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Holstad Y, Johansson B, Lindqvist M, Westergren A, Sundström Poromaa I, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Wikström AK, Bay A. Self-rated health in primiparous women with congenital heart disease before, during and after pregnancy - A register study. SCAND CARDIOVASC J 2024; 58:2295782. [PMID: 38130125 DOI: 10.1080/14017431.2023.2295782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
Background. Poor maternal self-rated health in healthy women is associated with adverse neonatal outcomes, but knowledge about self-rated health in pregnant women with congenital heart disease (CHD) is sparse. This study, therefore, investigated self-rated health before, during, and after pregnancy in women with CHD and factors associated with poor self-rated health. Methods. The Swedish national registers for CHD and pregnancy were merged and searched for primiparous women with data on self-rated health; 600 primiparous women with CHD and 3062 women in matched controls. Analysis was performed using descriptive statistics, chi-square test and logistic regression. Results. Women with CHD equally often rated their health as poor as the controls before (15.5% vs. 15.8%, p = .88), during (29.8% vs. 26.8% p = .13), and after pregnancy (18.8% vs. 17.6% p = .46). None of the factors related to heart disease were associated with poor self-rated health. Instead, factors associated with poor self-rated health during pregnancy in women with CHD were ≤12 years of education (OR 1.7, 95%CI 1.2-2.4) and self-reported history of psychiatric illness (OR 12.6, 95%CI 1.4-3.4). After pregnancy, solely self-reported history of psychiatric illness (OR 5.2, 95%CI 1.1-3.0) was associated with poor self-rated health. Conclusion. Women with CHD reported poor self-rated health comparable to controls before, during, and after pregnancy, and factors related to heart disease were not associated with poor self-rated health. Knowledge about self-rated health may guide professionals in reproductive counselling for women with CHD. Further research is required on how pregnancy affects self-rated health for the group in a long-term perspective.
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Affiliation(s)
- Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Lindqvist
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | | | | | | | - Mikael Dellborg
- Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
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Ferreira MS, da Silva ZP, de Almeida MF, Alencar GP. Is parenthood associated with self-rated health among women in Brazil? PLoS One 2023; 18:e0293262. [PMID: 37903132 PMCID: PMC10615280 DOI: 10.1371/journal.pone.0293262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/09/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Previous studies conducted in Europe and North America addressing the relationship between self-rated health and parenthood offer inconsistent results, with effects ranging from nonsignificant to significant and in opposite directions. The aim of the present study was to explore the relationship between parenthood and self-rated health (SRH) among women in Brazil (a country with strong inequalities) considering the time interval from the last delivery in the analyses, as proposed in previous studies set in Sweden. METHODS The study used data from cross-sectional National Health Surveys in Brazil conducted from 2013 to 2014 and 2019 to 2020 with selected groups of 20,046 and 25,100 women for whom complete data were available on the variables of interest. The primary outcome was self-rated health measured on a five-point scale. Partial proportional odds models were employed. RESULTS Compared to women that were not a parent, primiparous women whose delivery was within less than one year had a lower likelihood of worse SRH (OR (95% CI): 0.58-0.84 in 2013, and 0.64-0.94 in 2019), whereas multiparous women whose last delivery was more than one year earlier had greater likelihood of worse SRH (OR (95% CI): 1.08-1.27 in 2013, and 1.21-1.39 in 2019). CONCLUSIONS An association was found between parenthood and SRH among Brazilian women. Considering the epidemiological relevance of SRH, different aspects of parenthood concerning parity and time since the last delivery should be considered in further analyses.
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Affiliation(s)
- Matheus Souza Ferreira
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil
| | - Zilda Pereira da Silva
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil
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Amiri S. Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis. SLEEP MEDICINE RESEARCH 2023; 14:66-79. [DOI: 10.17241/smr.2023.01732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 08/28/2023] Open
Abstract
Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.
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Reppen K, Henriksen L, Schei B, Magnussen EB, Infanti JJ. Experiences of childbirth care among immigrant and non-immigrant women: a cross-sectional questionnaire study from a hospital in Norway. BMC Pregnancy Childbirth 2023; 23:394. [PMID: 37245035 DOI: 10.1186/s12884-023-05725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Immigrant women have higher risks for poor pregnancy outcomes and unsatisfactory birth experiences than the general population. The mechanisms behind these associations remain largely unknown, but they may result from differential care provided to immigrant women or unsatisfactory interactions with health providers. This study aimed to investigate immigrant and non-immigrant women's experiences of health care during childbirth, particularly assessing two dimensions: perceived general quality of care and attainment of health care needs during childbirth. METHODS This was a cross-sectional study carried out over 15 months in 2020 and 2021, and data were collected from a self-completed questionnaire. The labour and birth subscale from the Experience of Maternity Care questionnaire was used to assess the primary outcome of care experiences. A total of 680 women completed the questionnaire approximately within two days after birth (mean 2.1 days) at a hospital in Trondheim, in central Norway. The questionnaire was provided in eight languages. RESULTS The 680 respondents were classified as immigrants (n = 153) and non-immigrants (n = 527). Most women rated their quality of care during childbirth as high (91.5%). However, one-quarter of the women (26.6%) reported unmet health care needs during childbirth. Multiparous immigrant women were more likely than multiparous non-immigrant women to report that their health care needs were unmet during childbirth (OR: 3.31, 95% CI: 1.91-5.72, p < 0.001, aOR: 2.83, 95% CI: 1.53-5.18, p = 0.001). No other significant differences between immigrant versus non-immigrant women were found in subjective ratings of childbirth care experiences. Having a Norwegian-born partner and a high level of Norwegian language skills did not influence the immigrant women's experience of childbirth care. CONCLUSIONS Our findings indicate that many women feel they receive high-quality health care during childbirth, but a considerable number still report not having their health care needs met. Also, multiparous immigrant women report significantly more unmet health care needs than non-immigrants. Further research is required to assess immigrant women's childbirth experiences and for health care providers to give optimal care, which may need to be tailored to a woman's cultural background and individual expectations.
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Affiliation(s)
- Kristin Reppen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
| | - Elisabeth Balstad Magnussen
- Division of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jennifer Jean Infanti
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Negative childbirth experience in relation to mode of birth and events during labour: A mixed methods study. Eur J Obstet Gynecol Reprod Biol 2023; 282:146-154. [PMID: 36731207 DOI: 10.1016/j.ejogrb.2023.01.031] [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: 10/19/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore descriptions of negative childbirth experience in relation to mode of birth and events during labour. DESIGN A descriptive study using a convergent mixed methods design. Written responses to open-ended online questions regarding negative childbirth experience were explored using qualitative content analysis. Generated sub-themes were quantified, and stratified on mode of birth and events during labour. PARTICIPANTS AND SETTING 112 women with low ratings of overall childbirth experience, participating in a randomised controlled trial evaluating internet-based cognitive behavioural therapy in Sweden. Qualitative data were collected before randomisation, three months postpartum. RESULTS Four sub-themes emerged from the qualitative analysis: Experiencing fear-based emotions, Experiencing physical distress, Being affected by caregivers' and partner's behaviour and Being affected by bad facilities and poor organisation. Only small differences were found when stratifying sub-themes on mode of birth and events during labour. Regardless of mode of birth and events during labour, the childbirth experience was dominated by fear-based emotions. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Mixed-methods analyses demonstrate the challenges in understanding negative childbirth experience in relation to mode of birth and specific events during labour, with results clearly showing the multifaceted nature of this concept. The central role of fear in relation to negative childbirth experience should be considered when designing support during and after labour, to prevent adverse effects of the childbirth experience.
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Pauley AM, Leonard KS, Cumbo N, Teti IF, Pauli JM, Satti M, Stephens M, Corr T, Roeser RW, Legro RS, Mackeen AD, Bailey-Davis L, Downs DS. Women's beliefs of pain after childbirth: Critical insight for promoting behavioral strategies to regulate pain and reduce risks for maternal mortality. PATIENT EDUCATION AND COUNSELING 2023; 107:107570. [PMID: 36410313 PMCID: PMC9789185 DOI: 10.1016/j.pec.2022.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Promoting behavioral strategies to better regulate pain and decrease the use of prescription pain medications immediately after childbirth is an attractive approach to reduce risks for adverse outcomes associated with the maternal mortality crisis. This study aimed to understand women's beliefs and experiences about pain management to identify important insights for promoting behavioral strategies to control postpartum pain. METHODS N = 32 postpartum women participated in a semi-structured interview about beliefs/experiences with managing postpartum pain. Higher- and lower-order themes were coded; descriptive statistics were used to summarize results. RESULTS Major trends emerging from the data were: (1) most women used a combination of medications (e.g., oxycodone and acetaminophen) and behavioral strategies (e.g., physical activity) in the hospital (94 %) and at discharge (83 %); (2) some women reported disadvantages like negative side effects of medications and fatigue from physical activity; and (3) some women reported they would have preferred to receive more evidence-based education on behavioral strategies during prenatal visits. CONCLUSION Our findings showed that most women were prescribed medications while in the hospital and at discharge, and used non-prescription, behavioral strategies. PRACTICAL IMPLICATIONS Future research is needed to test behavioral strategies in randomized clinical trials and clinical care settings to identify impact on reducing adverse maternal health outcomes.
