1.63), nausea (OR, 1.50; OR, 1.80), preterm labor (OR, 1.54; OR, 1.51), or being on bed rest (OR, 1.34; OR, 1.56) associated with both PPD symptoms and PPD diagnosis, respectively. Being in a car accident associated with PPD symptoms only (OR, 1.65), whereas having hypertension (OR, 1.94) or a blood transfusion (OR, 2.98) was associated with PPD diagnosis only. Among women from Alaska or Maine, having preterm labor (OR, 2.54, 2.11) or nausea (OR, 2.15, 1.60) was associated with both PPD symptoms and PPD diagnosis, respectively. Having vaginal bleeding (OR, 1.65), kidney/bladder infection (OR, 1.74), a blood transfusion (OR, 3.30), or being on bed rest (OR, 1.87) was associated with PPD symptoms only, whereas having diabetes before pregnancy (OR, 5.65) was associated with PPD diagnosis only. CONCLUSIONS The findings of this exploratory study revealed differences in the antenatal morbidities that were associated with PPD symptoms versus diagnosis in both samples, and can assist prenatal care providers in prioritizing and screening for these morbidities that are associated with PPD during pregnancy. Additional research is warranted to confirm the results of this study in other samples and populations. Developing strategies to 1) improve general awareness of PPD and the appropriate antenatal morbidity risk factors to focus on in clinical settings, and 2) increase screening for the antenatal morbidities determined to be predictors of PPD in this study are warranted in preventing PPD.
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Affiliation(s)
- Swathy Sundaram
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado.
| | - Jeffrey S Harman
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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Niklasson B, Georgsson Öhman S, Segerdahl M, Blanck A. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section. Acta Obstet Gynecol Scand 2015; 94:622-8. [DOI: 10.1111/aogs.12613] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Boel Niklasson
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Obstetrics and Gynecology; Karolinska Institute; Karolinska University Hospital; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
| | - Susanne Georgsson Öhman
- Sophiahemmet University; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Märta Segerdahl
- Department of Physiology and Pharmacology; Karolinska Institute; Stockholm Sweden
| | - Agneta Blanck
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Obstetrics and Gynecology; Karolinska Institute; Karolinska University Hospital; Stockholm Sweden
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Flanagan JC, Gordon KC, Moore TM, Stuart GL. Women's Stress, Depression, and Relationship Adjustment Profiles as They Relate to Intimate Partner Violence and Mental Health During Pregnancy and Postpartum. PSYCHOLOGY OF VIOLENCE 2015; 5:66-73. [PMID: 25642352 PMCID: PMC4310243 DOI: 10.1037/a0036895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study applied latent class analysis to examine whether homogeneous subgroups of women emerged based on their self-reported stress, depression, and relationship adjustment during pregnancy. We also examined whether women in different groups experienced different intimate partner violence (IPV) and mental health symptoms during pregnancy and postpartum. METHOD 180 women completed assessments during the first 18 weeks of pregnancy and 122 completed follow-up assessments six weeks postpartum. RESULTS A two-class solution best fit the data. One group reported higher mean stress and depression and poorer relationship adjustment compared to the other group. The high severity class reported more psychological IPV victimization and perpetration and more physical IPV victimization during pregnancy compared to the low severity class. Membership in the high severity class was associated with higher postpartum depression. CONCLUSIONS Findings highlight the associations between different profiles of mental and relational health during pregnancy and postpartum. Future studies should explore the utility of dyadic interventions aimed at reducing stress, depression, and IPV, and improving relationship adjustment as a means to improve women's health during pregnancy and postpartum. These findings also highlight the potential utility of applying person-centered analytic approaches to the study of women's and couples' health during this time period.
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Zourladani A, Zafrakas M, Chatzigiannis B, Papasozomenou P, Vavilis D, Matziari C. The effect of physical exercise on postpartum fitness, hormone and lipid levels: a randomized controlled trial in primiparous, lactating women. Arch Gynecol Obstet 2014; 291:525-30. [PMID: 25138123 DOI: 10.1007/s00404-014-3418-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of an exercise training program combining low-impact dance aerobic, resistance and stretching exercise on physical fitness, hormone and lipid levels of postpartum, primiparous, lactating women. METHODS Thirty seven primiparous, lactating women were randomly assigned at 4-6 weeks postpartum to either follow an exercise training program of 50-60 min aerobic, strengthening and stretching exercise, 3 days a week, for 12 weeks (interventional group; n = 20) or no training program at all (control group; n = 17). The following parameters were measured at baseline and 12 weeks later: (1) for evaluation of physical fitness: VO2max, muscular endurance, joint mobility and body fat; (2) for evaluation of the lipidemic profile: triglyceride, total cholesterol, HDL and LDL levels, and (3) levels of hormones associated with lactation: prolactin, estradiol, cortisol, TSH, fT3 and fT4. RESULTS After completion of the exercise training program, comparisons between the interventional and the control group showed statistically significant mean changes in VO2max (p = 0.003), muscular endurance of the upper extremities (p < 0.001), and the abdomen (p < 0.001), flexibility (p = 0.042), and body fat (p = 0.007). There were no significant differences between the two groups in mean changes of lipid and hormone levels. CONCLUSION Implementation of a low-impact exercise training program appears to improve physical fitness of postpartum women, while it does not seem to affect lipid levels and lactation-associated hormone levels. Hence, implementation of an exercise training program combining low-impact dance aerobic, resistance and stretching exercise is feasible in postpartum, primiparous, lactating women.
