Inside a Postpartum Nursing Center: Tradition and Change

Risk and protective factors for postpartum depressive symptoms among women in postpartum nursing center

OBJECTIVES

In Taiwan, many women receive postpartum care at postpartum nursing centers for one month. However, limited research has examined the postpartum depressive symptoms in women residing in postpartum nursing center. The objectives of this study were to investigate the prevalence of postpartum depressive symptoms and to identify the risk factors and protective factors for postpartum depressive symptoms in postpartum nursing center.

MATERIALS AND METHODS

This was an observational study. Postpartum women who were over 20 years old and able to speak Mandarin Chinese or Taiwanese, and had delivered singleton, live infants at term were recruited between January 2020 and June 2020 from a postpartum nursing center in central Taiwan. A questionnaire including sociodemographic characteristics, the Edinburgh Postnatal Depression Scale, and a pain scale was administered at first week and last week in the postpartum nursing center.

RESULTS

A total of 60 postpartum women participated in the study. The prevalence rates of postpartum depressive symptoms after admission and before discharge from a postpartum nursing center were 13% and 8%, respectively. The postpartum depressive symptoms and postpartum pain intensity (including perineum pain and postoperative pain after caesarean delivery) scores were significantly decreased after staying at the postpartum nursing center. The risk factors for postpartum depressive symptoms were previous abortion experience and postpartum pain, while the protective factors were having child care arrangements after return home and having 8-11 h of sleep per day.

CONCLUSIONS

There is a need for the early detection and management of postpartum depressive symptoms in postpartum nursing center.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

BACKGROUND

The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks.

METHODS

The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. RESULTS: PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2-5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50).

CONCLUSION

Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women's mental and physical health in the early postpartum in China.

Experiences of Implementing Rooming-in Practice for First-Time Mothers in a Postpartum Care Center

Introduction

Practices promoted by the Baby-Friendly Hospital Initiative have become a part of the current mainstream postpartum infant care. However, adherence to rooming-in practice by health-care facilities is lower than that of other steps under this initiative.

Objective

The aim of this study was to investigate the experiences in implementing the rooming-in policy among first-time mothers at a postpartum center.

Methods

The present study is a qualitative research conducted using the descriptive phenomenological method. This study was performed at a postpartum care center in Southern Taiwan between August 2018 and December 2018. Semi-structured interviews were conducted with 20 postpartum mothers during their postpartum care center stay.

Results

Based on interview data, this study identified three main themes about implementing full-time rooming-in experiences: (a) against the rule of taking plenty of rest during the postpartum period, (b) negative experiences and myths regarding implementing rooming-in experience, and (c) postpartum care centers service content affect first-time mothers' willingness to implement rooming-in.

Conclusions

In postpartum care centers, first-time mothers' willingness to implement full-time rooming-in significantly decreases due to the effects of the "doing-the-month" culture, postpartum physical recovery status, stress of the rooming-in experience, myths regarding rooming-in practice, trusting professional neonate care services more than own care, and attitude toward payment for services.

Obstetric anesthesia clinic childbirth course combined with labor epidural analgesia is associated with a decreased risk of postpartum depression : a prospective cohort study

BACKGROUND

Postpartum depression (PPD) is a serious complication commonly seen in postnatal women. In this paper, an investigation was conducted to see if obstetric anesthesia clinic childbirth course combined with labor epidural analgesia (LEA) was associated with a decreased risk of PPD.

METHODS

Six hundred fifty-five nulliparous women were enrolled in this prospective cohort study. The parturients were divided into 4 groups, with Group C being the control group, Group AC received the obstetric anesthesia clinic childbirth course only, Group LEA received LEA only, and Group AC + LEA received both the obstetric anesthesia clinic childbirth course and LEA. Maternal and neonatal variables in the perinatal period were recorded. PPD at 6 weeks was assessed using the Chinese version of the Edinburgh Postpartum Depression Scale (EPDS), where a score ≥ 10 is the threshold for PPD. Multivariate logistic regression analysis was performed to assess the association between obstetric anesthesia clinic childbirth course combined with LEA and postpartum depression.