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Affiliation(s)
- Abigail M Pauley
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States.
| | - Krista S Leonard
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States
| | - Nicole Cumbo
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - Isabella F Teti
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - Mohamed Satti
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA, United States
| | - Mark Stephens
- Department of Family and Community Medicine, Penn State College of Medicine, University Park, PA 16802, United States
| | - Tammy Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Robert W Roeser
- Department of Health and Human Development, Pennsylvania State University, University Park, PA 16802, United States
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - A Dhanya Mackeen
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA, United States
| | - Lisa Bailey-Davis
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, United States
| | - Danielle Symons Downs
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States; Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
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Ali-Saleh O, Goldblatt H, Baron-Epel O. "My problem is that I live next door to my mother-in-law": Arab women's postpartum experiences with positive and negative social interactions and the impact on their well-being: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3985-e3994. [PMID: 35289013 DOI: 10.1111/hsc.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Social support is commonly associated with women's postpartum health. Yet such support can also have unintended effects and trigger negative reactions. This study provides a qualitative examination of the positive and negative social interactions described by Arab postpartum women. Participants were Arab women recruited at Mother and Child Healthcare Clinics (MCHC). Inclusion criteria were married women over the age of 18 with a healthy newborn who described both positive and negative social experiences. Exclusion criteria were signs of postpartum depression. Data were gathered using semi-structured in-depth interviews that were audio-recorded and transcribed verbatim. Themes and categories were extracted based on interpretative phenomenological analysis. The impact of lived experiences on the well-being of postpartum women was explored. Data analysis revealed three main themes: (1) Support from the family and community: positive impact on the mother; (2) Negative social interactions as invasion of mother's personal space; (3) Impact of negative social interactions on mother's relationship with her family. A deeper understanding of the social environment of these women and the factors that affect their well-being during the critical postpartum period can help MCHC staff offer culturally appropriate support and relevant interventions.
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Affiliation(s)
- Ola Ali-Saleh
- Northern District Health Bureau, Ministry of Health, Nof HaGalil, Israel
- Department of Nursing, the Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
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Nagle U, Naughton S, Ayers S, Cooley S, Duffy RM, Dikmen-Yildiz P. A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up. Midwifery 2022; 113:103419. [DOI: 10.1016/j.midw.2022.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
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Juarez Padilla J, Singleton CR, Pedersen CA, Lara-Cinisomo S. Associations between Self-Rated Health and Perinatal Depressive and Anxiety Symptoms among Latina Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911978. [PMID: 36231278 PMCID: PMC9565349 DOI: 10.3390/ijerph191911978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 06/01/2023]
Abstract
PURPOSE The objective of this study was to determine whether decreases in or consistently low preconception to pregnancy self-rated health (SRH) were associated with perinatal depressive and anxiety symptoms among Latinas. METHODS This is a secondary data analysis of 153 perinatal Latinas. Three groups were created to capture SRH from preconception to pregnancy: a decline in ratings, consistently low, and good+ (i.e., good, very good, or excellent). SRH was measured using two questions about their perceived physical health before and during pregnancy. Depressive symptoms and anxiety symptoms were assessed in the third trimester and six weeks postpartum using the Edinburgh Postnatal Depression Scale and State-Trait Anxiety Inventory, respectively. Life stressors were assessed in pregnancy using a modified version of the Life Experiences Survey. Linear regressions tested the associations. RESULTS Women with consistently low (i.e., fair or poor) SRH reported significantly more prenatal depressive symptoms than women who reported consistently good+ SRH. Women who reported a decline in SRH to fair or poor reported more prenatal anxiety symptoms but decreased postpartum anxiety symptoms than women who reported consistently good+ ratings. Life stressors were positively associated with prenatal depressive and anxiety symptoms. CONCLUSIONS Healthcare practitioners should assess changes in SRH ratings to identify risks for prenatal depressive and anxiety symptoms among Latinas, who have elevated rates of depressive and anxiety symptoms compared to non-Hispanic White women. Policymakers should provide healthcare providers with mental health resources to support at-risk Latinas during the prenatal period.
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Affiliation(s)
- Janeth Juarez Padilla
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY 10032, USA
| | - Chelsea R. Singleton
- Department of Social, Behavioral, and Populations Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Cort A. Pedersen
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA
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Davidsen AS, Birkmose AR, Kragstrup J, Siersma V, Ertmann RK. The association of a past childbirth experience with a variety of early physical and mental symptoms in subsequent pregnancies. Midwifery 2022; 112:103406. [PMID: 35772244 DOI: 10.1016/j.midw.2022.103406] [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: 07/07/2021] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some women have a perceived negative experience of childbirth due to various reasons- e.g., obstetric complications or the feeling of loss of control. We do not know enough about the effects of a perceived negative experience of a childbirth on a woman's subsequent pregnancies. The aim of this study was to investigate whether a previously perceived negative childbirth experience affects a woman's physical and mental well-being in a later pregnancy. METHODS A prospective cohort study in Danish general practice, based on information about women's childbirth experiences from the Pregnancy Health Record filled in by the general practitioner (GP) and data from an electronic questionnaire completed by the women. RESULTS A total of 1288 women were included in the analysis. Women who had given birth before were found to have a significantly higher risk of experiencing nausea, varicose veins and uterine contractions, and a lower risk of pelvic cavity pain in the current pregnancy. Women having given birth before were significantly more likely to assess their physical fitness as poor and to experience poor well-being. Women with a perceived negative experience of childbirth had more sleep problems and a higher prevalence of poor self-rated health than women with unproblematic childbirth experience. CONCLUSION This study showed that women with a previously perceived negative experience of childbirth are affected according to their mental health in their subsequent pregnancy.
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Affiliation(s)
- Agnes S Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Anna R Birkmose
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ruth K Ertmann
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Huschke S. 'The System is Not Set up for the Benefit of Women': Women's Experiences of Decision-Making During Pregnancy and Birth in Ireland. QUALITATIVE HEALTH RESEARCH 2022; 32:330-344. [PMID: 34852686 PMCID: PMC8727824 DOI: 10.1177/10497323211055461] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In this article, I draw on in-depth qualitative interviews with 23 women, conducted in 2019/2020, focusing on their involvement in decision-making during pregnancy and birth. The study is located in Ireland, where comparably progressive national policies regarding informed choice in labour and birth clash with the day-to-day reality of a heavily medicalised, paternalistic maternity care system. I represent the subjective experiences of a diverse group of women through in-depth interview excerpts. In my analysis, I move beyond describing what is happening in the Irish maternity system to discussing why this is happening - relating the findings of the research to the international literature on authoritative knowledge, technocratic hospital cultures and risk-based discourses around birth. In the last section of the article, I offer concrete, empirically grounded and innovative recommendations how to enhance women's involvement in decision-making.
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Affiliation(s)
- Susann Huschke
- Public and Patient Involvement (PPI) Research Unit (School of Medicine) and Health Research Institute, University of Limerick, Limerick, Ireland
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12
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Viirman F, Hesselman S, Wikström AK, Skoog Svanberg A, Skalkidou A, Sundström Poromaa I, Wikman A. Self-rated health before pregnancy and adverse birth outcomes in Sweden: A population-based register study. Birth 2021; 48:541-549. [PMID: 34184771 DOI: 10.1111/birt.12567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Poor self-rated health (SRH) at time of childbirth has been associated with adverse birth outcomes. However, it is not known whether prepregnancy SRH contributes to these outcomes or whether SRH is a proxy for some other factors. Therefore, the purpose of this study was to explore the associations between poor SRH before pregnancy and adverse birth outcomes. In addition, maternal characteristics associated with SRH before pregnancy were explored. METHODS A population-based register study encompassing 261 731 deliveries in Sweden between January 2013 and July 2017 was conducted. The associations between poor SRH before pregnancy, rated at first antenatal visit, and the adverse birth outcomes of stillbirth, small for gestational age (SGA), and preterm birth were investigated with logistic regression analyses and presented as crude (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Poor SRH before pregnancy was largely characterized by a history of psychiatric care and was associated with stillbirth (OR 1.37, 95% CI 1.04-1.79), SGA birth (OR 1.29, 95% CI 1.19-1.39), and preterm birth (OR 1.41, 95% CI 1.32-1.50). Adjusting for established risk factors for adverse birth outcomes, poor SRH remained associated with SGA birth (aOR 1.16, 95% CI 1.07-1.26) and preterm birth (aOR 1.25, 95% CI 1.17-1.33), but not with stillbirth (aOR 1.08, 95% CI 0.81-1.43). CONCLUSIONS SRH assessments could be used in early pregnancy to identify women in need of more extensive follow-up, as SRH appears to capture something beyond currently known risk factors for adverse birth outcomes.