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Affiliation(s)
- A Zourladani
- School of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Glowacka M, Rosen N, Chorney J, Snelgrove Clarke E, George RB. Prevalence and predictors of genito-pelvic pain in pregnancy and postpartum: the prospective impact of fear avoidance. J Sex Med 2014; 11:3021-34. [PMID: 25124648 DOI: 10.1111/jsm.12675] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is limited knowledge regarding the symptom profile of genito-pelvic pain in pregnancy and postpartum, and potential psychosocial predictors of this pain. Prior studies have reported a positive association between prepregnancy pain and postpartum genito-pelvic pain. Greater fear avoidance has been associated with increased genital pain intensity in women, unrelated to childbirth. This relationship has not been examined prospectively in a postpartum population. AIMS The study aims were to examine the symptom profile of genito-pelvic pain during pregnancy and at 3 months postpartum, and the impact of prepregnancy nongenito-pelvic pain and fear avoidance in pregnancy on genito-pelvic pain at 3 months postpartum. METHODS First-time expectant mothers (N = 150) completed measures of fear avoidance (pain-related anxiety, catastrophizing, hypervigilance to pain), prepregnancy nongenito-pelvic pain, childbirth-related risk factors (e.g., episiotomy), and breastfeeding. MAIN OUTCOME MEASURES Those reporting genito-pelvic pain in pregnancy and/or at 3 months postpartum answered questions about the onset (prepregnancy, during pregnancy, postpartum) and location (genital, pelvic, or both) of the pain and rated the intensity and unpleasantness of the pain on numerical rating scales. RESULTS Of 150 women, 49% reported genito-pelvic pain in pregnancy. The pain resolved for 59% of women, persisted for 41%, and 7% of women reported a new onset of genito-pelvic pain after childbirth. Prepregnancy nongenito-pelvic pain was associated with an increased likelihood of postpartum onset of genito-pelvic pain. Greater pain-related anxiety was associated with greater average genito-pelvic pain intensity at 3 months postpartum. CONCLUSIONS Results suggest that about half of women may develop genito-pelvic pain during pregnancy, which will persist for about a third, and a subset will develop this pain after childbirth. Prior recurrent nongenito-pelvic pain may enhance the risk of developing genito-pelvic pain postpartum, while greater pain-related anxiety in pregnancy may increase the risk for greater intensity of postpartum genito-pelvic pain.
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Affiliation(s)
- Maria Glowacka
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Barkin JL, Bloch JR, Hawkins KC, Thomas TS. Barriers to Optimal Social Support in the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2014; 43:445-54. [DOI: 10.1111/1552-6909.12463] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mortazavi F, Mousavi SA, Chaman R, Khosravi A. Maternal quality of life during the transition to motherhood. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e8443. [PMID: 25031866 PMCID: PMC4082526 DOI: 10.5812/ircmj.8443] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 11/26/2013] [Accepted: 03/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the elements of the broadening focus of health care beyond its traditional and restricted concept has been the increasing adoption quality of life approach to health care research and practice. OBJECTIVES To investigate the QOL of women in the third trimester of pregnancy and at 8 weeks postpartum and factors associated with the overall QOL. MATERIALS AND METHODS Three hundred and fifty seven pregnant women attending urban health centers in Shahroud city, located in Northeast of Iran, completed the World Health Organization Quality of Life questionnaire (WHOQOL)-BREF and General Health Questionnaire (GHQ28) in the third trimester of pregnancy and at 8 weeks postpartum. Also, breastfeeding difficulties were assessed at 4 weeks postpartum. Statistical analysis was performed using SPSS 18 for descriptive statistics, paired t-test, linear regression and multiple regression analysis. RESULTS There were significant differences between the ante-and postnatal periods in mean scores in the physical (P < 0.001) and social relationship (P = 0.033) aspects of QOL. Multiple regression analysis revealed that factor adversely affected the global score of the QOL in the antenatal period was antepartum psychological disorders. Factors that adversely affected the global score of QOL in the postnatal period were postpartum psychological disorders, breastfeeding difficulties, multiparity, higher pregnancy weight gain, and cesarean. CONCLUSIONS Results indicated that in this low risk group of women physical health and social relationship improved from pregnancy to postpartum. Interventions to promote psychological status during pregnancy and early postpartum should be designed.
