Understanding and meeting the needs of women in the postpartum period: the Perinatal Maternal Health Promotion Model

The role of lack of grandparental support in perinatal depression

BACKGROUND

Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression.

METHODS

The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale.

RESULTS

Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression.

LIMITATIONS

Intergenerational conflicts and quality of grandparenting were not assessed.

CONCLUSIONS

Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.

"Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden"

OBJECTIVE

This study aimed to investigate new mothers' self-rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers' experiences of received support from the midwifery clinic.

DESIGN

A cross-sectional survey.

SETTING AND PARTICIPANTS

The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers.

MEASUREMENT AND FINDINGS

Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self-rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility.

CONCLUSION AND IMPLICATION FOR PRACTICE

It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.

Parent-identified gaps in preparation for the postpartum period in the United States: An integrative review

BACKGROUND

In the United States, 35% of all pregnancy-related deaths occur between 24 h and 6 weeks after delivery, yet the first outpatient visit is not typically scheduled until 6 weeks postpartum. Thus, the ability to independently navigate this period is critical to maternal well-being and safety. However, previous research suggests that many women feel unprepared to manage the challenges they encounter during this time, and there is a current need to synthesize the existing evidence. Therefore, the purpose of this integrative review is to describe parent-identified gaps in preparation for the postpartum period in the United States.

METHODS

Using the Integrative Review framework by Whittemore and Knafl, a systematic search of Medline, CINAHL, PsychInfo, Web of Science, and a hand-search was conducted for peer-reviewed articles published in English between 1995 and 2023. Results were reported according to PRISMA 2020 guidelines. Studies that met eligibility criteria were synthesized in a literature matrix.

RESULTS

Twenty-two studies met inclusion criteria. Four themes were identified: Mental Health Concerns, Physical Concerns, Infant Feeding and Care Concerns, and General Concerns and Recommendations. Many women, regardless of parity, reported feeling unprepared for numerous postpartum experiences, including depression, anxiety, physical recovery, breastfeeding, and infant care. Parents reported difficulty differentiating normal postpartum symptoms from complications. Hospital discharge teaching was viewed as simultaneously overwhelming and inadequate. Parent recommendations included the need for earlier and more comprehensive postpartum preparation during pregnancy, delivered in multiple formats and settings. Parents also reported the need for earlier postpartum visits and improved outpatient support.

CONCLUSIONS

Our findings indicate that many parents in the United States feel unprepared to navigate a wide variety of emotional, physical, breastfeeding, and infant-care experiences. Future research should explore innovative educational approaches to postpartum preparation during pregnancy as well as outpatient programs to bridge the current gaps in postpartum care.

Leading Stressors and Coping Strategies Associated With Maternal Physical and Mental Health During the Extended Postpartum Period

INTRODUCTION

A critical gap exists in understanding stressors and coping that affect women's health beyond 6 weeks postpartum. Using new stressor and coping scales tailored to postpartum women, we examined the relationship of postpartum-specific stressors and coping to women's physical and mental health between 2 to 22 months after childbirth.

METHODS

A total of 361 women of diverse race, ethnicity, and functional abilities recruited through clinical and online methods completed online surveys that included Sources of Stress-Revised subscales, such as overload, changes after pregnancy, and low support resources; Postpartum Coping Scale subscales, such as self-regulation, self-care, and health promotion; Patient-Reported Outcomes Measurement Information System Global Health, covering physical and mental health dimensions; and social demographic items. Analyses included hierarchical linear regression models adjusted for social factors.

RESULTS

Education and employment were the only social factors associated with physical and mental health, respectively. After adjusting for social factors, overload (P < .001) and coping through health promotion (P = .020) were the only additional variables associated with physical health. After adjusting for social factors, overload (P < .001) and low support resources (P = .002) and coping through self-care (P = .036) were the only additional variables associated with mental health. Thus, being overloaded was the key stressor associated with decreases in physical and mental health. Health promotion was associated with increases in physical health, and self-care was associated with increases in mental health.

DISCUSSION

These findings point to directions for health care and community interventions to promote health for postpartum women under stress. Strengths of our study include application of stress and coping scales tailored to postpartum women, whereas a limitation is use of a cross-sectional design.

A multilevel developmental psychopathology model of childbirth and the perinatal transition

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.

Postpartum care: Clinical considerations for improving genital and sexual health

The postpartum period encompasses the biological and psychoaffective transition to motherhood. However, it remains a most neglected phase in a woman's life. Furthermore, the transition to parenthood is a critical and potentially disrupting factor in a couple's relationship, which can be complicated by undiagnosed biological and psychosexual difficulties. Lack of recognition of the many biological and medical factors that can affect women's health and sexuality in the postpartum period is a common and persistent clinical omission worldwide. Communication difficulties exist between healthcare professionals and women and there are wording biases in describing female genitalia. This can further contribute to the diagnostic lack of attention and timely diagnosis and treatment of even very bothersome symptoms. Early diagnosis and treatment of common postpartum conditions is vital and quality care for new mothers should include psychological and emotional support, lactation assistance, early diagnosis and treatment of genital and sexual pain symptoms, pelvic floor rehabilitation and sexual health guidance. The inclusion of correct genital hygiene practices is a critical element of postpartum gynaecological counselling and can help improve overall genital and sexual health. In this review, we summarise the variability in global professional guidelines for postpartum care, identify common health problems faced by postpartum women and discuss appropriate postpartum care. We pay specific attention to prominent biological or medical factors that can impact the emotional and psychosexual wellbeing of women and couples. The aetiology, diagnosis and treatment of sexual dysfunction, in particular sexual pain disorders, is therefore discussed with a pragmatic approach. Finally, the role of intimate hygiene care is discussed with special attention given to cleanser ingredients with solid scientific evidence to help clinicians adopt a more tailored approach with their clinical recommendations.

Unique Profiles of Postpartum Family Needs and Evidence of Racial and Ethnic Disparities: Insights from Community Implementation of Family Connects

OBJECTIVES

To delineate specific family needs during the postpartum period using data from Family Connects (FC), a universal home-visiting initiative, and to scrutinize potential racial and ethnic disparities in these needs.