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Affiliation(s)
- Frida Viirman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susanne Hesselman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Center for Clinical Research Dalarna, Falun, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Self-Rated Health and Pain Problems in Mothers of Healthy Children or Children Requiring Outpatient Observation or Hospitalisation: A Pilot Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189543. [PMID: 34574464 PMCID: PMC8466010 DOI: 10.3390/ijerph18189543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
A child's illness or disability is a considerable stressor for the mother and a risk factor for many psychological problems and somatic diseases. The purpose of the study was to (1) assess the prevalence of poor SRH and pain, (2) compare self-rated health and pain, (3) and identify the determinants of SRH and pain in mothers of healthy children and children requiring ambulatory observation or hospitalization. The study covered 234 mothers of both healthy and unhealthy children who required outpatient observation or treatment at an intensive care unit, neonatal intensive care unit, or oncology department. To analyse the variables obtained, the following tools were used: Self-Rated Health, Numerical Rating, Interpersonal Support Evaluation List, Peritraumatic Distress Inventory, Modified Hospital Anxiety and Depression Scale, and Impact of Effects Scale-Revised. The self-assessment of health in mothers of healthy children and those in need of outpatient observation or hospitalization at units with various specialities differed in a statistically significant way. The severity of the average and maximum pain among mothers of healthy children and those with a history of disease differed statistically significantly. Poor SRH co-occurred with severe maximum pain in all of the examined groups. Both in the control group and the group of mothers of children requiring outpatient observation, poor SRH co-occurred with a high level of anxiety. Only in the control group was a correlation found between the severity of the average and maximum pain and the severity of anxiety and depression symptoms.
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Izydorczyk B, Walenista W, Kamionka A, Lizińczyk S, Ptak M. Connections Between Perceived Social Support and the Body Image in the Group of Women With Diastasis Recti Abdominis. Front Psychol 2021; 12:707775. [PMID: 34434150 PMCID: PMC8381222 DOI: 10.3389/fpsyg.2021.707775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The psychological features of the body image and the role of perceived social support for women with diastasis recti abdominis (DRAM) is significant for the treatment of this group of patients, but it is difficult to identify research on this topic. We aimed to search for similarities and differences between postpartum women with DRAM in terms of their psychological features of the body image and perceived social support from the partner, family and friends. Methods: Three hundred forty-five Polish women with DRAM were asked to fill the The Multidimensional Body-Self Relations Questionnaire (MBSRQ), The Multidimensional Scale of Perceived Social Support (MSPSS) and The Drawing Self-Assessment Sheet. Data analysis included the stepwise regression analysis and k-cluster analysis. Results: We identified several predictors in the group of women with DRAM. Social support of partner, family, and friends are the predictors of self-assessment of general body appearance. Social support of family is a predictor of self-assessment of the health of the body. Social support of friends is a predictor of self-esteem of weight and fear of gaining weight. Moreover, three clusters of women with DRAM were found. Type 1-women with DRAM with one child and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight, and fear of weight gain, and low level of social support; Type 2-women with DRAM with three or more children and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight and fear of weight gain, and high level of social support; and Type 3-women with DRAM with two children and high self-esteem for the general appearance of the body, high level of self-esteem for health of the body, low self-esteem of weight and fear of weight gain, and high levels of social support. Conclusions: Social support is a predictor of body image in women with DRAM, but there are other factors that influence body acceptance more in this group of women. Furthermore the three clusters featured in the study may help in treating women with DRAM.
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Affiliation(s)
- Bernadetta Izydorczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Wiktoria Walenista
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Agata Kamionka
- Department of Psychology, Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Sebastian Lizińczyk
- Katowice Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Magdalena Ptak
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Joensuu J, Saarijärvi H, Rouhe H, Gissler M, Ulander VM, Heinonen S, Mikkola T. Maternal childbirth experience and time of delivery: a retrospective 7-year cohort study of 105 847 parturients in Finland. BMJ Open 2021; 11:e046433. [PMID: 34135044 PMCID: PMC8211041 DOI: 10.1136/bmjopen-2020-046433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore how the time of delivery influences childbirth experience. DESIGN A retrospective cohort study. SETTING Childbirth in the four Helsinki and Uusimaa Hospital District hospitals, Finland, from 2012 to 2018. PARTICIPANTS 105 847 childbirths with a singleton live fetus. MAIN OUTCOME MEASURES Childbirth experience measured by Visual Analogue Scale (VAS). RESULTS The major difference in average childbirth experience measured by VAS was between primiparas (8.03; 95% CI 8.01 to 8.04) and multiparas (8.47; 95% CI 8.45 to 8.48). Risk ratio (RR) of the low VAS (≤5) was 2.3 when primiparas were compared with multiparas. Differences in VAS between distinct periods were found in two stages: annual and time of day. The decrease in VAS from 2012-2016 to 2017-2018 in primiparas was from 7.97 (95% CI 7.95 to 7.99) to 7.80 (95% CI 7.77 to 7.83) and from 2014-2016 to 2017-2018 in multiparas from 8.60 (95% CI 8.58 to 8.61) to 8.49 (95% CI 8.47 to 8.52). Corresponding RRs of low VAS were 1.3 for primiparas and 1.2 for multiparas. Hourly differences in VAS were detected in primiparas between office hours 08:00-15:59 (7.97; 95% CI 7.94 to 7.99) and other times (night 00:00-07:59; 7.91; 95% CI 7.88 to 7.94; and evening 16:00-23:59; 7.90; 95% CI 7.87 to 7.92). In multiparas differences in VAS were detected between evening (8.52; 95% CI 8.50 to 8.54) and other periods (night; 8.56; 95% CI 8.54 to 9.58; and office hours; 8.57; 95% CI 8.55 to 8.59). CONCLUSION The maternal childbirth experience depended on the time of delivery. Giving birth during the evening led to impaired childbirth experience in both primiparas and multiparas, compared with delivery at other times. The impact of labour induction on childbirth experience should be further examined. The reorganisation of delivery services and the reduction of birth preparations might affect annual VAS. VAS is a simple method of measuring the complex entity of childbirth experience, and our results indicate its ability to capture temporal variation.
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Affiliation(s)
- Johanna Joensuu
- Faculty of Management and Business, Tampere University, Tampere, Finland
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - Hannu Saarijärvi
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Information, Finnish Institute of Health and Welfare, Helsinki, Finland
- Division of Family Medicine, Karolinska Institute Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tomi Mikkola
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
- Folkhälsän Research Center, Biomedicum, Helsinki, Finland
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Wuytack F, Smith V, Cleary BJ. Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev 2021; 1:CD011352. [PMID: 33427305 PMCID: PMC8092572 DOI: 10.1002/14651858.cd011352.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many women experience perineal pain after childbirth, especially after having sustained perineal trauma. Perineal pain-management strategies are an important part of postnatal care. Non-steroidal anti-inflammatory drugs (NSAIDs) are a commonly-used type of medication in the management of postpartum pain, and their effectiveness and safety should be assessed. This is an update of a review first published in 2016. OBJECTIVES To determine the effectiveness of a single dose of an oral NSAID for relief of acute perineal pain in the early postpartum period. SEARCH METHODS For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (9 December 2019), OpenSIGLE and ProQuest Dissertations and Theses (28 February 2020), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing a single dose of a NSAID versus a single dose of placebo, paracetamol or another NSAID for women with perineal pain in the early postpartum period. We excluded quasi-RCTs and cross-over trials. We included papers in abstract format only if they had sufficient information to determine that they met the review's prespecified inclusion criteria. DATA COLLECTION AND ANALYSIS Two review authors (FW and VS) independently assessed all identified papers for inclusion and risks of bias, resolving any discrepancies through discussion. Two review authors independently conducted data extraction, including calculations of pain relief scores, and checked it for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 35 studies examining 16 different NSAIDs and involving 5136 women (none were breastfeeding). Studies were published between 1967 and 2013. Risk of bias due to random sequence generation, allocation concealment and blinding of outcome assessors was generally unclearly to poorly reported, but participants and caregivers were blinded, and outcome data were generally complete. We downgraded the certainty of evidence due to risk of bias, suspected publication bias, and imprecision for small numbers of participants. NSAID versus placebo Compared to women who receive a placebo, more women who receive a single-dose NSAID may achieve adequate pain relief at four hours (risk ratio (RR) 1.91, 95% confidence interval (CI) 1.64 to 2.23; 10 studies, 1573 women; low-certainty evidence) and at six hours (RR 1.92, 95% CI 1.69 to 2.17; 17 studies, 2079 women; very low-certainty evidence), although we are less certain about the effects at six hours. At four hours after administration, women who receive a NSAID are probably less likely to need additional analgesia compared to women who receive placebo (RR 0.39, 95% CI 0.26 to 0.58; 4 studies, 486 women; moderate-certainty evidence) and may be less likely to need additional analgesia at six hours after initial administration, although the evidence was less certain at six hours (RR 0.32, 95% CI 0.26 to 0.40; 10 studies, 1012 women; very low-certainty evidence). One study reported that no adverse events were observed at four hours post-administration (90 women). There may be little or no difference in maternal adverse effects between NSAIDs and placebo at six hours post-administration (RR 1.38, 95% CI 0.71 to 2.70; 13 studies, 1388 women; low-certainty evidence). Fourteen maternal adverse effects were reported in the NSAID group (drowsiness (5), abdominal discomfort (2), weakness (1), dizziness (2), headache (2), moderate epigastralgia (1), not specified (1)) and eight in the placebo group (drowsiness (2), light-headedness (1), nausea (1), backache (1), dizziness (1), epigastric pain (1), not specified (1)), although not all studies assessed adverse effects. Neonatal adverse effects were not assessed in any of the studies. NSAID versus paracetamol NSAIDs may lead to more women achieving adequate pain relief at four hours, compared with paracetamol (RR 1.54, 95% CI 1.07 to 2.22; 3 studies, 342 women; low-certainty evidence). We are uncertain if there is any difference in adequate pain relief between NSAIDs and paracetamol at six hours post-administration (RR 1.82, 95% CI 0.61 to 5.47; 2 studies, 99 women; very low-certainty evidence) or in the need for additional analgesia at four hours (RR 0.55, 