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Affiliation(s)
- Forough Mortazavi
- School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, IR Iran
| | - Seyed Abbas Mousavi
- School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding Author: Seyed Abbas Mousavi, Research Center of Psychiatry, Golestan University of Medical Sciences, 5 Azar Hospital, 5 Azar St, P.O.Box: 4916936175, Gorgan, IR Iran. Tel: +98-1714446070, Fax: +98-1714460008, E-mail:
| | - Reza Chaman
- Department of Community Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, IR Iran
| | - Ahmad Khosravi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
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Health after childbirth: Patterns of reported postpartum morbidity from Lebanon. Women Birth 2014; 27:15-20. [DOI: 10.1016/j.wombi.2013.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 02/08/2013] [Accepted: 02/09/2013] [Indexed: 11/20/2022]
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Jarosinski JM, Pollard DL. Postpartum depression: perceptions of a diverse sample of low-income women. Issues Ment Health Nurs 2014; 35:189-97. [PMID: 24597584 DOI: 10.3109/01612840.2013.848960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Postpartum depression (PPD) continues to significantly impact women and their families during the perinatal period. Consequences of untreated PPD in the mother may lead to impaired mother-infant bonding, recurring psychiatric illness, and fewer positive parenting behaviors. North Carolina participates in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey and has the second highest self-reported rate of postpartum depressive symptoms at 19.0%. The full study used both quantitative and qualitative methods. The qualitative approach, an interpretive Heideggerian perspective, elicited the postpartum clients' perceptions of risk factors, how those perceptions affected the pregnancy experience, and how self-efficacy played a role in their perceived ability to make healthy choices. The sample was comprised of 60 pregnant women between the ages of 18 and 40. Four themes were found: (1) Feeling joy and apprehension at once, (2) Depression is something you think about (3) Rearranging your thinking, and (4) Garnering support. The women in this study believed that support was an indispensable tool in dealing with feelings of sadness and depression. Critical aspects of becoming involved in their pregnancy included changing their expectations and knowing how to detect and seek help when depressive symptoms occurred.
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Sadat Z, Abedzadeh-Kalahroudi M, Kafaei Atrian M, Karimian Z, Sooki Z. The Impact of Postpartum Depression on Quality of Life in Women After Child's Birth. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14995. [PMID: 24719747 PMCID: PMC3965880 DOI: 10.5812/ircmj.14995] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 10/21/2013] [Accepted: 11/27/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is a common problem after child's birth and may influence the quality of life (QOL). Investigation of postpartum QOL and depression can be useful for better care for mothers and improvement of their well-being. OBJECTIVES The objective of this study was to assess the life quality in mothers with and without PPD. PATIENTS AND METHODS In a prospective study, women who had experienced child's birth with and without PPD were recruited in Kashan-Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS) and QOL was measured by SF-36 questionnaire. Data collection was conducted at two assessment points: second month (n = 321) and fourth month (n = 300) postpartum. Based on EPDS, a score of 13 or more was defined as PPD. Mean scores of SF-36 questionnaire were compared between women with and without PPD at two assessment points and within each group from the first to the second assessments. Moreover, correlation between scores of EPDS and scores of life quality dimensions were evaluated. Data were analyzed by using the Student's t-test, Mann-Whitney U-test, ANOVA, Kruskal-Wallis, Chi-square test, Pair t test, Wilcoxon, Pearson and Spearman Correlation Coefficient. RESULTS Differences in seven out of eight mean scores of QOL dimensions (except role-physical) between depressed and non-depressed women at the first and the second assessments were significant. Results of changes in mean scores of QOL dimensions from the first to the second assessments in each group showed that non-depressed women scored higher in all of eight dimensions with significant differences in two dimensions (bodily pain and role-emotional as well as mental health component). In depressed women, scores of life quality decreased in some of QOL dimensions but differences were not significant. There were significant negative correlations between EPDS scores and scores of seven out of eight SF-36 sub-scales (except role-physical) in addition to physical and mental health components at two assessments. The highest correlation was found between EPDS scores and emotional well-being and total scores of SF-36 dimension at the first and the second assessments (r = -o.489, r = -0.381), respectively. CONCLUSIONS The findings demonstrated that postpartum depression leads to a lower life quality at second and fourth months postpartum. Integration of PPD screening into routine postnatal care is recommended.
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Affiliation(s)
- Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | | | | | - Zahra Karimian
- Department of Reproductive Health, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Zahra Sooki
- Department of Reproductive Health, Shahroud University of Medical Sciences, Shahroud, IR Iran
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81
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Haran C, van Driel M, Mitchell BL, Brodribb WE. Clinical guidelines for postpartum women and infants in primary care-a systematic review. BMC Pregnancy Childbirth 2014; 14:51. [PMID: 24475888 PMCID: PMC3906750 DOI: 10.1186/1471-2393-14-51] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
Abstract
Background While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. Methods PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Results Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Conclusions Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.