METHOD

FC implementation data spanned from July 1, 2009, to August 31, 2021, in seven counties across the USA. Data encompassed nurse-led in-home assessments for 34,119 families. Nurses evaluated needs across four domains (healthcare, parenting/childcare, safe home, and parent support) comprising 12 risk factors.

FINDINGS

Overall, families reported high levels of need, and community connections were facilitated for 57% of visited families. Significant differences in need profiles between whites and minority groups were revealed, reflecting both disparity and uniqueness. Employing the Oaxaca decomposition approach, we found that racial/ethnic disparities in socioeconomic attributes were associated with racial/ethnic gaps in the need profiles.

CONCLUSIONS

The event of giving birth is both high risk and high opportunity for preventive intervention. Home-visiting programs, as an evidence-based approach, must address the diverse spectrum of familial needs comprehensively.

Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US

OBJECTIVES

The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population.

METHODS

39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design.

RESULTS

Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers.

CONCLUSIONS

Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Home Visits for Postpartum Depression Intervention among Low-Income Latinas: Results from the PST4PPD Project

Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.

Suicide Ideation within and outside the Perinatal Period: An Exploration of Interpersonal Factors from a Maternal Cohort in Rural Pakistan to Improve Intervention Targeting

OBJECTIVE

Suicide accounts for substantial mortality in low-resourced settings and contributes to nearly 20% of maternal deaths. In Asia, interpersonal conflict is a salient factor that contributes to suicidal thoughts and actions, yet limited research has been done to explore the type and timing of such conflicts and a woman's accompanying social support. Identifying such risk factors can inform improved efforts to identify who to target for psychosocial interventions.

METHODS

Using the Bachpan Cohort study of mothers in Pakistan (n = 1154), we examined the prevalence and interpersonal influences on SI within the past two weeks of pregnancy and then at 3, 6, and 24 months after birth. Using hierarchical mixed effects models, we explored the separate and combined associations of interpersonal factors [e.g., social support, interpersonal conflict, isolation, and past year intimate partner violence (IPV)] on SI at each timepoint.

RESULTS

SI prevalence was highest in pregnancy (12.2%) and dropped to 5% throughout two years postpartum. The interpersonal conflict was independently associated with increased odds of SI in pregnancy and 24 months postpartum. IPV was associated with increased SI in pregnancy and 24 months postpartum. Isolation was not associated with SI at any timepoint. Perceived social support remained a robust independent factor associated with reduced SI at all timepoints.

CONCLUSION

In addition to screening and deploying interventions for perinatal women with depression, targeting interventions for those who also experience interpersonal conflict, including intimate partner violence, may significantly reduce suicidal thoughts and related sequelae. Social support is a viable and potentially powerful target to reduce the burden of suicide among women.HIGHLIGHTSSuicidal ideation prevalence was higher in pregnancy compared to postpartum.Perceived social support was independently associated with reduced suicidal ideation.Interventions addressing suicide must attend to women's family and social context.

The Lived Experience of Family Support Among Women During and After Childbirth in Jordan: A Phenomenological Study

Introduction

Many studies highlight the importance of family support in enhancing the experience of childbirth among women.

Objective

This qualitative study aimed to describe the lived experience of family support from the perspective of women during and after childbirth in the Jordanian context.

Methods

A qualitative descriptive phenomenological approach was used to explore the experiences of women's family support in the context of their childbirth experiences. A total of 11 Jordanian women participated in the study. Face-to-face semi-structured interviews were conducted to collect data.

Results

Four major themes emerged from the data describing family support provided to women during and after childbirth. These themes were family support during childbirth, family support in the postpartum period, importance of family support during and after childbirth, and challenges related to receiving family support. Supportive family members primarily included the husband, the woman's family, and the family-in-law, according to the traditions inherited in the Jordanian context and culture.

Conclusion

The study findings could help maternal health professionals screen pregnant women who are at risk of receiving low family support, contribute to developing effective interventions regarding family-centered care, and enhance the overall childbirth experience for women in Jordanian cultural contexts.

Common maternal health problems and their correlates in early post-partum mothers

BACKGROUND

Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status.

OBJECTIVE

This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore.

DESIGN

This was a cross-sectional study, based on a self-administered questionnaire.

METHODS

A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale.

RESULTS

The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001).

CONCLUSION

Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.

Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women

PURPOSE

Postpartum care is an opportunity to provide essential follow-up care to people who have given birth, but inequalities in access by race and socioeconomic status (SES) are well-documented. The purpose of this study is to provide an in-depth description of the barriers to postpartum care using a mixed-methods design.

METHODS

Mixed method analyses using convergent design with three stages including (1) bivariate logistic regression of survey data representative of postpartum women in Kalamazoo County, Michigan, (2) thematic qualitative analyses of focus group interviews of survey participants, and (3) bivariate logistic regression and logistic regression meditation analyses using themes operationalized with survey data measures.

RESULTS

In Kalamazoo county, 82.0% of women attended their postpartum visit. White women and women with higher SES were 2.84 (SE = 1.35, p < .001) and 5.73 (SE = 3.10, p < .001) times more likely to attend postpartum visits than women of color and those with lower SES. Qualitative analyses identified four common barriers: (1) misaligned goals for appointments, (2) time and scheduling of appointments, (3) prioritization of children, and (4) material resources and health insurance coverage. The quantitative analyses found mixed support for these barriers and found limited evidence that these barriers mediated the relationship between race or SES and postpartum attendance.

CONCLUSIONS FOR PRACTICE

The qualitative findings identify barriers that are amenable to practice-level interventions including changes to scheduling procedures and employing patient-centered care. The quantitative findings further suggest that although inequalities in postpartum care are present, interventions on these barriers may benefit women regardless of race and SES.

Mitochondrial might: powering the peripartum for risk and resilience

The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation - all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders.

Do postpartum insomnia, fatigue and depression affect the maternal role of primiparous women?