95% CI 0.27 to 1.13; 1 study, 73 women; very low-certainty evidence). NSAIDs may reduce the risk of requiring additional analgesia at six hours compared with paracetamol (RR 0.28, 95% CI 0.12 to 0.67; 1 study, 59 women; low-certainty evidence). One study reported that no maternal adverse effects were observed at four hours post-administration (210 women). Six hours post-administration, we are uncertain if there is any difference between groups in the number of maternal adverse effects (RR 0.74, 95% CI 0.27 to 2.08; 3 studies, 300 women; very low-certainty evidence), with one case of pruritis in the NSAID group and one case of sleepiness in the paracetamol group. Neonatal adverse effects were not assessed in any of the included studies. Comparisons of different NSAIDs or doses did not demonstrate any differences in effectiveness for any primary outcome measures; however, few data were available on some NSAIDs. None of the included studies reported on any of this review's secondary outcomes. AUTHORS' CONCLUSIONS In women who are not breastfeeding and who sustained perineal trauma, NSAIDs (compared to placebo or paracetamol) may provide greater pain relief for acute postpartum perineal pain and fewer women need additional analgesia, but uncertainty remains, as the evidence is rated as low- or very low-certainty. The risk of bias was unclear for many studies, adverse effects were often not assessed and breastfeeding women were not included. While this review provides some indication of the likely effect, there is uncertainty in our conclusions. The main reasons for downgrading were the inclusion of studies at high risk of bias and inconsistency in the findings of individual studies. Future studies could examine NSAIDs' adverse effects, including neonatal effects and the compatibility of NSAIDs with breastfeeding, and could assess other secondary outcomes. Future research could consider women with and without perineal trauma, including perineal tears. High-quality studies could be conducted to further assess the efficacy of NSAIDs versus paracetamol and the efficacy of multimodal treatments.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Brian J Cleary
- Department of Pharmacy, Rotunda Hospital, Dublin 1, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Puddister S, Ali-Saleh O, Cohen-Dar M, Baron-Epel O. Health may be compromised by social interactions depending on culture among postpartum Arab and Jewish Israeli women. BMC Pregnancy Childbirth 2020; 20:480. [PMID: 32825830 PMCID: PMC7441553 DOI: 10.1186/s12884-020-03168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Social support is generally perceived to facilitate health in postpartum women; however, previous research shows that this is not always true. Social interactions intended to provide support can be perceived as negative and in turn, may have negative impacts on maternal health. The purpose of the present study was to asses if social support and negative interactions at one month after childbirth can predict maternal health four months after childbirth, and if this relationship is influenced by culture. Methods This prospective longitudinal cohort study included randomly selected Arab (n = 203) and Jewish (n = 202) women who attended Mother and Child Health Clinics in Northern Israel one month after giving birth. The women were interviewed at one and four months after childbirth using a questionnaire including measures of health (self-reported health (SRH) and health problems), socioeconomic and demographic status, obstetric characteristics, social support, negative social interactions and perceptions of customs and traditions intended to help the mother cope after childbirth. Multivariable regressions were run to identify the variables predicting health four months after childbirth. Results The response rate for both interviews was 90%. Negative social interactions one month after childbirth significantly predicted health problems in Arab and Jewish women (Beta 0.20 and 0.37 respectively) and SRH among Arab women only (odds ratio (OR) 0.32, confidence interval (CI) 0.19–0.54) four months after childbirth. Social support at one month after childbirth significantly predicted better SRH in both Jewish and Arab women four months after childbirth (OR 2.33, CI 1.38–3.93 and 1.59, CI 1.01–2.46 respectively) and fewer health problems only among Jewish women (Beta − 0.37). Conclusions Social support and negative social interactions appear to be predictive of health in postpartum women. Associations varied between Arabs and Jews, indicating that social support may be more important for predicting health among Jewish women and negative interactions may be more important among Arab women. Healthcare practitioners should be aware of the cultural context and social circumstances of postpartum women to ensure they receive the social support and care they need.
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Affiliation(s)
- Sadie Puddister
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 31905, Mount Carmel, Haifa, Israel
| | - Ola Ali-Saleh
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 31905, Mount Carmel, Haifa, Israel.,Northern Region Health Office, Ministry of Health, Nazareth, Israel
| | - Michal Cohen-Dar
- Northern Region Health Office, Ministry of Health, Nazareth, Israel
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 31905, Mount Carmel, Haifa, Israel.
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Aftyka A, Rosa W, Taczała J. Self-rated health in mothers of children hospitalised for severe illnesses and mothers of healthy children: cross-sectional study. Scand J Caring Sci 2019; 34:698-709. [PMID: 31657048 DOI: 10.1111/scs.12774] [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: 02/14/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Self-rated health (SRH) is a recognised tool for predicting morbidity and mortality. AIM The aim of the study was to investigate and compare SRH in a group of mothers of hospitalised children and mothers of healthy children and to indicate the variables associated with poor SRH in both groups. METHODS We conducted questionnaire-based cross-sectional research in a group of 184 women. Half of the respondents (n = 92) were the mothers of children hospitalised for a severe illnesses (Group H). The control group (n = 92) comprised mothers of healthy children (Group C). Self-Rated Health (SRH), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R) and Interpersonal Support Evaluation List (ISEL-40 v. GP) were used. In order to facilitate critical appraisal and interpretation of results, STROBE recommendations were used. RESULTS The prevalence of poor SRH was greater in mothers of children hospitalised for a severe illness than in those of healthy children (35 and 19%, respectively). In both groups, the risk of poor SRH was statistically significantly higher in those mothers who for the past 7 days reported at least moderate pain and in mothers who manifested anxiety symptoms. In both groups, the prevalence of poor SRH was statistically significantly lower if the respondents' children were in good health. The risk of poor SRH was associated with poor financial status in group H and with depression and at least moderate pain for the past 7 days in group C. RELEVANCE TO CLINICAL PRACTICE In order to provide mothers of severely ill children with high-quality health care including preventive measures, it is recommended that their health is assessed by healthcare professionals.
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Affiliation(s)
- Anna Aftyka
- Department of Anaesthesiological and Intensive Care Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Wojciech Rosa
- Department of Applied Mathematics, Faculty of Technology Fundamentals, Lublin University of Technology, Lublin, Poland
| | - Jolanta Taczała
- Department of Rehabilitation and Physiotherapy, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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Gürbüz B, Großkreutz C, Vortel M, Borde T, Rancourt RC, Stepan H, Sauzet O, Henrich W, David M, Seidel V. The influence of migration on women's satisfaction during pregnancy and birth: results of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ). Arch Gynecol Obstet 2019; 300:555-567. [PMID: 31267197 DOI: 10.1007/s00404-019-05227-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/19/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Approximately 21% of Germany's inhabitants have been born abroad or are of direct descent of immigrants. A positive birth experience has an effect on a woman's mental health and her future family planning choices. While international studies showed that immigrant women are less satisfied with their birth experience, no such study has been conducted in Germany until now. METHODS At our center of tertiary care in Berlin, with approximately 50% immigrants among patients, pregnant women of at least 18 years of age were offered participation in this study. A modified version of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) designed by Gagnon et al. in German, English, French, Spanish, Arabic and Turkish was used. We compared non-immigrant women to immigrant women and women with direct descent of immigrants. For certain analysis, the latter two groups were included together under the category "migration background". RESULTS During the study period, 184 non-immigrant, 214 immigrant women and 62 direct descendants of immigrants were included. The most frequent countries of origin were Syria (19%), Turkey (17%), and Lebanon (9%). We found a slight difference between groups regarding age (non-immigrants: mean 33 years versus women with any migration background: mean 31) as well as parity with more non-immigrants delivering their first child. No difference in the satisfaction with care was observed between immigrant and any migration background groups (p ≥ 0.093 in the two-sided Fisher's exact test). At least 75.8% of all participating women reported complete satisfaction with care during labor, birth and after birth. Interestingly, the level of German language proficiency did not influence the immigrant patient's satisfaction with care. CONCLUSION The study results show no difference regarding overall satisfaction with care during labor and birth despite a relevant language barrier. We are for the first time providing the MFMCQ in German and Turkish. Further future analyses on the impact of patient expectations on satisfaction with care will be conducted.
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Affiliation(s)
- B Gürbüz
- Clinic of Obstetrics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - C Großkreutz
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Vortel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Borde
- Alice Salomon Hochschule, Berlin, Germany
| | - R C Rancourt
- Division of 'Experimental Obstetrics', Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany
| | - H Stepan
- Clinic of Obstetrics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - O Sauzet
- Bielefeld School of Public Health and Centre for Statistics, Bielefeld University, Bielefeld, Germany
| | - W Henrich
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M David
- Clinic of Gynecology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - V Seidel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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Ghanbari-Homayi S, Fardiazar Z, Meedya S, Mohammad-Alizadeh-Charandabi S, Asghari-Jafarabadi M, Mohammadi E, Mirghafourvand M. Predictors of traumatic birth experience among a group of Iranian primipara women: a cross sectional study. BMC Pregnancy Childbirth 2019; 19:182. [PMID: 31117987 PMCID: PMC6532129 DOI: 10.1186/s12884-019-2333-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. METHODS A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens' birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. RESULTS The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40-5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12-8.50, P < .001), and the fear of childbirth (OR = 3.47, CI 1.68-7.19, P < .001). CONCLUSIONS The findings revealed the high rate of traumatic birth experience among the primimarous women and identified the importance of a woman-centered care where a woman can actively make decision about the care she receives receive during labour and birth.