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Affiliation(s)
| | | | | | - Wendy E Brodribb
- Discipline of General Practice, School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Level 8, Health Sciences Building, Herston 4029, Australia.
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82
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Zubaran C, Foresti K. Correlation between breastfeeding and maternal health status. EINSTEIN-SAO PAULO 2014; 11:180-5. [PMID: 23843058 PMCID: PMC4872891 DOI: 10.1590/s1679-45082013000200008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/30/2013] [Indexed: 12/29/2022] Open
Abstract
Objective: To examine the relation between breastfeeding efficacy and health status in a sample of 88 mothers from Southern Brazil. Methods: Research participants completed the Portuguese version of the General Health Questionnaire and the Personal Health Scale. Breastfeeding efficacy was evaluated using the Breastfeeding Self-Efficacy Scale. Correlations between breastfeeding and health status scores were examined using Pearson's correlation coefficient. Results: The results of this study revealed significant correlations between the scores of the two general health and well-being questionnaires and the Breastfeeding Self-Efficacy Scale. Bivariate regression analyses revealed that both health status instruments significantly predicted Breastfeeding Self-Efficacy Scale scores. Conclusion: Breastfeeding efficacy is significantly related to maternal health status in Southern Brazil.
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83
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Angelo RDCDO, Silva DCD, Zambaldi CF, Cantilino A, Sougey EB. Influence of body posture on the association between postpartum depression and pain. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2014; 36:32-9. [PMID: 27000546 DOI: 10.1590/2237-6089-2013-0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/20/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the association between postpartum depression (PPD), intensification of back pain and exacerbation of changes in postural alignment intrinsic to puerperium. METHODS Eighty women at 2 to 30 weeks postpartum were included in the study according to the following criteria: literate mothers, gestation of 34 to 42 weeks, and healthy live-born infants. All mothers agreed to participate in the study. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Pain was assessed using a visual analogue scale (VAS) and the Nordic Musculoskeletal Questionnaire (NMQ), and posture, using real time naturalistic observation. RESULTS There was a statistically significant association between PPD and pain intensity (p = 0.002). The upper back was the most frequent pain site among depressed women, both before (p = 0.04) and after delivery (p = 0.01). There were no associations between PPD and type of posture (p = 0.328). However, pain intensity was greater among depressed women in the swayback group (p < 0.001). CONCLUSION The intensification of puerperal pain is closely associated with PPD. Our results suggest that back pain may be both a risk factor and a comorbidity of PPD among puerperal women and that pain and type of posture are interdependent.
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84
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Song JE, Chae HJ, Kim CH. Changes in perceived health status, physical symptoms, and sleep satisfaction of postpartum women over time. Nurs Health Sci 2013; 16:335-42. [DOI: 10.1111/nhs.12109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 10/10/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ju-Eun Song
- College of Nursing; Ajou University; Suwon South Korea
| | - Hyun Ju Chae
- Department of Nursing; Joongbu University; Geumsan South Korea
| | - Chang Hee Kim
- Department of Nursing; Konyang University; Daejeon South Korea
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85
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Chang HY, Lai YH, Jensen MP, Shun SC, Hsiao FH, Lee CN, Yang YL. Factors associated with low back pain changes during the third trimester of pregnancy. J Adv Nurs 2013; 70:1054-64. [DOI: 10.1111/jan.12258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 01/06/2023]
Affiliation(s)
- Hao-Yuan Chang
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Yeur-Hur Lai
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine; University of Washington; Seattle Washington USA
| | - Shiow-Ching Shun
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Fei-Hsiu Hsiao
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Chen-Nan Lee
- Department of Gynecology and Obstetrics; National Taiwan University Hospital; Taipei Taiwan
| | - Ya-Ling Yang
- School of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
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86
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Ho CL, Chang LI, Wan KS. The relationships between postpartum adaptation and postpartum depression symptoms of first pregnancy mothers in Taiwan. Int J Psychiatry Med 2013; 45:1-13. [PMID: 23805600 DOI: 10.2190/pm.45.1.a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Motherhood is a critical situation characterized by role conflicts. These conflicts between the roles of mother, worker, and wife are the norm in the postpartum period and may jeopardize a mother's well-being. The purpose of this study was to explore the relationships between postpartum adaptation and depression among new mothers who live in northern Taiwan. MATERIAL AND METHODS A total of 186 first pregnancy mothers were recruited via convenience sampling methods and they completed mailed questionnaires between 1 week and 2 months after giving birth. Structured questionnaires including Demographic Inventory Scale, Postpartum Self-Evaluation Questionnaire, and Edinburgh Postnatal Depression Scale were used. RESULTS Ninety-four (50.5%) women exhibited depressive symptoms (EPDS > 10) and 73 (39.2%) women needed to consult the doctor (EPDS > 12). The risk factors for postpartum depression symptoms included unplanned birth, low socioeconomic status, and part-time employment. The correlation between women's different aspects of postpartum adaptation and depression ranged was from low to medium. The best predictors of postpartum depression were confidence in their own competence of motherhood tasks, satisfaction with life circumstances, and partner participating in child care. These three subsets explained 44.8% of the total variance. CONCLUSION This study shows that healthcare providers who work with primiparas during the first 2 months after giving birth should pay more attention to postpartum depression, keeping in mind associated risk factors. A new mother's confidence in her own abilities as a new mother may be particularly important in determining the likelihood of postpartum depression.