Many factors negatively affect the motherhood role. Fatigue, insomnia and depression, which are among these factors, have not been investigated together in any study. Therefore, we carried out this study to determine the effect of insomnia, fatigue and depressive symptoms on the motherhood role in primiparous mothers. In this descriptive and cross-sectional study, we included 153 women who met the inclusion criteria using the simple, random sampling method. To determine the independent variables affecting the motherhood role, we used the backward regression model. In this study, we determined that the women's spending more energy while they performed the activities of daily living in the postpartum period, their suffering from insomnia due to baby care and their depressive symptoms affected their motherhood role by 32.6 percent. We also determined that there was a moderately significant relationship between insomnia, fatigue and depressive symptoms in the postpartum period. In particular, because depressive symptoms are the variable most related with the motherhood role (r = -0.520; p < .001), women should be followed-up regularly in the postpartum period from this aspect. It is also important to deal with insomnia in the early postpartum period, because it is a common problem in most women after childbirth.

The relationship between perceived stress and pregnancy distress with self-care of pregnant women: The mediating role of social support-A cross-sectional study

Background and Aims

Pregnancy is a stressful experience, which can affect different aspects of a woman's life. Yet, women with a supportive network of friends and family may experience lower stress and improved self-care behavior. The study aimed to investigate the relationship between perceived stress and pregnancy distress with the self-care of pregnant women, as well as the mediating role of social support.

Methods

This cross-sectional study was conducted from February to May 2022 in Babol, Iran. A total of 157 pregnant women participated in the study. The participants completed five questionnaires, including a demographic and obstetric questionnaire, a Self-care questionnaire, Perceived Social support (PSS), Perceived Stress Inventory (PSI), and Pregnancy Specific Distress. Structural equation modeling was used to test the hypothesis relationships among the variables.

Results

We found that Perceived stress (β = -0.221, p = 0.012β) and pregnancy distress (β = -0.203, p = 0.002β) had a negative and significant effect on the self-care of pregnant women. Also, perceived stress (β = -0.429, p < 0.001β) and pregnancy distress (β = -0.381, p < 0.001β) had a negative and significant effect on the social support of pregnant women. The results exhibited a significant specific indirect effect between pregnancy distress, perceived stress, and pregnancy self-care, with social support as the mediator: standardized indirect effect = -0.068, -0.076, respectively.

Conclusion

According to the findings, social support plays a direct and mediating role in improving self-care behaviors among pregnant women. Therefore, providing strategies and measures to improve perceived social support by maternal health professionals may be expected to reduce the impact of stress on pregnant women's self-care. The implementation of policies and social interventions to improve the social support of pregnant women can be one of the applications of the findings.

Adapting group care to the postpartum period using a human-centered design approach in Malawi

BACKGROUND

Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi.

METHODS

We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2-4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper.

RESULTS

All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period.

CONCLUSIONS

Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.

Extended postpartum intimate partner violence and its associated factors: community-based cross-sectional study design

BACKGROUND

Intimate partner violence is a global problem that threatens mothers. It has multidimensional consequences but has not gained attention from scholars after childbirth.

OBJECTIVE

To assess the prevalence of extended postpartum intimate partner violence and its associated factors.

METHOD

A community-based cross-sectional study design was employed among 570 postpartum mothers in Arba Minch Town, Southern Ethiopia, from May 21st to June 21st, 2022. A pretested, face-to-face interviewer-administered structured questionnaire was used. Bivariable and multivariable logistic regression analyses were used. The level of statistical significance was declared at P < 0.05 with a 95% CI.

RESULTS

Overall, the prevalence of extended postpartum intimate partner violence was 45% (95% CI: 40.89, 49.20). Participants whose husband has no formal education (AOR = 3.62; 95%CI: 1.32, 9.90) and only secondary education (AOR = 2.96; 95%CI: 1.56, 5.48), husband alcohol consumption (AOR = 1.73; 95%CI: 1.06, 2.80), husband dominance in decision-making (AOR = 1.94; 95%CI: 1.13, 3.33), husband disappointment in the gender of the baby (AOR = 2.13; 95%CI: 1.28, 3.56), previous history of intimate partner violence (AOR = 5.71; 95%CI: 3.59, 9.07), and low social support (AOR = 4.37; 95%CI: 2.53, 7.55) were significantly associated factors.

CONCLUSIONS AND RECOMMENDATIONS

The prevalence of extended postpartum intimate partner violence was found to be high. Thus, increasing awareness of husbands with no formal education and having lower academic achievement, incorporating maternal social support assessment into maternity and child health care; teaching on alcohol reduction behavior and gender roles; and screening of mothers during the prenatal period should be given.

Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence

Postpartum depression, with a prevalence ranging between 14% and 25% worldwide, has been considered an urgent health concern that negatively affects both mothers' and their infants' health. Postpartum depression may negatively affect maternal sociodemographic and anthropometric parameters and lifestyle factors. Nutrition has recently been identified as a crucial factor for the management and co-treatment of postpartum depression. This survey aims to determine the possible association of postpartum depression with mothers' socio-demographic and anthropometric characteristics, perinatal outcomes, breastfeeding practices, and Mediterranean diet (MD) adherence.

METHODS

This is a cross-sectional survey, which was performed on 3941 women during the postpartum period. Postpartum depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Anthropometric parameters and perinatal outcomes were retrieved from mothers' medical records. Sociodemographic data and breastfeeding practices were recorded by face-to-face interviews between enrolled mothers and trained personnel. Mediterranean diet adherence was assessed by MedDietScore. Both univariate and multivariate binary logistic regression were applied for analyzing our data.

RESULTS

Postpartum depression was significantly associated with lower educational level, Greek nationality, higher prevalence of multiparity and overweight/obesity postpartum, higher incidence of caesarean section and not breastfeeding, and lower levels of MD adherence. In multivariate analysis, postpartum depression was independently associated with mothers' educational level, postpartum BMI status, type of delivery, breastfeeding practices, and MD adherence after adjusting for multiple confounding factors.

CONCLUSIONS

This study has provided evidence that elevated MD compliance was related to a decreased risk of postpartum depression. Additionally, postpartum depression was associated with multiple sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Future well-designed, prospective studies with high-quality methodology should be performed to obtain conclusive results.

Modification and Psychometric Analyses of Stress and Coping Scales for the Extended Postpartum Period

OBJECTIVE

To modify and psychometrically assess two scales that are used to measure stress and coping during the extended postpartum period.

DESIGN

Instrument modification and psychometric assessment.

SETTING

Online, community, and health care settings.