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Affiliation(s)
| | - Zahra Fardiazar
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | | | | | - Eesa Mohammadi
- Department of Nursing, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran.
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Redshaw M, Martin CR, Savage-McGlynn E, Harrison S. Women's experiences of maternity care in England: preliminary development of a standard measure. BMC Pregnancy Childbirth 2019; 19:167. [PMID: 31088487 PMCID: PMC6518811 DOI: 10.1186/s12884-019-2284-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As maternity services evolve and the population of women served also changes, there is a continuing need to effectively document the views of women with recent experience of care. A woman's maternity experience can have a positive or negative effect upon her emotional well-being and health, in the immediate and the long-term, which can also impact the infant and the wider family system. Measuring women's perceptions of maternity services is an important way of monitoring the quality of care provision, as well as providing key indicators to organisations of the services that they are providing. It follows that, without information identifying possible areas in need of improvement, it is not clear what changes should be made to improve the experiences of women during their journey through maternity services from pregnancy to the early weeks at home with a new baby . The objective is to describe the development process and psychometric properties of a measure of women's experience of maternity care covering the three distinctly different phases of maternity - pregnancy, labour and birth, and the early postnatal period. METHODS Data from a national survey of women who had recently given birth (n = 504) were used. Exploratory and confirmatory factor analytic methods were employed. The measure was assessed for underlying latent factor structure, as well as for reliability, internal consistency, and validity (predictive, convergent and discriminant). RESULTS The models developed confirmed the use of three separate, but related scales about experience of maternity care during pregnancy, labour and birth and the postnatal period. Data reduction was effective, resulting in a measure with 36 items (12 per scale). CONCLUSION The need for a psychometrically robust and qualitatively comprehensive measure of women's experience of maternity care has been addressed in the development and validation of this prototype measure. The whole measure can be used at one time point, or the three separate subscales used as individual measures of experience during particular phases of the maternity journey with identified factor structures in their own right.
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Affiliation(s)
- Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Colin R Martin
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Emily Savage-McGlynn
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Sian Harrison
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Yokoyama Y, Hakulinen T, Sugimoto M, Silventoinen K, Kalland M. Maternal subjective well-being and preventive health care system in Japan and Finland. Eur J Public Health 2019; 28:652-657. [PMID: 29272457 DOI: 10.1093/eurpub/ckx211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Maternal well-being is an important issue not only for mothers but also for their offspring and whole families. This study aims to clarify differences in subjective well-being for mothers with infants and associated factors by comparing Japanese and Finnish mothers. Methods In Finland, 101 mothers with infants who received health check-ups at child's age 4 months participated in the study. In Japan, 505 mothers with infants who should receive health check-ups at child's age 4 months and, whose age, age of the infant and number of children matched with the Finnish mothers were selected. The factors associated with maternal subjective well-being were explored by the linear regression analysis. All Finnish mothers had individual infant health check-ups by nurses in Child Health Clinics nearly monthly. The same nurse was responsible for following up the family throughout the years. All Japanese participants received group health check-up once at child's age 3 to 4 months, and a nurse did not cover same child and their mother. Results Finnish mothers showed significantly better subjective well-being compared with Japanese mothers. Whereas 85% of Finnish mothers responded that they had obtained childcare information from public health nurses, significantly fewer Japanese mothers indicated the same response (8%). Linear regression analyses disclosed that mothers' subjective well-being was associated with country, mothers' stress and age. Conclusion Finnish mothers had better subjective well-being than Japanese mothers. Our results may indicate that the Finnish health care system supports mothers better than the Japanese health care system does.
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Affiliation(s)
- Yoshie Yokoyama
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Tuovi Hakulinen
- Children, Adolescence and Families Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Masako Sugimoto
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Karri Silventoinen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mirjam Kalland
- Swedish School of Social Science, University of Helsinki, Helsinki, Finland
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Alderdice F, Henderson J, Opondo C, Lobel M, Quigley M, Redshaw M. Psychosocial factors that mediate the association between mode of birth and maternal postnatal adjustment: findings from a population-based survey. BMC WOMENS HEALTH 2019; 19:42. [PMID: 30832642 PMCID: PMC6399915 DOI: 10.1186/s12905-019-0738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mode of birth has been found to be associated with maternal postnatal adjustment with women who have Caesarean Sections (CS) thought to be at higher risk of emotional distress. However the relationship is complex and studies have demonstrated mixed findings. The aim of this study is to evaluate a model that explores the direct relationship between mode of birth and postnatal maternal adjustment at 3 months and indirect relationships through psychosocial variables. METHODS A secondary analysis of a population-based survey conducted in England, UK in 2014. The analysis included primiparous women with singleton babies who provided information about mode of birth (n = 2139). RESULTS Maternal postnatal adjustment, as measured by Maternal postnatal wellbeing and Satisfaction with care during labour and birth, varied by mode of birth. Women who had an unplanned CS had the poorest postnatal adjustment. Mode of birth was not associated with Maternal/infant sense of belonging. Four out of the five proposed mediation variables (Perceived control, Maternal expectation, Support in labour, How long until the mother held her baby), showed partial mediation of the relationship between mode of birth and both Maternal postnatal wellbeing and Satisfaction with care during labour and birth. The strongest mediator was Perceived control and the only variable not to show a significant mediation effect was Health of the infant at 3 months. CONCLUSIONS Birth by unplanned, but not planned, caesarean section was associated with poorer maternal adjustment and instrumental birth was associated with lower maternal satisfaction with labour and birth. These relationships were found to be partially mediated by psychosocial variables. Psychosocial interventions in the perinatal period should be considered to optimise maternal postnatal adjustment.
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Affiliation(s)
- Fiona Alderdice
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Charles Opondo
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Marci Lobel
- Professor of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Maria Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Assessment of significant psychological distress at the end of pregnancy and associated factors. Arch Womens Ment Health 2018; 21:313-321. [PMID: 29071455 DOI: 10.1007/s00737-017-0795-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study is to study the prevalence of mental distress at the end of pregnancy and after birth and the impact of selected socio-demographic and obstetric factors. This is a cross-sectional study. The sample is consisted of 351 puerperal women at the age of 18 and over. Sociodemographic, obstetric variables were collected to detect significant psychological distress; the instrument used was General Health Questionnaire (GHQ-28). Logistic multivariable regressions were used to investigate associations. The prevalence of significant mental distress amounted to 81.2%, mostly related to social relationship and anxiety. The women who affirmed having more stress during pregnancy had too significantly increased emotional distress before the birth as well as during early puerperium, increasing somatic symptoms (p < 0.001; OR 2.685; CI 95% 1.583-4.553), anxiety (p < 0.001; OR 4.676; CI 95% 2.846-7.684), and depressive symptoms (p < 0.01). Somatic symptoms (p < 0.05; OR 2.466; CI 95% 1.100-5.528) and social dysfunction (p < 0.001; OR 1.672; CI 95% 0.711-3.932) occur most frequently in women who already had children. Regarding socio-demographic data, being an immigrant is the only protective factor reducing the social dysfunction in the last weeks of pregnancy (p < 0.01; OR 0.478; CI 95% 0.274-0.832). Psychological distress at the end of a full-term pregnancy and in the postpartum period occurs frequently and was associated mainly with stress experienced during pregnancy and parity. It is advisable to perform proper assessment of stress and significant psychological distress at the early stage of pregnancy and repeatedly later on until delivery. Information and support from professionals can help to decrease and prevent their negative impact on maternal and fetal health, as observed in the current evidence.