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87
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Cheng CY, Walker LO, Chu TP. Physical Conditions and Depressive Symptoms of Chinese Postpartum Mothers in the United States and Taiwan. Health Care Women Int 2013; 34:539-55. [DOI: 10.1080/07399332.2012.655389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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88
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Larkin V. An exploration of midwives' experiences and practice in relation to their assessment of maternal postnatal genital tract health. Midwifery 2013; 30:72-81. [PMID: 23522663 DOI: 10.1016/j.midw.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/30/2013] [Accepted: 02/02/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE to explore the experiences and practice of midwives in relation to the assessment of maternal postnatal genital tract health. DESIGN a constructionist grounded theory methodology was employed to guide the research design and processes. Ethical approval was gained from the regional research ethics committee and the research and development committee at the data collection site. Sampling was purposeful and data were collected using narrative style in depth interviews involving 14 midwives. Observations of 15 postnatal assessments involving five midwives and 15 postnatal women were also undertaken. SETTING a small maternity unit providing midwifery care to childbearing women in both the hospital and community setting in the North East of England. FINDINGS three themes were identified from the data and form the framework of the constructed grounded theory: Methods, Motivators and Modifiers. Within each theme are a number of categories and focused codes. The Methods theme summarises a range of assessment methods used by the midwives, including risk assessment, questioning and clinical observations. The Motivators theme incorporates factors which motivated how, when and why the midwives undertook genital tract assessment and includes verification, personal preferences and sensitive care. The Modifiers theme consists of factors and contexts, which facilitated or inhibited the midwives' ability to negotiate an appropriate approach to assessment including therapeutic relationship, care in context and evolving midwifery knowledge. CONCLUSIONS the findings of this study suggest midwives are aware of a range of assessment methods; however there was less articulation or demonstration of methods pertaining to assessment of uterine health. The motivating and modifying factors highlight midwife, woman and contextual factors, which may enhance and inhibit the midwives clinical reasoning process. The complexity of contemporary midwifery practice is illuminated as these factors conflict and create practice tensions and contradictions for the midwives. Implications include the need to ensure midwives have the knowledge regarding uterine health and the skills, affective abilities, resources and opportunities to engage women in health assessments within the complexity of contemporary practice.
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Affiliation(s)
- Valerie Larkin
- University of Northumbria, Room H210, Coach Lane Campus East, Coach Lane, Benton, Newcastle upon Tyne, NE7 7XA, UK.
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89
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Barimani M, Oxelmark L, Johansson SE, Langius-Eklöf A, Hylander I. Professional support and emergency visits during the first 2 weeks postpartum. Scand J Caring Sci 2013; 28:57-65. [DOI: 10.1111/scs.12036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Mia Barimani
- Center for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society; Karolinska Insititutet; Stockholm Sweden
| | - Lena Oxelmark
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg; Sweden
| | - Sven-Erik Johansson
- Center for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society; Karolinska Insititutet; Stockholm Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society; Karolinska Institute; Stockholm Sweden
| | - Ingrid Hylander
- Center for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society; Karolinska Insititutet; Stockholm Sweden
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90
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Henderson J, Redshaw M. Who is well after childbirth? Factors related to positive outcome. Birth 2013; 40:1-9. [PMID: 24635418 DOI: 10.1111/birt.12022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poor outcomes after childbirth are associated with physical ill health and with an absence of a positive sense of well-being. Postnatally poor physical health is thought to be influenced by the care received, the nature of the birth, and associated complications. The aim of this study was to estimate the effects of a range of clinical and other factors on positive outcome and well-being 3 months after childbirth. METHODS This study used data on more than 5,000 women from a 2010 National Maternity Survey about their experiences of maternity care, and health and well-being 3 months after childbirth. Positive outcome was defined as women reporting no problems and feeling "very well" at the time of the survey. RESULTS In the univariate analysis, several variables were significantly associated with positive outcome, including sociodemographic, antenatal, intrapartum, and postnatal factors. In the final logistic regression model, young mothers, those without physical disability and those with no or few antenatal or early postnatal problems, were most likely to have positive outcomes. Other significant factors included a positive initial reaction to the pregnancy, not reporting antenatal depression, fewer worries about the labor and birth, and access to information about choices for care. CONCLUSIONS This study shows how positive outcomes for women after childbirth may be influenced by health, social, and care factors. It is important for caregivers to bear these factors in mind so that extra support may be made available to those women who are likely to be susceptible to poor outcome.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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91