PARTICIPANTS

Mothers with infants who were 2 to 22 months old: 20 in Phase 1 and 373 in Phase 2.

METHODS

In Phase 1, participants from diverse backgrounds served as content experts to recommend modifications of items on two scales: Sources of Stress-Revised (SoS-R) and Postpartum Coping Scale (PCS). The results were 32-item modified versions of each scale. In Phase 2, we conducted a psychometric analysis of both revised scales using principal components analysis to identify dimensionality, Cronbach's alphas to estimate internal consistency reliability, and Pearson correlations to estimate validity of the SoS-R and PCS with the Perceived Stress Scale and the Brief COPE, respectively.

RESULTS

We identified six components for the SoS-R: Overload, Changes After Pregnancy, Baby-Related Concerns, Working Mother Concerns, Low Support Resources, and Isolated Motherhood. The Cronbach's alpha for the SoS-R was .94. The SoS-R subscales demonstrated correlations with the Perceived Stress Scale that ranged from 0.55 to 0.30. We identified six components for the PCS: Self-Regulation, Spiritual Care, Self-Care, Use and Seek Support, Internal and External Resources, and Health Promotion. The Cronbach's alpha coefficients for the PCS ranged from .84 to .66. The highest correlations observed between the PCS subscales and the Brief COPE subscales ranged from 0.67 to 0.26.

CONCLUSION

The SoS-R and PCS each include six components. Internal consistency reliability for all SoS-R subscales and four of six PCS subscales exceeded .70. The dimensions of each scale highlight areas of clinical and research concern.

The Effect of Fear of Happiness as a Cultural Phenomenon on Anxiety and Self-Efficacy in the Puerperae

INTRODUCTION

Individuals who believe that experiencing positive emotions such as happiness could lead to negative results can suppress their authentic positive feelings to prevent undesired consequences. The aim of this study was to determine the levels of fear of happiness as a cultural phenomenon among puerperal women and the effects of fear of happiness on anxiety and self-efficacy in these women.

METHOD

This cross-sectional study was conducted in the puerperal service of a hospital in Turkey between September 2021 and June 2022 (n = 287). The study data were collected through State-Trait Anxiety Inventory Scale (STAI-I and STAI-II), General Self-Efficacy (GSE) Scale, and Fear of Happiness Scale (FHS).

RESULTS

There was a significant relationship between STAI-II and GSE and FHS scores, which explained 43.4% (R2 = .434) of the variance (p < .001). Also, a significant relationship of GSE with working at an income-generating job, STAI-I, and STAI-II was found (p = .008, p = .040, p < .001, respectively). It was found that the puerperae who stated that they needed training on the postpartum process and baby care had high levels of fear of happiness (p = .007).

DISCUSSION

Screening puerperae in terms of fear of happiness is important for determining their psychological well-being. Health care professionals should be aware that fear of happiness as a cultural approach negatively affects anxiety and therefore self-efficacy levels of puerperae. Providing a comprehensive training to the puerperae on parenthood and self-efficacy as well as mental health support is important for them to cope with fear of happiness.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Women report better experiences from maternity care after postnatal consultations: A cross sectional study

OBJECTIVE

To determine if the patient reported experiences (PREMs) of women in maternity care differ by whether or not they had a postnatal consultation before leaving the birth institution.

METHODS

Secondary analysis of cross-sectional data to compare PREMs of women who had received an individual consultation (86 %), a group consultation (3 %), and women who had received no consultation (11 %). PREMs were collected using a self-administered questionnaire. Eight summated scales were constructed from 29 single items, pertaining to different parts of the received care. Scores ranged between 0 and 100, with high scores representing positive experiences.

RESULTS

Among the 8156 sampled women, 3387 (42 %) responded. There were statistically significant (p ≤ 0.002) differences (from 3.7 to 16.3 points) on all eight scales. The scores from women who had an individual postnatal consultation were consistently higher than the scores from the other groups. The largest difference was in the scale with the worst score: information about women's health during the postnatal stay.

CONCLUSION

Women who participated in individual postnatal consultations reported more positive experiences compared to those who did not.

PRACTICE IMPLICATION

The consistent differences found in this study provide support for administering individual postnatal consultations.

A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research

OBJECTIVE

To use scoping review methods to construct a conceptual framework based on current evidence of group well-child care to guide future practice and research.

METHODS

We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework.

RESULTS

The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare.

CONCLUSION

Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.

Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub-Saharan Africa: evidence from Demographic and Health Survey Data

BACKGROUND

Resuming sexual activity early after childbirth can cause reproductive health problems such as unwanted pregnancy, unsafe abortion, and short birth intervals, especially if contraception is not used. However, it is uncommon for healthcare providers to discuss postpartum sexual practices during prenatal and postnatal care. Therefore, this study aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in sub-Saharan Africa.

METHODS

Secondary data analysis from the most recent Demographic and Health Surveys data from the period of 2014 to 2019/2020 of 23 countries in sub-Saharan Africa were used. A total weighted sample of 118,371 women who gave birth in the three years before the surveys were used. We analyzed the data using Stata version 14. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with early resumption of sexual intercourse. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with the outcome variables.

RESULTS

The magnitude of early resumption of sexual intercourse among postpartum women was 67.97% (95% CI: 67.60, 68.34). Urban resident (AOR = 1.91; 95% CI: 1.83, 2.06), women with primary education 1.11 (AOR = 1.11; 95% CI: 1.07 to 1.31) and secondary education and above level 1.17 (AOR = 1.17; 95% CI: 1.09 to 1.29), husbands with primary education 1.32 (AOR = 1.32; 95% CI: 1.27, 1.38) and secondary education and above level 1.15 (AOR = 1.15; 95% CI: 1.11 to 1.25), family planning use (AOR = 95%; CI: 1.77, 1.91), fertility intention wanted then 1.24 (AOR = 1.24; 95%; CI: 1.19, 1.32) and wanted later 1.27 (AOR = 1.27; 95%; CI: 1.22, 1.46), religion (AOR = 2.08; 95%CI: 1.97, 2.17), and place of delivery (AOR = 1.51; 95%CI = 1.36, 1.65) were significantly associated with early resumption of sexual intercourse.