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Lara-Cinisomo S, Swinford C, Massey D, Hardt H. Diabetes, Prenatal Depression, and Self-Rated Health in Latina Mothers. Diabetes Spectr 2018; 31:159-165. [PMID: 29773936 PMCID: PMC5951227 DOI: 10.2337/ds17-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Latinas in the United States have elevated rates of diabetes and prenatal depression (PND). The presence of diabetes and PND can also have a negative effect on women's self-rated health (SRH), a commonly used indicator of health that is consistent with objective health status and is a predictor of mortality. However, the associations between PND, diabetes, and SRH have not been tested, particularly among Latinas, who have elevated risk of both medical conditions. To address this gap, this pilot study tested the association between PND and diabetes using data from Latinas enrolled during their third trimester of pregnancy and explored whether these health conditions were associated with SRH in these women. METHODS For this study, the Edinburgh Postnatal Depression Scale was used to determine PND status, self-reported medical history to determine diabetes status, and SRH before and during the current pregnancy in a sample of 34 prenatal Latinas. Participants were invited to take part in the study in their third trimester of pregnancy. Bivariate analyses and logistic regressions were used to test associations between demographic variables, PND, diabetes, and SRH. RESULTS There was no significant association between PND and diabetes status in this sample of Latinas. There was a significant difference in SRH from pre-pregnancy to pregnancy, with worse ratings reported during pregnancy. Furthermore, women with PND or diabetes reported worse SRH, even after controlling for pre-pregnancy SRH. CONCLUSION SRH is an important and robust variable associated with PND and diabetes in prenatal Latinas, making it an important factor to assess when treating this high-risk group.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Claire Swinford
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Danielle Massey
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Heidi Hardt
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
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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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Kim SM, Cheon JY, Park YG, Kim HR, Shin JC, Ko HS. The associations between parity, other reproductive factors, and osteoarthritis in women aged over 50 years; data from the Korean National Health and Nutrition Examination Survey V (2010–2012). Taiwan J Obstet Gynecol 2017; 56:153-158. [DOI: 10.1016/j.tjog.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/19/2022] Open
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Aksu S, Varol FG, Hotun Sahin N. Long-term postpartum health problems in Turkish women: prevalence and associations with self-rated health. Contemp Nurse 2016; 53:167-181. [DOI: 10.1080/10376178.2016.1258315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sevde Aksu
- Department of Midwifery, Balıkesir Health High School, Balıkesir University, Balıkesir, Turkey
| | - Füsun G. Varol
- Medical Faculty Hospital, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
| | - Nevin Hotun Sahin
- Department of Obstetrical and Gynecological Nursing, Florence Nightingale School of Nursing, Istanbul University, Istanbul, Turkey
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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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Wuytack F, Smith V, Cleary BJ. Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev 2016; 7:CD011352. [PMID: 27412362 PMCID: PMC6461153 DOI: 10.1002/14651858.cd011352.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Many women experience perineal pain after childbirth, especially after having sustained perineal trauma. Perineal pain-management strategies are thus an important part of postnatal care. Non-steroidal anti-inflammatory drugs (NSAIDs) are a commonly used type of medication in the management of postpartum pain and their effectiveness and safety should be assessed. OBJECTIVES To determine the effectiveness of a single dose of an oral NSAID for relief of acute perineal pain in the early postpartum period. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2016), OpenSIGLE, ProQuest Dissertations and Theses, the ISRCTN Registry and ClinicalTrials.gov (31 March 2016). We also reviewed reference lists of retrieved papers and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing a single dose of a NSAID versus a single dose of placebo, paracetamol or another NSAID for women with perineal pain in the early postpartum period. Quasi-RCTs and cross-over trials were excluded. DATA COLLECTION AND ANALYSIS Two review authors (FW and VS) independently assessed all identified papers for inclusion and risk of bias. Any discrepancies were resolved through discussion and consensus. Data extraction, including calculations of pain relief scores, was also conducted independently by two review authors and checked for accuracy. MAIN RESULTS We included 28 studies that examined 13 different NSAIDs and involved 4181 women (none of whom were breastfeeding). Studies were published between 1967 and 2013, with the majority published in the 1980s. Of the 4181 women involved in the studies, 2642 received a NSAID and 1539 received placebo or paracetamol. Risk of bias was generally unclear due to poor reporting, but in most studies the participants and personnel were blinded, outcome data were complete and the outcomes that were specified in the methods section were reported.None of the included studies reported on any of this review's secondary outcomes: prolonged hospitalisation or re-hospitalisation due to perineal pain; breastfeeding (fully or mixed) at discharge; breastfeeding (fully or mixed) at six weeks; perineal pain at six weeks; maternal views; postpartum depression; instrumental measures of disability due to perineal pain. NSAID versus placeboCompared to women who received a placebo, more women who received a single dose NSAID achieved adequate pain relief at four hours (risk ratio (RR) 1.91, 95% confidence interval (CI) 1.64 to 2.23, 10 studies, 1573 participants (low-quality evidence)) and adequate pain relief at six hours (RR 1.92, 95% CI 1.69 to 2.17, 17 studies, 2079 participants (very low-quality evidence)). Women who received a NSAID were also less likely to need additional analgesia compared to women who received placebo at four hours (RR 0.39, 95% CI 0.26 to 0.58, four studies, 486 participants (low-quality evidence)) and at six hours after initial administration (RR 0.32, 95% CI 0.26 to 0.40, 10 studies, 1012 participants (low-quality evidence)). Fourteen maternal adverse effects were reported in the NSAID group (drowsiness (5), abdominal discomfort (2), weakness (1), dizziness (2), headache (2), moderate epigastralgia (1), not specified (1)) and eight in the placebo group (drowsiness (2), light headed (1), nausea (1), backache (1), dizziness (1), epigastric pain (1), not specified (1)), although not all studies assessed adverse effects. There was no difference in overall maternal adverse effects between NSAIDs and placebo at six hours post-administration (RR 1.38, 95% CI 0.71 to 2.70, 13 studies, 1388 participants (very low-quality evidence)). One small study (with two treatment arms) assessed maternal adverse effects at four hours post-administration, but there were no maternal adverse effects observed (one study, 90 participants (low-quality evidence)). Neonatal adverse effects were not assessed in any of the included studies. NSAID versus paracetamolNSAIDs versus paracetamol were also more effective for adequate pain relief at four hours (RR 1.54, 95% CI 1.07 to 2.22, three studies, 342 participants) but not at six hours post-administration. There was no difference in the need for additional analgesia between the two groups at four hours (RR 0.55, 95% CI 0.27 to 1.13, one study, 73 participants), but women in the NSAID group were less likely to need any additional analgesia at six hours (RR 0.28, 95% CI 0.12 to 0.67, one study, 59 participants). No maternal adverse effects were reported four hours after drug administration (one study). Six hours post-administration, there was no difference between the groups in the number of maternal adverse effects (RR 0.74, 95% CI 0.27 to 2.08, three studies, 300 participants), with one case of pruritis in the NSAID group and one case of sleepiness in the paracetamol group. Neonatal adverse effects were not assessed in any of the included studies.Comparisons of different NSAIDs and different doses of the same NSAID did not demonstrate any differences in their effectiveness on any of the primary outcome measures; however, few data were available on some NSAIDs. AUTHORS' CONCLUSIONS In women who are not breastfeeding and who sustained perineal trauma, NSAIDs (compared to placebo) provide greater pain relief for acute postpartum perineal pain and fewer women need additional analgesia when treated with a NSAID. However, the risk of bias was unclear for many of the included studies, adverse effects were often not assessed and breastfeeding women were not included in the studies. The overall quality of the evidence (GRADE) was low with the evidence for all outcomes rated as low or very low. The main reasons for downgrading were inclusion of studies with high risk of bias and inconsistency of findings of individual studies.NSAIDs also appear to be more effective in providing relief for perineal pain than paracetamol, but few studies were included in this analysis.Future studies should examine NSAIDs' adverse effects profile including neonatal adverse effects and the compatibility of NSAIDs with breastfeeding, and assess other important secondary outcomes of this review. Moreover, studies mostly included women who had episiotomies. Future research should consider women with and without perineal trauma, including perineal tears. High-quality studies should be conducted to further assess the efficacy of NSAIDs versus paracetamol and the efficacy of multimodal treatments.
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Affiliation(s)
- Francesca Wuytack
- Trinity College DublinSchool of Nursing and MidwiferyD'Olier StreetDublinIreland2
| | - Valerie Smith
- Trinity College DublinSchool of Nursing and MidwiferyD'Olier StreetDublinIreland2
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Brahm P, Cortázar A, Fillol MP, Mingo MV, Vielma C, Aránguiz MC. Maternal sensitivity and mental health: does an early childhood intervention programme have an impact? Fam Pract 2016; 33:226-32. [PMID: 26370623 DOI: 10.1093/fampra/cmv071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maternal sensitivity (MS) and mental health influence mother-child attachment and the child's mental health. Early interventions may promote resilience and facilitate healthy development of the children through an impact on mothers' outcomes such as their sensitivity and mental health. Play with Our Children (POC) is an early intervention programme aiming to promote a positive mother-child interaction for children who attend three family health centres of deprived areas of Santiago de Chile. OBJECTIVE To estimate the effect of the programme POC on MS and mental health. METHODS A quasi-experimental design with propensity score matching estimations was employed. MS was measured with the Q-Sort of Maternal Sensitivity, and maternal mental health was assessed with the Patient Health Questionnaire and the Parenting Stress Index. Mean-difference comparison and difference-in-difference method were used as statistical strategies. The sample included 102 children from 2 to 23 months of age, 54 of them participated in the intervention and 48 children were the comparison group. RESULTS Estimates showed that participation in POC was positively associated with less stress in mothers of children younger than 12 months (P < 0.05) and positively associated with MS for mothers of children from 12 to 23 months (P < 0.05). There were no significant differences in maternal depression scores. CONCLUSION The dyadic early intervention POC may influence mother's mental health and indirectly impact children's well-being during critical stages of their development by strengthening their mother's sensitivity towards them.