RESULTS

A total of 124 maternities had EPDS ≥10 points, the incidence of PPD was 18.9%。The incidence of PPD and EPDS scores were significantly lower in Group AC + LEA than in Group C (12.1% vs 26.8%, P <  0.05; 6 (5, 7) vs 7 (5, 11), P <  0.05). Received an anesthesia clinic childbirth course combined with LEA was associated with a decreased risk of PPD (OR 0.273, 95% CI, 0.100-0.743, P = 0.013). Multivariate logistic regression analysis identified 5 other independent factors for PPD, including maternal SAS score in the delivery room, W-DEQ score in the delivery room, living in a confinement center, EPDS score at 1st week postpartum and perinatal care satisfaction .

CONCLUSIONS

Received an obstetrics anesthesia clinic childbirth course combined with LEA for nulliparous women with a single term cephalic pregnancy was associated with a decreased risk of PPD at 6 weeks.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2000039163. Registered on 20/10/2020.

Analysis of Obstetric Clinical Nursing Integrating Situational Teaching Simulation

This paper applies the situational teaching mode to obstetric clinical nursing. When explaining the nursing operation skills, according to the pre written script, design some common clinical nurse-patient conflicts and carry out situational simulation performances, so as to inspire students to think about how to effectively communicate with patients and their families and establish a harmonious nurse-patient relationship. At the same time, this paper also urges students to improve their initiative of autonomous learning and actively participate in the whole process of learning, rather than passively accept knowledge. Finally, the teaching methods of combining obstetric clinical nursing teaching with experimental teaching were compared to explore the effectiveness of situational teaching simulation teaching mode. Through the experimental comparative analysis, it can be seen that the obstetric clinical nursing teaching model based on situational teaching simulation has a certain effect and has a good guiding significance for the practical teaching of obstetric clinical nursing.

Design of Exercise Nursing Program for Pelvic Floor Muscle Function Recovery at 42 Days Postpartum

In order to explore the effect of exercise nursing intervention for pelvic floor muscle function recovery at 42 days postpartum, this paper conducts experimental research through controlled experiments, combines statistical methods to carry out digital processing, and sets a single variable of nursing intervention to provide a basis for experimental control, and statistical test results are used for effect evaluation. It has been discovered via experimental study that pelvic floor muscle function recovery exercise training for normal delivery women may enhance the mother's compliance with the pelvic floor muscle function exercise. Moreover, it can reduce the occurrence of urinary incontinence and pelvic organ prolapse, improve the postpartum pelvic floor function of postpartum women, improve the quality of life, and have a significant recovery effect. In addition, it is a simple, noninvasive, and highly safe continuation nursing measure, which can effectively improve the quality of obstetric care and has strong clinical use value.

Immigrant Southeast and East Asian mothers’ transnational postpartum cultural practices: A meta-ethnography

Objective:

Southeast and East Asian mothers experience the postpartum period differently than that of the general population. Despite the documented difference, there is limited representation of postpartum cultural practices in nursing and midwifery research. The purpose of this meta-ethnography is to synthesize qualitative findings from studies that examined postpartum cultural practices of Southeast and East Asian mothers globally to ensure better maternal health outcomes.

Methods:

Noblit and Hare’s seven-step meta-ethnographic approach was used. We analyzed constructs, concepts, themes, and metaphors using Krippendorff’s content analysis. The guidelines for preferred reporting the synthesis of qualitative research were adhered to enhancing transparency (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Results:

The collaborative search process in the following databases, PsycINFO, CINAHL, and Scopus, resulted in eight high quality research studies published between January 2017 and February 2020. Five studies discussed postpartum traditions of immigrant mothers (n = 67) living in North America (n = 67), while three studies explored that of mothers living in Southeast and East Asian. Mothers (n = 132) from China, Hong Kong, Taiwan, Korea, Vietnam, and Hmong participated.

Findings:

Three themes emerged: (1) importance of maintaining postpartum cultural practices; (2) barriers of “doing-the-month”; and (3) modification: practicality over tradition. Although participants recognized value in postpartum traditions, the lack of social support deterred more immigrant than non-immigrant Southeast and East Asian mothers from “doing-the-month.” Due to the influence of western medicine, clinicians’ postpartum care suggestions, and use of modern technology (e.g., Internet), Southeast and East Asian mothers had informed choices to adapt, modify, or “break with tradition.”