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Sadat Z, Taebi M, Saberi F, Kalarhoudi MA. The relationship between mode of delivery and postpartum physical and mental health related quality of life. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2013; 18:499-504. [PMID: 24554950 PMCID: PMC3917135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The postpartum period is a critical life event for women leading physical, emotional, and social changes. Postpartum quality-of-life may be affected by delivery mode. The purpose of this study was to determine the association between postpartum health related quality-of-life (HRQoL) and mode of delivery. MATERIALS AND METHODS In a prospective study, 300 women consisting of 150 vaginal deliveries (VD) and 150 cesarean sections (CS) were recruited between August 2007 and October 2008 from health centers. Stratified random sampling was performed to select 10 Health Centers in Kashan City, Iran. Physical and mental HRQoL was measured using the SF-36 questionnaire and compared between VD and CS groups 2 and 4 months after delivery. Data were analyzed by using the Student's t-test, Mann-Whitney U-test, and Chi-square test. RESULTS Results showed physical HRQoL at 2 months after VD was better than CS significantly; there were significant differences in the physical functioning and role physical subscales. Furthermore mental HRQoL at 4 months after VD was better than CS significantly; there were significant difference in the social function and emotional health subscales. CONCLUSION The findings demonstrated that VD leads to a better physical health at 2 months after delivery and mental health at 4 months after delivery. Efforts should be made to reduce CS.
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Affiliation(s)
- Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboubeh Taebi
- Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Miss Mahboubeh Taebi, Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Farzaneh Saberi
- Department of Midwifery, Kashan University of Medical Sciences, Kashan, Iran
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92
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Abstract
BACKGROUND Physical and psychological problems after childbirth are common, and may have a significant negative and long-term impact on women's wellbeing and daily functioning. The method of birth may be a particularly important factor influencing women's health and wellbeing following birth, however, population-wide evidence is limited. This study uses data from 5,332 women who responded to a national survey of women's experiences of maternity care in England. We examined women's postnatal wellbeing in the first three months after birth, and whether these varied by mode of birth. METHODS This is a secondary analysis of survey data using a random sample of women selected from birth registration. We used multinomial logistic regression models to examine the association between women's self-reported psychological symptoms, health problems and mode of birth. RESULTS Women who had forceps-assisted vaginal births and unplanned caesarean section births reported the poorest health and wellbeing, while those of women who had unassisted vaginal births and planned caesarean section births were less affected by the birth process. Most women's physical and emotional health appeared to improve with time, however, those who had a forceps-assisted vaginal birth were more likely to report ongoing posttraumatic-type symptoms several months after the birth. CONCLUSIONS Mode of birth was associated with differences in outcomes at three months. By comparison to women who had unassisted vaginal births, the risk of reduced postnatal health and wellbeing was higher amongst the women who had forceps-assisted vaginal births but not amongst women who had ventouse-assisted vaginal births. This would suggest that it is important to differentiate the different types of instrumental birth in outcome studies. Of concern was the higher rate of posttraumatic-type symptoms among women who had forceps-assisted vaginal births relative to the other modes of birth. Women who have forceps-assisted births should be monitored carefully by health professionals in the postnatal period, and in the months after childbirth, when they could be offered the opportunity to discuss their labour and birth.
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93
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Rosenthal DG, Learned N, Liu YH, Weitzman M. Characteristics of Mothers with Depressive Symptoms Outside the Postpartum Period. Matern Child Health J 2012; 17:1030-7. [DOI: 10.1007/s10995-012-1084-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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94
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Measurement invariance of the SF-12 across European-American, Latina, and African-American postpartum women. Qual Life Res 2012; 22:1135-44. [DOI: 10.1007/s11136-012-0232-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/28/2022]
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95
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Lal M, Pattison HM, Allan TF, Callender R. Does post-caesarean dyspareunia reflect sexual malfunction, pelvic floor and perineal dysfunction? J OBSTET GYNAECOL 2012; 31:617-30. [PMID: 21973137 DOI: 10.3109/01443615.2011.594915] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim was to define post-caesarean dyspareunia as a sexual and pelvic-perineal symptom. Post-caesarean (80 elective, 104 emergency) and 100 vaginally delivered primiparae had domiciliary interviews at 10 months postpartum. A total of 50 (28% and 27%) post-caesarean and 46 (46%) vaginally delivered, reported dyspareunia. Severely impaired general sexual health occurred in 82 (24% elective, 25% emergency, 35% vaginally delivered) as category 3 (dyspareunia with sexual symptoms) and 27 (10% elective, 7% emergency, 12% vaginally delivered) as category 4 (reduced frequency < 6). The risk of dyspareunia (RR 1.14, CI 0.73, 1.77) or impaired general sexual health (RR 0.93, CI 0.32, 2.74) was similar among those with or without perineal trauma. Both caesarean and perineal scars were associated with sexual malfunction. Primiparae with new incontinence had a lower risk of dyspareunia than impaired general sexual health. Awareness of the associations of post-caesarean dyspareunia and impaired general sexual health with incontinence would facilitate appropriate obstetric decision-making. Further research is indicated.