CONCLUSION

The study revealed that more than two-thirds of the women had resumed sexual intercourse early after childbirth. Hence, the concerned bodies should strengthen the integration of postpartum education on sexual resumption with maternal, neonatal, and child health care services to reduce the early resumption of sexual intercourse. In addition, healthcare providers providing counseling on the resumption of postpartum sexual intercourse should focus on these factors to ensure a more effective outcome.

The Influence of Social Media on Alcohol Consumption of Mothers of Children and Adolescents: A Scoping Review of the Literature

Alcohol misuse is a common problem in many countries, where alcohol is often portrayed as a fun and interactive coping strategy for mothers to manage the demands of motherhood. Social media platforms have established themselves as a popular forum for mothers to share information and create an environment in which mothers may be exposed to and influenced by alcohol-related content. Given the increased social acceptance and normalization of drinking among mothers, especially during the recent pandemic, a critical analysis of social media influences on alcohol behaviours and consumption is warranted. A scoping review mapped the evidence on social media influences and alcohol consumption among mothers of children and teenagers younger than eighteen years old. Several databases were consulted, and the evidence was collated into two themes and seven subthemes. Factors related to alcohol consumption in motherhood include (1) community and social support, (2) coping and mental health, (3) motherhood expectations and identity, (4) alcohol consumption, (5) marketing strategies, (6) everyday issues, and (7) social media influence. Numerous social, economic, and health problems are associated with alcohol misuse. The current literature suggests that social media is a powerful tool to disseminate messages about alcohol and normalize mothers' drinking behaviours.

Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

BACKGROUND

Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care.

METHODS

We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people's experience with and evaluation of the model.

RESULTS

Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions.

CONCLUSION

We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.

Association of postpartum medication practices with early breastfeeding cessation among mothers with chronic conditions: A prospective cohort study

INTRODUCTION

Use of medications is a common concern for breastfeeding women, particularly when they are strongly needed or unavoidable to manage maternal chronic conditions. Yet the influence of medication usage patterns on breastfeeding duration in mothers with chronic conditions is unclear. The objective of this study was to examine whether postpartum medication practices were associated with shorter breastfeeding duration or earlier than planned breastfeeding cessation among mothers with chronic conditions.

MATERIAL AND METHODS

We analyzed 346 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study (Alberta, Canada) who initiated breastfeeding after birth. Data were collected through self-report questionnaires spanning late pregnancy to 6 months postpartum. Based on reported use of preexisting medications while breastfeeding, women were classified as continuing medications (reference group), discontinuing one or more medications, or those who did not use preexisting medications. Cox proportional hazards regression was used to analyze the association of medication practices and overall breastfeeding duration in weeks. Logistic regression was used to analyze the association of medication practices and earlier than planned breastfeeding cessation. Multivariable models adjusted for demographic and health-related factors.

RESULTS

Overall, 30.6% of women with chronic conditions stopped breastfeeding in the first 6 months, almost all of whom did so earlier than planned. In multivariable models, medication discontinuation was significantly associated with shorter breastfeeding duration (adjusted hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03-2.70) and earlier than planned breastfeeding cessation (adjusted odds ratio [OR] 1.85, 95% CI 1.01-3.42), whereas medication non-use was not associated with differences in breastfeeding outcomes.

CONCLUSIONS

Women with chronic conditions who discontinued preexisting medications while breastfeeding had significantly shorter breastfeeding duration and were less likely to meet their breastfeeding goals in the first 6 months postpartum compared to women who continued preexisting medications.

Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden

OBJECTIVE

Continuity of care as provided by midwives promoting the health and well-being of new mothers during the postnatal period is critical; thus, access to midwifery services needs to be facilitated. The aim of this study was to describe new mothers' and midwives' experiences and perceptions of a new coordinated postnatal care intervention in a midwifery clinic.

DESIGN

New mothers responded to open-ended questions in a survey, and midwives were interviewed individually about the intervention. A deductive content analysis research related to continuity of care concepts was used.

SETTING AND PARTICIPANTS

The study was carried out at a midwifery clinic in a larger city in Sweden, for an eight-month period in 2019 and 2020. Two hundred and sixteen answers from new mothers and nine interviews with midwives were analysed.

INTERVENTION

All registered pregnant women at the midwifery clinic received enhanced postnatal support based on a new coordinated postnatal care model. The focus was on continuity of care, from pregnancy to the postnatal period and included planning for the first weeks after childbirth at the end of pregnancy, early postnatal contact and several visits to the midwifery clinic.

FINDINGS

New mothers describing the coordinated postnatal care model highlighted continuity and accessibility as empowering factors that made them feel assured and confident. Midwives emphasised the pregnancy to postnatal continuity as crucial to providing care based on individual needs.

KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Using a structured and coordinated care model as a midwife that includes planning for the postnatal period together with the pregnant woman at the end of pregnancy may be a good and relatively easy way to create continuity and thus ensure satisfaction and confidence in expectant and new mothers.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus

BACKGROUND

This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment.

METHODS

This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed.

RESULTS

The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus.

CONCLUSIONS

Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

Background Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care. Methods We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people’s experience with and evaluation of the model. Results Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions. Conclusion We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.

Using the teach-back method to improve postpartum maternal-infant health among women with limited maternal health literacy: a randomized controlled study

AIM

This study aimed to evaluate the effects of using the teach-back method among women with limited maternal health literacy (LMHL) on maternal health literacy(MHL), postpartum health behaviours and maternal-infant health outcomes.

METHODS

A randomized controlled study was conducted in the obstetrics department of Anhui Provincial Hospital, China. A total of 258 pregnant women with LMHL were recruited at the point of admission to the hospital for birth and randomly assigned to the control group (n = 130), where women received routine education sessions, and the teach-back group (n = 128), where women received routine education sessions plus a teach-back intervention. The two groups were assessed in terms of MHL before and after the intervention, breastfeeding execution, uptake of 42-day postpartum check-ups, complete uptake of one-time recommended vaccines, and physical health outcomes. Statistical tests were employed for data analysis.