Conclusion:

Similarities and differences existed in how each Southeast and East Asian mother accepted and engaged with postpartum cultural practices, a process which aligned with one’s definition of health. Maternity care providers should further elicit Southeast and East Asian mothers’ needs based on individualized assessments beginning in prenatal care with emphasis on social support for mothers who have recently immigrated and given birth in their adopted countries.

Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study

BACKGROUND

Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.

OBJECTIVES

To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes.

DESIGN

A single-blind, randomised controlled trial.

SETTING

A prenatal clinic of a teaching hospital.

PARTICIPANTS

First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group.

METHODS

A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months.

RESULTS

Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p < .001), and postpartum at 1-week (p < .001), 1-month (p < .001) and 3-months (p < .01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p < .001) and 6-months postpartum (MD: 7.0, p < .05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p < .05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p < .02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05).

CONCLUSIONS

The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.

TRIAL REGISTRATION

Registered with www.clinicaltrials.gov (NCT03807726).

The maternity ward of a teaching hospital: reconfiguration of maternal-child nursing care

OBJECTIVE

to analyze the strategies used by nurses and nurse professors for a better position in the maternity ward of the teaching hospital of the Universidade Federal do Espírito Santo.

METHOD

this is a social-historical study with a qualitative approach. The primary sources were written documents, such as official letters, memos, ordinances, standards and routines of the hospital; photographic material; and oral testimonies from seven participants. The interviews were performed using a semi-structured questionnaire, with questions regarding the adaptation from a sanatorium to a teaching hospital, the challenges faced, and the strategies adopted by the nursing department.

RESULTS

the results allowed us to understand the close link between the maternity ward and the nursing course of the Universidade Federal do Espírito Santo, which created a differentiated nursing care that integrated training and care with a broader and humanized look.

FINAL CONSIDERATIONS

the actions of the nurses were recognized and gave them professional visibility, influencing a new form of care in the maternity ward.

Food Therapy in Sinosphere Asia

Traditional Chinese Food Therapy has long been an integral part of dietary practices in Sinosphere Asia. This therapy is defined by the classification of foods into cooling (Yin) and heaty (Yang) and the manipulation of dietary intake of these foods as a therapeutic strategy for chronic diseases. Both functional dyspepsia (FD) and irritable bowel syndrome (IBS) are chronic, functional gut disorders widely prevalent in Sinosphere Asia. Diet is increasingly recognized as a symptom trigger in FD and IBS, and the evidence suggesting the utility of diet therapies as front-line management is growing, particularly in the West. Specifically, a diet low in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols is an efficacious therapy for patients with IBS. In contrast, a proportion of patients with IBS in Sinosphere Asia utilize Chinese Food Therapy for symptom management. Chinese Food Therapy provides an attractive target for integration with evidence-based Western dietary therapies as a management strategy in FD and IBS. However, significant gaps in research exist with the utility of Chinese Food Therapy that first need to be addressed. This includes a lack of standardization for heaty and cooling classification, limited mechanistic rationale or clinical studies supporting its efficacy in FD and IBS, and the lack of an ideal practitioner for implementation of Chinese Food Therapy. Hence, the review provides a summary of the role of diet and nutrition in Sinosphere Asia with an emphasis on FD and IBS, and an examination of how modern dietary practices may be able to be integrated into practices in this region.

The care needs of postpartum women taking their first time of doing the month: a qualitative study

BACKGROUND

In contemporary Taiwan, after giving birth, many women undertake a traditional postpartum practice called 'doing the month', which occurs in the medical context of postpartum nursing centres instead of at home. Thus, healthcare workers must identify and address the care needs of new mothers in this setting to improve the care of new mothers and their baby and family.

AIM

To explore new mothers' care needs from their own perspectives during the period of doing the month.

METHODS

A qualitative study was performed. Eligible participants recruited through purposive sampling were interviewed comprehensively.

RESULTS

Twenty-seven primiparous women participated (mean age: 32 years; mean marriage length: 3.4 years). Four themes were identified: the need to increase energy to gain more yang force, the need to internalise mothering, the need to be supported by the family and friends, and the need to be understood.

CONCLUSIONS

For effective care, sufficient support and guidance must be provided to first-time mothers and their families, especially when mother-baby rooming-in is the standard of care.