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Affiliation(s)
- M Lal
- Women's and Children's Directorate, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK.
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96
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Feinberg E, Donahue S, Bliss R, Silverstein M. Maternal depressive symptoms and participation in early intervention services for young children. Matern Child Health J 2012; 16:336-45. [PMID: 21140201 PMCID: PMC3108048 DOI: 10.1007/s10995-010-0715-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many young children with developmental delay who are eligible for early intervention (EI) services fail to receive them. We assessed the relationship between depressive symptoms in mothers, a potentially modifiable risk, and receipt of EI services by their eligible children. We conducted multivariable analyses of a nationally representative sample of children eligible for EI services at 24 months using data from the Early Childhood Longitudinal Study-Birth Cohort. Maternal depressive symptoms were assessed at 9 and 24 months. Birthweight <1,000 g, genetic and medical conditions associated with developmental delay, or low scores on measures of developmental performance defined EI eligibility. Service receipt was ascertained from parental self-report. Models were adjusted for sociodemographic and child risk. Among the 650 children who were eligible to receive EI services as infants, 33.2% of children whose mothers were depressed received services compared to 27.0% whose mothers were not depressed (aOR 1.8; 95% CI 0.8, 4.0). Among the 650 children who became eligible to receive services as toddlers, 13.0% of children whose mothers were depressed received services compared to 2.6% whose mothers were not depressed (aOR 4.6, 95% CI 1.5, 14.6). Among children receiving EI services, prevalence of depressive symptoms was 23.0% for mothers whose children became eligible as infants and 57.5% for mothers whose children became eligible as toddlers. Depressive symptoms in mothers of children eligible to receive EI services did not appear to limit participation. EI programs may be an appropriate setting in which to address maternal depressive symptoms.
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Affiliation(s)
- Emily Feinberg
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
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97
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Senturk V, Hanlon C, Medhin G, Dewey M, Araya M, Alem A, Prince M, Stewart R. Impact of perinatal somatic and common mental disorder symptoms on functioning in Ethiopian women: the P-MaMiE population-based cohort study. J Affect Disord 2012; 136:340-9. [PMID: 22196052 PMCID: PMC3314986 DOI: 10.1016/j.jad.2011.11.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 11/06/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known of the relationship between perinatal somatic and common mental disorder (CMD) symptoms and impaired functioning in women from settings where the burden of undernutrition and infectious disease morbidity is high. METHODS A population-based sample of 1065 women from Butajira, Ethiopia, was recruited in pregnancy (86.4% of those eligible) and reassessed two months postnatal (954 with singleton, live infants). At both time-points, women were administered a modified version of the Patient Health Questionnaire-15 and the Self-Reporting Questionnaire (locally-validated) to assess somatic and CMD symptoms, respectively. Negative binomial regression was used to investigate associations of CMD and somatic symptoms with functional impairment (World Health Organisation Disability Assessment Scale, version-II), after adjusting for maternal anthropometric measures, physical ill-health and sociodemographic factors. RESULTS In pregnancy, somatic and CMD symptoms were independently associated with worse maternal functional impairment after adjustment for confounders (WHODAS-II score multiplied by 1.09 (95%CI 1.06, 1.13) and 1.11 (95%CI 1.08, 1.14) respectively for each additional symptom). In the postnatal period, the size of association between somatic symptoms and functional impairment was diminished, but the association with CMD symptoms was virtually unchanged (multiplier value 1.04 (95%CI 1.00, 1.09) and 1.11 (95%CI 1.07, 1.16) respectively). LIMITATIONS Use of largely self-report measures. CONCLUSIONS Somatic and CMD symptoms were independently associated with functional impairment in both pregnancy and the postnatal period, with CMD symptoms showing a stronger and more consistent association. This emphasises the public health relevance of both CMD and somatic symptoms in the perinatal period.