RESULTS

There was no significant difference between the two groups in terms of MHL and other social, demographic, and medical status at baseline. After the intervention, the teach-back group had a higher level of MHL (p < 0.001), better postpartum health behaviours in terms of exclusive breastfeeding within 24 hours postpartum (x² = 22.853, p<0.001), exclusive breastfeeding within 42 days postpartum (x² = 47.735, p<0.001), uptake of 42-day postpartum check-ups (x² = 9.050, p = 0.003) and vaccination (x² = 5.586, p = 0.018) and better maternal-infant health outcomes in terms of the incidence of subinvolution of the uterus (x² = 6.499, p = 0.011), acute mastitis (x² = 4.884, p = 0.027), postpartum constipation (x² = 5.986, p = 0.014), overweight (x² = 4.531, p = 0.033) and diaper dermatitis (x² = 10.896, p = 0.001).

CONCLUSIONS

This study shows that the teach-back method is effective for enhancing MHL, leading to positive postpartum health behaviours, and improving postpartum maternal-infant health outcomes among women with LMHL. The teach-back method may play an important role in improving postpartum maternal-infant health and could be considered in maternal health education.

TRIAL REGISTRATION NUMBER

Our trial has been prospectively registered at ClinicalTrials.gov (Ref. No.: NCT04858945) and the enrollment date was 26/04/2021.

Evaluation of Nursing Care in the Early Postpartum Period

Objective: Evaluation of the care given in the postpartum period is vital in terms of the quality of care. The aim of this study was to evaluate nursing care in the early postpartum period. Methods: This descriptive and cross-sectional study was conducted in a postpartum clinic between December 2016 and January 2017 with 130 mothers in postpartum period, and 18 nurses and midwives working in the same postpartum clinic. Data were collected using a personal information form, and the Postpartum Nursing Care Evaluation Tool (PPNCET). The data analysis was conducted using percentages, arithmetic mean, independent samples t-test, Mann-Whitney U test, and Kruskal-Wallis test. Results: The mean age of the mothers was 26.80 ± 4.90, and of the nurses and midwives was 35.83 ± 12.14. The mean PPNCET score of the mothers was 141.58 ± 32.03. The mean care subscale score of the mothers was 69.88 ± 12.06 and of the education subscale was 71.70 ± 19.97. The mean PPNCET score of the nurses and midwives was 153.50 ± 23.18. The mean care subscale score of the nurses and midwives was 73.38 ± 8.84, and the mean education subscale score was 80.11 ± 14.33. Conclusions: The mean PPNCET score of mothers and nurses and midwives were higher than the average. Higher PPNCET scores of the nurses and midwives compared to the mothers suggests that either the postpartum care given was not perceived as adequate by the mothers, or the care was not served in adequate quality. To increase postpartum care satisfaction of the mothers, involving nurses and midwives in the care process more is suggested. In line with these results, planning in-service training programs to develop the knowledge and skills of the nurses and midwives would be beneficial in increasing the quality of service

Women's lived experiences of preterm birth and neonatal care for premature infants at a tertiary hospital in Ghana: A qualitative study

Preterm birth is a leading cause of death in children under five and a major public concern in Ghana. Women's lived experiences of care following preterm birth in clinical setting represents a viable adjunctive measure to improve the quality of care for premature infants. This qualitative study explored the knowledge and experiences of women who have had preterm birth and the associated challenges in caring for premature infants at a tertiary hospital. A qualitative design using in-depth interviews (IDIs) was conducted among women who experienced preterm birth with surviving infants at the Korle-Bu Teaching Hospital in Accra, Ghana. A thematic content analysis using the inductive analytic framework was undertaken using Nvivo. Thirty women participated in the study. We observed substantial variation in women's knowledge on preterm birth: some women demonstrated significant understanding of preterm delivery including its causes such as hypertension in pregnancy, and potential complications including neonatal death whilst others had limited knowledge on the condition. Women reported significant social and financial challenges associated with preterm birth that negatively impacted the quality of postnatal care they received. Admission of preterm infants at the neonatal intensive care unit (NICU) generated enormous psychological and emotional stress on the preterm mothers due to uncertainty associated with the prognosis of their babies, health system challenges and increased cost. Context-specific recommendations to improve the quality of care for prematurely born infants were provided by the affected mothers and include urgent need to expand the National Health Insurance Scheme (NHIS) coverage and more antenatal health education on preterm birth. Mothers of premature infants experienced varied unanticipated challenges during the care for their babies within the hospital setting. While knowledge of preterm birth seems adequate among women, there was a significant gap in the women's expectations of the challenges associated with the care of premature infants of which the majority experience psychosocial, economic and emotional impact.

Psychological and situational factors associated with COVID-19 vaccine intention among postpartum women in Pakistan: a cross-sectional study

OBJECTIVES

Contributing factors to COVID-19 vaccination intention in low-income and middle-income countries have received little attention. This study examined COVID-19-related anxiety and obsessive thoughts and situational factors associated with Pakistani postpartum women's intention to get COVID-19 vaccination.

DESIGN

Cross-sectional study administering a survey by a telephone interview format between 15 July and 10 September 2020.

SETTING

Four centres of Aga Khan Hospital for Women and Children-Garden, Kharadar, Karimabad and Hyderabad-in Sindh Province, Pakistan.

PARTICIPANTS

Women who were enrolled in our longitudinal Pakistani cohort study were approached (n=1395), and 990 women (71%) participated in the survey, of which 941 women who were in their postpartum period were included in the final analysis.

PRIMARY OUTCOME MEASURE AND FACTORS

COVID-19 vaccine intention, sociodemographic and COVID-19-related factors, Coronavirus anxiety, obsession with COVID-19 and work and social adjustment were assessed. Multiple multinomial logistic regression analysis was used to identify factors associated with women's intentions.

RESULTS

Most women would accept a COVID-19 vaccine for themselves (66.7%). Only 24.4% of women were undecided about vaccination against COVID-19, and a small number of women rejected the COVID-19 vaccine (8.8%). Women with primary education were less likely to take a COVID-19 vaccine willingly than those with higher education. COVID-19 vaccine uncertainty and refusal were predicted by having no experience of COVID-19 infection, childbirth during the pandemic, having no symptoms of Coronavirus anxiety and obsession with COVID-19. Predictors for women's intention to vaccinate themselves and their children against COVID-19 were similar.

CONCLUSION

Understanding the factors shaping women's intention to vaccinate themselves or their children would enable evidence-based strategies by healthcare providers to enhance the uptake of the COVID-19 vaccine and achieve herd immunity against Coronavirus.