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Affiliation(s)
- Paulina Brahm
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile,
| | - Alejandra Cortázar
- Centre for Comparative Politics of Education, Universidad Diego Portales, Santiago 8370056, Chile
| | | | - María Verónica Mingo
- Fundación Infancia Primero, Santiago 7500776, Chile, Department of Child Study and Human Development, Tufts University, Medford, MA 02155, USA and
| | - Constanza Vielma
- Centre for Comparative Politics of Education, Universidad Diego Portales, Santiago 8370056, Chile
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Smarandache A, Kim THM, Bohr Y, Tamim H. Predictors of a negative labour and birth experience based on a national survey of Canadian women. BMC Pregnancy Childbirth 2016; 16:114. [PMID: 27193995 PMCID: PMC4870779 DOI: 10.1186/s12884-016-0903-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A negative birth experience has been shown to have a significant impact on the well-being and future choices of mothers. The objective of this study was to assess the prevalence of, and identify the risk factors associated with a negative birth experience for women in Canada. METHODS The study was based on secondary data analysis of the Maternity Experiences Survey (MES), a Canadian population database administered to 6,421 Canadian women in 2006. The examined outcome - negative birth experience - was derived from mothers' self-report of overall labour and birth experience. Independent variables were maternal demographics, health characteristics, pregnancy-related characteristics, and birth characteristics. Multivariable logistic regression analysis was performed to determine the significant predictors of negative birth experience. Adjusted Odds Ratios (AOR) and 95 % Confidence Intervals (CI) are reported. RESULTS Negative birth experience was reported among 9.3 % of women. The main significant predictors of a negative birth experience included older age (AOR 2.29, 95 % CI, 1.03-5.07), violence experienced in the past two years (AOR, 1.62, 95 % CI, 1.21-2.18), poor self-perceived health (adjusted OR, 1.95, 95 % CI, 1.36-2.80), prenatal classes attended (adjusted OR, 1.36, 95 % CI, 1.06-1.76), unintended pregnancy (adjusted OR, 1.30, 95 % CI, 1.03-1.63), caesarean birth (AOR, 1.65, 95 % CI, 1.32-2.06), and neonate admission to intensive care (AOR, 1.40, 95 % CI, 1.08-1.82). CONCLUSION Significant predictors of a negative labour and birth experience were identified through this study, a first in the Canadian context. These findings suggest future research directions and provide a basis for the design and evaluation of maternal health policy and prevention programs.
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Affiliation(s)
- Andrei Smarandache
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Theresa H M Kim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Yvonne Bohr
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Fisher J, Rowe H, Wynter K, Tran T, Lorgelly P, Amir LH, Proimos J, Ranasinha S, Hiscock H, Bayer J, Cann W. Gender-informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: cluster randomised controlled trial. BMJ Open 2016; 6:e009396. [PMID: 26951210 PMCID: PMC4785308 DOI: 10.1136/bmjopen-2015-009396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. DESIGN Cluster-randomised controlled trial. SETTING 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). PARTICIPANTS English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. INTERVENTION WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. MAIN OUTCOME MEASURES Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. RESULTS In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. CONCLUSIONS WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare. TRIAL REGISTRATION NUMBER ACTRN12613000506796; Results.
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Affiliation(s)
- Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Wynter
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paula Lorgelly
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jenny Proimos
- Victorian Department of Education and Training, Melbourne, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Centre for Community Child Health, The Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jordana Bayer
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
| | - Warren Cann
- Parenting Research Centre, Melbourne, Victoria, Australia
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Bobevski I, Rowe H, Clarke DM, McKenzie DP, Fisher J. Early postnatal demoralisation among primiparous women in the community: measurement, prevalence and associated factors. BMC Pregnancy Childbirth 2015; 15:259. [PMID: 26459266 PMCID: PMC4603773 DOI: 10.1186/s12884-015-0680-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022] Open
Abstract
Background Demoralisation is a psychological state occurring in stressful life situations where a person feels unable to respond effectively to their circumstances, characterised by feelings of distress, subjective incompetence, helplessness and hopelessness. The period after the birth of a first baby is a time of great changes and disruptions to many aspects of the mother's physical, psychological and social functioning. This can lead to feelings of distress, a sense of incompetence and helplessness. This study aimed to examine: (1) the psychometric properties of the Demoralisation Scale in a community setting; (2) the prevalence of demoralisation symptoms among primiparous women in the community; and (3) factors that are uniquely associated with demoralisation in the early postnatal period. Methods Primiparous women attending community maternal health centres (n = 400) were recruited and administered the study's questionnaires through a telephone interview. Results The Demoralisation Scale was found to be a reliable and valid tool among women in the community who had recently given birth. Higher levels of demoralisation were independently associated with lower confidence on going home from the hospital after birth, lower rating of mother's self-rated global health, more than 3 h of infant crying and fussing in the last 24 h, and a controlling partner, after symptoms of depression and anxiety, and vulnerable personality characteristics were controlled for. Conclusions The relevance of demoralisation to postnatal health practitioners in the community is in helping them to better understand women's experiences and to intervene in a way that is more meaningful and less stigmatising to women.
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Affiliation(s)
- Irene Bobevski
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - David M Clarke
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Dean P McKenzie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Research Development & Governance, Epworth HealthCare, Melbourne, Australia.
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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McMahon CA, Boivin J, Gibson FL, Hammarberg K, Wynter K, Fisher JRW. Older maternal age and major depressive episodes in the first two years after birth: findings from the Parental Age and Transition to Parenthood Australia (PATPA) study. J Affect Disord 2015; 175:454-62. [PMID: 25679200 DOI: 10.1016/j.jad.2015.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 12/10/2014] [Accepted: 01/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study examines whether (1) older maternal age is associated with increased risk of depressive episodes between four months and two years after first birth and (2) the role of subsequent reproductive, social and child factors in vulnerability to later onset depression. METHOD 592 women were recruited in the third trimester of pregnancy in three age-groups (≤ 30 years; 31-36 years,≥37 years); 434 (73%) completed all assessments at four months and two years after birth. Major Depression episodes (MDE) were assessed at four months and two years using the Mini International Neuropsychiatric Interview (MINI). Maternal (age, mode of conception, prior mood symptoms, health), child (temperament, health), reproductive (subsequent fertility treatment, pregnancy, birth, pregnancy loss) and social contextual variables (language background, paid work, practical support, life stresses) were assessed in pregnancy and postnatally using validated questionnaires and structured interview questions. RESULTS Maternal age was not related to prevalence or timing of MDE. Depression symptoms, poor child health, low practical support at four months and a non-English language background predicted episodes of depression between four months and two years, ps <0.05. LIMITATIONS Life history risks for depression were not considered, nor symptom profiles over time. CONCLUSIONS Findings indicate that despite a more complex reproductive context, older first time mothers are not more likely to report major depressive episodes in the first two years after birth. Prevalence for the whole sample was at the lower end of reported community ranges and was comparable early and later in the postpartum period. Screening for depression after childbirth should not be restricted to the early months.
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Affiliation(s)
- Catherine A McMahon
- Centre for Emotional Health, Department of Psychology, Macquarie University North Ryde, NSW, 2109, Australia.
| | - Jacky Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, UK
| | | | - Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Karen Wynter
- Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Jane R W Fisher
- Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
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Rowe H, Wynter K, Lorgelly P, Amir LH, Ranasinha S, Proimos J, Cann W, Hiscock H, Bayer J, Burns J, Ride J, Bobevski I, Fisher J. A cluster randomised controlled trial of a brief couple-focused psychoeducational intervention to prevent common postnatal mental disorders among women: study protocol. BMJ Open 2014; 4:e006436. [PMID: 25248497 PMCID: PMC4173107 DOI: 10.1136/bmjopen-2014-006436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Postnatal common mental disorders among women are an important public health problem internationally. Interventions to prevent postnatal depression have had limited success. What Were We Thinking (WWWT) is a structured, gender-informed, psychoeducational group programme for parents and their first infant that addresses two modifiable risks to postnatal mental health. This paper describes the protocol for a cluster randomised controlled trial to test the clinical effectiveness and cost-effectiveness of WWWT when implemented in usual primary care. METHODS AND ANALYSIS 48 maternal and child health (MCH) centres from six diverse Local Government Areas, in Victoria, Australia are randomly allocated to the intervention group (usual care plus WWWT) or the control group (usual care). The required sample size is 184 women in each group. English-speaking primiparous women receiving postpartum healthcare in participating MCH centres complete two computer-assisted telephone interviews: baseline at 4 weeks and outcome at 6 months postpartum. Women attending intervention MCH centres are invited to attend WWWT in addition to usual care. The primary outcome is meeting Diagnostic and Statistical Manual-IV (DSM-IV) diagnostic criteria for major depressive episode; generalised anxiety disorder; panic disorder with or without agoraphobia, agoraphobia with or without panic, social phobia, adult separation anxiety or adjustment disorder with depressed mood, anxiety or mixed depressed mood and anxiety within the past 30 days at 6 months postpartum. Secondary outcomes are self-rated general and emotional health, infant sleep problems, method of infant feeding, quality of mother-infant relationship and intimate partner relationship, and healthcare costs and outcomes. ETHICS AND DISSEMINATION Approval to conduct the study has been granted. A comprehensive dissemination plan has been devised. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12613000506796. UTN: U1111-1125-8208.