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Affiliation(s)
- Vesile Senturk
- King's College London (Institute of Psychiatry), London, United Kingdom,Department of Psychiatry, University of Ankara, Turkey
| | - Charlotte Hanlon
- King's College London (Institute of Psychiatry), London, United Kingdom,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia,Corresponding author.
| | - Girmay Medhin
- Aklilu-Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Michael Dewey
- King's College London (Institute of Psychiatry), London, United Kingdom
| | - Mesfin Araya
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Martin Prince
- King's College London (Institute of Psychiatry), London, United Kingdom
| | - Robert Stewart
- King's College London (Institute of Psychiatry), London, United Kingdom
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Webster J, Nicholas C, Velacott C, Cridland N, Fawcett L. Quality of life and depression following childbirth: impact of social support. Midwifery 2011; 27:745-9. [DOI: 10.1016/j.midw.2010.05.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 04/23/2010] [Accepted: 05/21/2010] [Indexed: 12/01/2022]
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Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic stress disorder in new mothers: results from a two-stage U.S. national survey. Birth 2011; 38:216-27. [PMID: 21884230 DOI: 10.1111/j.1523-536x.2011.00475.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prevalence rates of women in community samples who screened positive for meeting the DSM-IV criteria for posttraumatic stress disorder after childbirth range from 1.7 to 9 percent. A positive screen indicates a high likelihood of this postpartum anxiety disorder. The objective of this analysis was to examine the results that focus on the posttraumatic stress disorder data obtained from a two-stage United States national survey conducted by Childbirth Connection: Listening to Mothers II (LTM II) and Listening to Mothers II Postpartum Survey (LTM II/PP). METHODS In the LTM II study, 1,373 women completed the survey online, and 200 mothers were interviewed by telephone. The same mothers were recontacted and asked to complete a second questionnaire 6 months later and of those, 859 women completed the online survey and 44 a telephone interview. Data obtained from three instruments are reported in this article: Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Postpartum Depression Screening Scale (PDSS), and the Patient Health Questionnaire-2 (PHQ-2). RESULTS Nine percent of the sample screened positive for meeting the diagnostic criteria of posttraumatic stress disorder after childbirth as determined by responses on the PSS-SR. A total of 18 percent of women scored above the cutoff score on the PSS-SR, which indicated that they were experiencing elevated levels of posttraumatic stress symptoms. The following variables were significantly related to elevated posttraumatic stress symptoms levels: low partner support, elevated postpartum depressive symptoms, more physical problems since birth, and less health-promoting behaviors. In addition, eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well-being since birth. A stepwise multiple regression revealed that two predictor variables significantly explained 55 percent of the variance in posttraumatic stress symptom scores: depressive symptom scores on the PHQ-2 and total number of physical symptoms women were experiencing at the time they completed the LTM II/PP survey. CONCLUSION In this two-stage national survey the high percentage of mothers who screened positive for meeting all the DSM-IV criteria for a posttraumatic stress disorder diagnosis is a sobering statistic.
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Monteiro SMDR, Jancey J, Howat P, Burns S, Jones C, Dhaliwal SS, McManus A, P Hills A, Anderson AS. The protocol of a randomized controlled trial for playgroup mothers: Reminder on Food, Relaxation, Exercise, and Support for Health (REFRESH) Program. BMC Public Health 2011; 11:648. [PMID: 21843366 PMCID: PMC3166931 DOI: 10.1186/1471-2458-11-648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother's physical activity levels are relatively low, while their energy consumption is generally high resulting in 58% of Australian women over the age of 18 years being overweight or obese. This study aims to confirm if a low-cost, accessible playgroup based intervention program can improve the dietary and physical activity behaviours of mothers with young children. METHODS/DESIGN The current study is a randomized controlled trial lifestyle (nutrition and physical activity) intervention for mothers with children aged between 0 to 5 years attending playgroups in Perth, Western Australia. Nine-hundred participants will be recruited and randomly assigned to the intervention (n = 450) and control (n = 450) groups. The study is based on the Social Cognitive Theory (SCT) and the Transtheoretical Model (TTM), and the Precede-Proceed Framework incorporating goal setting, motivational interviewing, social support and self-efficacy. The six month intervention will include multiple strategies and resources to ensure the engagement and retention of participants. The main strategy is home based and will include a specially designed booklet with dietary and physical activity information, a muscle strength and flexibility exercise chart, a nutrition label reading shopping list and menu planner. The home based strategy will be supported by face-to-face dietary and physical activity workshops in the playgroup setting, posted and emailed bi-monthly newsletters, and monthly Short Message Service (SMS) reminders via mobile phones. Participants in the control group receive no intervention materials. Outcome measures will be assessed using data that will be collected at baseline, six months and 12 months from participants in the control and intervention groups. DISCUSSION This trial will add to the evidence base on the recruitment, retention and the impact of community based dietary and physical activity interventions for mothers with young children. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.
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Affiliation(s)
- Sarojini MDR Monteiro
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Jonine Jancey
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Peter Howat
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Sharyn Burns
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
| | - Carlie Jones
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Satvinder S Dhaliwal
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Alexandra McManus
- Curtin Health Innovation Research Institute, Curtin University, Western Australia, Australia
| | - Andrew P Hills
- Griffith University and Mater Medical Research Institute, Queensland, Australia
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
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