Operationalizing Whole-Person Postpartum Care: Health Care Provider-Level Strategies

Postpartum mothers report feeling unsupported and unprepared by their health care providers to meet the challenges of the postpartum period. This gap perpetuates a cycle of disappointment with and disengagement from postpartum care services. The need to revamp postpartum care has been recognized at the population level but implementing changes at the health care provider level is challenging without practical guidance. The needs of new mothers are broad in scope and variable between individuals, requiring a whole-person care approach that is comprehensive yet nimble. Presented here are provider-level strategies to promote care that both elicits and is responsive to the unique care goals of this population.

Welcoming, supportive care in US birthing facilities and realization of breastfeeding goals

BACKGROUND

Emotional and physical support for birthing parents is positively associated with realization of their breastfeeding goals. However, few studies have investigated maternal descriptions of their postnatal unit experience of these domains.

RESEARCH AIM

The objective was to investigate maternal report of their birthing facility experiences and quantify the extent to which accounts of postpartum support were associated with meeting their breastfeeding goals.

METHODS

After IRB review, data were obtained through an online survey distributed from November 2016-May 2017. This analysis utilizes data from 2,771 birthing parents who were at least 18 years of age, experienced maternity care in the United States within five years, and reported that they had intended to breastfeed. Bivariate analysis was followed by logistic regression controlling for significant covariates.

RESULTS

In this sample of primarily non-Hispanic white birthing parents with intent to exclusively breastfeed, the following postnatal unit variables were associated with higher odds of meeting their breastfeeding goals, birthing parents feeling: welcomed (adjusted OR=1.36), that health care promoted their physical health (adjusted OR=1.41), that care promoted their emotional health (adjusted OR=1.38), that they were supported (adjusted OR=1.56), and that they were recognized by their health care team (adjusted OR=1.30). All the measured postnatal unit support variables were significantly correlated with each other, with correlation coefficients ranging from 0.15 to 0.81.

CONCLUSIONS

Before the COVID-19 pandemic, birthing parents' experiences on the postnatal unit were interrelated and associated with meeting their breastfeeding goals. As health care services are reviewed and prioritized during the COVID-19 pandemic and as part of ongoing strengthening of systems, qualitative and observational research can address the mechanisms underlying breastfeeding outcomes to inform the provision of more holistic and effective support.

Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology

Introduction

Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach.

Methods

Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood.

Results

Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences.

Conclusion

We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.

Systematic Review of Health Promotion Frameworks Focused on Health in the Postpartum Period

OBJECTIVE

To systematically review the scope and development of frameworks to promote health during the postpartum period.

DATA SOURCES

We searched PubMed, CINAHL, and American Psychological Association PsycInfo during May 2021.

STUDY SELECTION

We included English-language, peer-reviewed articles focused on frameworks for health promotion in the postpartum period. We placed no time limit on publication date. Our search resulted in 2,355 articles after we removed duplicates. After excluding articles based on titles and abstracts, we conducted full-text reviews of 23 articles. Three articles met inclusion criteria and addressed the following frameworks: Integrated Perinatal Health Framework, Perinatal Maternal Health Promotion Model, and Maternal Self-Care Framework.

DATA EXTRACTION

We extracted data into analytic tables that included categories for the scope, such as time frame, and criteria for the level of development of the frameworks, including the origins, concept definitions and theoretical linkages among concepts, and evidence of application in research or practice.

DATA SYNTHESIS

The three frameworks described in the articles included in our review covered various periods, including the reproductive life span, the first year after birth, and the first 6 weeks after birth. Overall, the frameworks were comprehensive. Most key concepts in the frameworks were defined, and some degree of relationships linking concepts was specified. Empirical referents were provided for most but not all concepts in the frameworks. Developers of the three frameworks elaborated on application in practice or health services, but only the developers of the Maternal Self-Care Framework indicated how their framework might be used in research. The Integrated Perinatal Health Framework and Maternal Self-Care Framework were partially derived from existing general theories; the methods used to develop the Perinatal Maternal Health Promotion Model were less clear.

CONCLUSION

The frameworks met most criteria and together provided a comprehensive strategy for health promotion during the postpartum period. Elaboration of the frameworks for application in research is needed.

Introducing the Postpartum Toolkit: An Examination of the Feasibility, Acceptability and Pilot Efficacy of an Online Clinical Tool to Enhance Postpartum Functioning and Emotional Wellbeing

During the postpartum period, a birth parent’s level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy data suggest that this tool may be effective in improving postpartum emotional wellbeing, though further controlled testing is warranted. A future iteration of the tool that incorporates participant feedback to improve feasibility of use could prove an effective means of delivering support to an at-risk population.

Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey

BACKGROUND

Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization.

RESEARCH AIMS

To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed.

METHODS

This was a prospective cross-sectional survey study. Through secure online survey, participants submitted (N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics.

RESULTS

Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood.

CONCLUSION

Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

Pregnancy, Motherhood and Partner Support in Visually Impaired Women: A Qualitative Study

Background: This qualitative study aimed to explore the experiences of women with vision impairments regarding the meaning of motherhood and their mothering-related issues and priorities. Methods: In-depth individual, semi-structured interviews were conducted between July and December 2020 with a group of visually impaired mothers residing in Italy. The interviews explored experiences related to pregnancy, childbirth, and motherhood; support received from partners, family, and friends; ways of interacting and communicating with the child; and the participants’ sense of personal self-efficacy and self-awareness. Results: Fifteen women participated in this study, ten with a congenital visual impairment and five with an acquired disability. The mean age of the sample was 49 years. The qualitative content analysis of the transcripts of the interviews pointed out four main themes or categories: (1) pregnancy and motherhood experiences, (2) family and social support, (3) relationship and communication with the child, and (4) self-efficacy and self-awareness. Conclusions: This study underlined that mothers with visual impairments show a strong desire to be recognized and accepted as women and mothers by their social environment. Adequate social and family support is associated with a better sense of personal self-efficacy and greater confidence in one’s skills as a mother.