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Affiliation(s)
- Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Wynter
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paula Lorgelly
- Faculty of Business and Economics, Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jenny Proimos
- Department of Education and Early Childhood Development, Melbourne, Victoria, Australia
| | - Warren Cann
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia, Parkville, Victoria, Australia
| | - Jordana Bayer
- School of Psychology, Faculty of Science, Technology and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Joanna Burns
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jemimah Ride
- Faculty of Business and Economics, Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Irene Bobevski
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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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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Morgan KJ, Eastwood JG. Social determinants of maternal self-rated health in South Western Sydney, Australia. BMC Res Notes 2014; 7:51. [PMID: 24447371 PMCID: PMC3899616 DOI: 10.1186/1756-0500-7-51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 01/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background From 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The aim of this study is to examine the relationship of maternal self-rated health, as a measure of well-being, to various socio-demographic factors including measures of social capital, country of birth, financial status and employment. Results The sample consisted of 23,534 mothers who delivered in South Western Sydney between 2004 and 2006. The data were collected as part of a routine post-partum assessment at 2–4 weeks postpartum. We examined the relationship of self-rated health with socio-demographic variables using binary logistic regression. Worse self-rated health was reported in 4% of women. Variables which were found to be significantly associated with worse self-rated health were: poor financial situation, public housing accommodation, fathers employment, no car access, unplanned pregnancy, maternal smoking, poor emotional and social support, and motherhood being more difficult than expected. Conclusion We confirmed the importance of social disadvantage and social isolation as independent risk factors for poor self-reported health. The findings reported here provide further justification for public health interventions which increase support for socially excluded mothers and strengthen their connection to their community.
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Affiliation(s)
| | - John G Eastwood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia.
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Teoli DA, Zullig KJ, Hendryx MS. Maternal Fair/Poor Self-Rated Health and Adverse Infant Birth Outcomes. Health Care Women Int 2014; 36:108-20. [DOI: 10.1080/07399332.2013.862796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schmied V, Johnson M, Naidoo N, Austin MP, Matthey S, Kemp L, Mills A, Meade T, Yeo A. Maternal mental health in Australia and New Zealand: A review of longitudinal studies. Women Birth 2013; 26:167-78. [DOI: 10.1016/j.wombi.2013.02.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/03/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
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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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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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Longitudinal study of depression and health status in pregnant women: incidence, course and predictive factors. Eur Arch Psychiatry Clin Neurosci 2013; 263:143-51. [PMID: 22743735 DOI: 10.1007/s00406-012-0336-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to determine the effect of isolated psychological intimate partner violence and psychosocial factors (social support and alcohol or drug use by a partner/family member) on psychological well-being (depression or poor self-perceived health status) at 5 and 12 months post-partum. A longitudinal cohort study was carried out with a consecutive sample of 1,400 women in their first trimester of pregnancy, who attended the prenatal programme in the Valencia Region (Spain) in 2008 and were followed up at 5 months and 12 months post-partum. A logistic regression model was fitted using generalized estimating equations, to assess the effect of isolated psychological intimate partner violence, social support, alcohol consumption and illicit drug use problems by a partner or family member on subsequent psychological well-being at follow-up. We observed a decrease in the incidence of poorer psychological well-being (post-partum depression and poor self-perceived health status) at 12 months post-partum. The strongest predictor of poor psychological well-being was depression (AOR = 6.83, 95 % CI: 3.44-13.58) or poor self-perceived health status (AOR = 5.34, 95 % CI: 2.37-12.02) during pregnancy. Isolated psychological IPV increased the risk of a deterioration in psychological well-being. Having a tangible social network was also a predictor of both post-partum depression and poor self-perceived health status. The effect of functional social support varied according to the type of psychological well-being indicator being used. Problems of alcohol consumption or illicit drug use by a partner or family member were a predictor of post-partum depression only. Psychological well-being during the first year after birth is highly affected by isolated psychological IPV and psychosocial factors.
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The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women. BMC Pregnancy Childbirth 2013; 13:1. [PMID: 23324161 PMCID: PMC3556498 DOI: 10.1186/1471-2393-13-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum. METHODS A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH--good SRH at baseline and follow-up, and, 2. Poor SRH--poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates. RESULTS The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house. CONCLUSIONS Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women's SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.
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46
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN, Barnett BEW. Relationship of postnatal depressive symptoms to infant temperament, maternal expectations, social support and other potential risk factors: findings from a large Australian cross-sectional study. BMC Pregnancy Childbirth 2012; 12:148. [PMID: 23234239 PMCID: PMC3556157 DOI: 10.1186/1471-2393-12-148] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 12/03/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND From 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The survey included the Edinburgh Postnatal Depression Scale (EPDS). The aim of the study was to determine the prevalence and risk factors for postnatal depressive symptoms in women living in metropolitan Sydney, Australia. METHODS Mothers (n=15,389) delivering in 2002 and 2003 were assessed at 2-3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were EPDS>9 and >12. Logistic regression was used for the multivariate analysis. RESULTS The prevalence of EPDS>9 was 16.93 per 100 (95% CI: 16.34 to 17.52) and EPDS>12 was 7.73 per 100 (95% CI: 6.96 to 7.78). The final parsimonious logistic regression models included measures of infant behaviour, financial stress, mother's expectation of motherhood, emotional support, sole parenthood, social support and mother's country of birth. CONCLUSIONS Infant temperament and unmet maternal expectations have a strong association with depressive symptoms with implications for the design of both preventative and treatment strategies. The findings also support the proposition that social exclusion and social isolation are important determinants of maternal depression.
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Affiliation(s)
- John G Eastwood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW, 2052, Australia
- Community Paediatrics, South Western Sydney Local Health Network, Hugh Jardine Building, Eastern Campus, Locked Mail Bag 7017, Liverpool, BC NSW, 1871, AUSTRALIA
| | - Bin B Jalaludin
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Lynn A Kemp
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Hai N Phung
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Bryane EW Barnett
- School of Psychiatry, The University of New South Wales, Sydney, NSW, 2052, Australia
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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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Emmanuel E, St John W, Sun J. Relationship between social support and quality of life in childbearing women during the perinatal period. J Obstet Gynecol Neonatal Nurs 2012; 41:E62-70. [PMID: 22861382 DOI: 10.1111/j.1552-6909.2012.01400.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period. DESIGN Longitudinal. SAMPLE Three public hospitals in metropolitan Brisbane, Australia. PARTICIPANTS Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth. METHODS The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS). RESULTS Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy. CONCLUSION Social support is a significant and consistent predictor of a mother's HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors.
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Affiliation(s)
- Elizabeth Emmanuel
- School of Nursing, Midwifery & Nutrition, James Cook University, Cairns, Australia.
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49
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Page RL, Padilla YC, Hamilton ER. Psychosocial factors associated with patterns of smoking surrounding pregnancy in fragile families. Matern Child Health J 2012; 16:249-57. [PMID: 21197563 PMCID: PMC3252496 DOI: 10.1007/s10995-010-0735-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although research has documented factors associated with maternal smoking, we need a more in-depth understanding of the risk factors associated with changes in smoking behaviors during the postpartum period. We investigate smoking patterns during pregnancy and 1 year postpartum as a function of relevant psychosocial factors. We use data on 3,522 postpartum mothers from the Fragile Families and Child Wellbeing Study to analyze the predictors of smoking among mothers who did not smoke during pregnancy but smoked at 1 year postpartum, mothers who smoked both during pregnancy and postpartum, and mothers who did not smoke during either period. Our covariates are grouped into four categories of risk factors for smoking: socioeconomic status, health care, life course and health, and partner and social support. Postpartum mothers in our sample were more likely to smoke throughout or after their pregnancies if they had only a high school education or less, had a household income three or more times below the poverty line, had public or no health insurance, breastfed for less than 5 months, were not married to the infant's father, if the infant's father currently smoked, and if they attended religious services less than once a week. Mental health problems were consistently associated with an increased risk of constant and postpartum smoking relative to non-smoking. Psychosocial factors play a role in postpartum smoking, but they have a stronger effect in predicting smoking that persists throughout pregnancy and the first year postpartum.
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Affiliation(s)
- Robin L Page
- School of Nursing, University of Texas at Austin, Austin, TX, USA.
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50
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Sumner LA, Valentine J, Eisenman D, Ahmed S, Myers H, Wyatt G, Liu H, Zhang M, Rodriguez MA. The influence of prenatal trauma, stress, social support, and years of residency in the US on postpartum maternal health status among low-income Latinas. Matern Child Health J 2012; 15:1046-54. [PMID: 20652383 PMCID: PMC3043120 DOI: 10.1007/s10995-010-0649-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This study examined the associations of prenatal psychosocial factors, including depressive symptoms, post-traumatic stress disorder symptoms, trauma exposure including intimate partner violence, perceived stress, and social support, with perceived postpartum health status. Low-income Latinas (N = 203) were recruited from two health plans within the first 12 weeks of their pregnancies and followed through 3 months after birth. Participants completed semi-structured interviews conducted in English or Spanish within the first 12 weeks of pregnancy, and again at 12 weeks postpartum. Perceived health status was measured by the SF-12. Participants with complete follow-up data (n= 193) were used in data analysis. Women were mostly foreign-born (75%) with low-incomes (59%) and reported postpartum health status in the average range (M = 102.5; SD = 12.2). Overall health status was positively associated with decreased levels of perceived stress (P < .0001), being foreign-born and having resided in the US <10 years (P = .003). Emotional well-being was positively linked with being foreign-born and having resided in the US <10 years (P = .002), increased levels of social support (P = .01), and decreased levels of perceived stress (P < .001). Exposure to non-specific IPV trauma (P = .01) and health problems experienced during pregnancy or delivery (P = .05) were negatively associated with physical health status. Prenatal psychosocial factors and length of residency in the US are differentially predictive of overall postpartum health status and emotional well-being, and have less impact on physical well-being after birth. Health professionals are encouraged to assess these factors in early pregnancy.
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Affiliation(s)
- Lekeisha A Sumner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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