Exploring the Unmet Needs of Postpartum Mothers: A Qualitative Study

This study aimed to identify unmet needs of mothers in the postpartum period. Semi-structured telephone interviews were conducted two weeks postpartum with a convenience sample of 26 mothers who gave birth at an academic medical center. Topics included mothers’ concerns, levels of preparedness, educational needs and preferences during antepartum, labor and birth, and postpartum periods. Data were qualitatively analyzed using NVivo and a combination of open coding and theoretical coding, based on the Perinatal Maternal Health Promotion Model. Three major themes emerged: concerns, expectations, and positive coping strategies, with variations by previous maternal experience. Findings suggest the need for different models of care with more anticipatory, mother-centered care to better meet mothers’ needs and enhance postpartum outcomes and breastfeeding success.

Experiences of Postnatal Mothers with Healthcare Providers in Rural Kenya: Insights from Applying the Mmogo Method

PURPOSE

To explore the experiences of postnatal mothers with health care providers during postnatal care in rural Kenya.

DESIGN

This was a visual-based narrative inquiry study that applied the Mmogo method® - a visual projective data-collection method.

METHODS

The participants were women (n=26) receiving postnatal care at purposively sampled rural health facilities (n=4) in Laikipia County Kenya.

FINDINGS

Two themes emerged from this study. First, the mothers had positive experiences with health care providers. Secondly, the mothers expressed expectations to enhance future experiences with health care providers.

CONCLUSIONS

Mothers had positive experiences and various expectations to enhance future experiences with health care providers that related to their postnatal needs. The mothers proposed the possible use of mobile phones by health care providers to meet their health education needs as well as receive psychological support.

CLINICAL EVIDENCE

Health care providers can use mobile phone devices to call and address some of the postnatal needs during the postnatal period.

Social support needs of first-time parents in the early-postpartum period: A qualitative study

Background

The early postpartum period is a critical time for first-time parents as they adapt to their new role. Perceived lack of social support is a risk factor for developing mental health problems. Insufficient or inappropriate professional support for both parents has been reported by many studies. Social support that appropriately meets parents' needs is an important protective factor for parents' wellbeing; however, little is known about the social support needs of both first-time parents.

Aims and objectives

To describe both first-time parents' formal social support needs in the early postpartum period.

Method

Individual semi-structured interviews were conducted with first-time parents recruited on the postpartum ward of a Swiss university hospital. Thematic analysis was used to identify themes and sub-themes.

Results

Fifteen mothers and eleven fathers were interviewed. Twelve themes were identified. Mothers' themes were "experiencing postpartum changes," "creation of a family unit," "self-esteem," "emotional needs," "difficulty in communicating their needs," and "the postpartum stay." Fathers' themes were "to be included in care procedures on the postpartum ward," "to be reassured," "to anticipate their postpartum stay" and "to consider their need as non-priority." Parental shared needs were: "to care for their newborn," and "returning home."

Conclusion

Mothers' and fathers' needs differed. Mothers needed more emotional support than fathers and fathers considered themselves as the main support for their partner. Fathers wanted to be integrated in the care of their newborn.

Demographics, health literacy and health locus of control beliefs of Australian women who take complementary medicine products during pregnancy and breastfeeding: A cross-sectional, online, national survey

Background

Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian sample.

Aim

The aim of this study is to determine the health literacy levels and HLOC beliefs of women who use CMPs in pregnancy and lactation and determine the types of CMPs used.

Methods

A cross‐sectional, national, online survey of Australian pregnant or breastfeeding women aged 18 years and older, and currently using CMPs was conducted.

Results

A total of 810 completed surveys (354 pregnant and 456 breastfeeding women) were analysed. Most had adequate functional health literacy levels (93.3%). Health care practitioners (HCPs) HLOC mean scores were the highest for the sample, followed by Internal HLOC beliefs mean scores. Almost all (n = 809) took at least one dietary supplement, the most popular being pregnancy and breastfeeding multivitamins, iron supplements and probiotics. Use was generally in line with clinical recommendations, except for low rates of iodine supplementation. Herbal medicine use was lower for the total sample (57.3%, n = 464), but significantly higher (p < .0001) for the breastfeeding cohort, with consumers taking one to four herbal medicines each. The most popular herbs were raspberry leaf, ginger, peppermint and chamomile (pregnant respondents) and chamomile, ginger and fenugreek (breastfeeding respondents).

Conclusions

Respondents were health literate, with high scores for Internal and HCP HLOC scales, suggesting that they are likely to demonstrate self‐efficacy, positive health behaviours and work well in partnership with HCPs. HCPs can facilitate discussions with pregnant and breastfeeding women using CMPs, while considering women's health literacy levels, health beliefs and goals.

Smoking status: A tacit screen for postpartum depression in primary care settings

BACKGROUND

Universal screening for postpartum depression (PPD) remains an unachieved national priority. A tacit screen that requires no additional resources for administration can help to achieve this priority. We examine the predictive utility of using smoking as a tacit screen for PDD. We first establish smoking is a valid proxy for more prominent psychosocial determinants of PPD and is a predictor for PPD.

METHODS

We analyzed PRAMS data (2012-2015; N=134,435). Time of smoking was categorized as nonsmoker, during the prenatal period, the postpartum, or continuously; PPD was assessed using two PHQ-2 style questions.

RESULTS

Compared to nonsmokers, women who smoked only during the prenatal period (OR: 1.41; 95% CI: 1.06 - 1.86), only during the postpartum (OR: 1.33; 95% CI: 1.18 - 1.49), and continuously throughout both periods (OR: 1.54; 95% CI: 1.41 - 1.69) were more likely to experience PPD. Smoking assessed at a prenatal visit (SN: 0.90, SP: 0.21), postpartum visit (SN: 0.86, SP: 0.25), or assessed at both visits (SN: 0.90, SP: 0.19) performed relatively well as a tacit screen for PPD, performing better among unmarried women (SN: 0.75 - 0.81; SP: 0.29 - 0.36).

LIMITATIONS

In this study, the criterion of positivity used was PRAMS' adapted version of the PHQ-2. This tacit screen may perform differently relative to a clinical diagnosis.

CONCLUSIONS

Time of smoking predicts risk of PPD and can be used to tacitly screen for PPD with reasonable accuracy without requiring any additional time in settings with limited resources for routine screening of PPD.