Understanding maternal postpartum needs: A descriptive survey of current maternal health services

"The needs of women in the postpartum period: A scoping review."

BACKGROUND

The postpartum period is critical and challenging for women, implying emotional, physical, social and spiritual changes. For a positive postpartum experience, it is important to receive consistent information and support from health professionals. However, this is not always the case, as care is more focused on the newborn, forgetting the needs of the puerperal woman.

AIM

The review aimed to map the published scientific knowledge about women's needs in the postpartum period.

METHODS

A Scoping Review was carried out, according to the method proposed by The Joanna Briggs Institute, in the MEDLINE Complete, MedicLatina and CINAHL Complete databases, and were selected articles since 2017 that answered the research question "What is the available evidence on women's needs in the postpartum period?". For the selection of articles, the eligibility criteria were defined.

RESULTS

A total of 6,647 articles were identified. After the exclusion of duplicate articles and the application of the eligibility criteria, at the end of the process, 27 articles were included in the review. The extracted data were grouped into four categories, which summarize the needs of women in the postpartum period: support, sharing, care and preparation for the postpartum period.

CONCLUSION

In the articles analysed, women reveal that they do not feel prepared for the postpartum period and identify several unmet needs, so health education and parenting skills training during pregnancy are essential to improve the postpartum experience and the transition to parenthood.

Women utilisation, needs and satisfaction with postnatal follow-up care in Oman: A cross-sectional survey

BACKGROUND

In Oman, there is a lack of data on utilisation, needs and women's satisfaction with care and information provided during postnatal follow-up period.

AIM

To investigate postnatal follow-up care utilisation and women's needs; level of postnatal information received and satisfaction with services.

METHODS

A purposive sample of women (n = 500), recruited in the immediate postnatal period at one metropolitan and one regional birthing hospital in Oman. An electronic survey link was sent to participants at 6-8 weeks postnatally. Quantitative variables were analysed as frequencies and chi-squared test.

RESULTS

A total of 328 completed surveys were received; a response rate of 66 %. Most respondents were located in the metropolitan area (n = 250) and between 20 and 39 years (n = 308). Utilisation was low as women reported no need or no benefit in attending. Women's information needs were not sufficiently met by HCPs, requiring women to seek information from family and the internet to meet their needs. Satisfaction with services was mostly neither satisfied nor dissatisfied (30 %) or satisfied (30 %).

CONCLUSION

Postnatal follow-up care utilisation in both metropolitan and regional areas is less than optimal and not utilised as there was no advice to attend or no appointment date/time given, no benefit experienced previously, no need and information needed sourced from family or the internet. The information provided by postnatal follow-up care consumers can be used to enhance service delivery, inform future updates to the national maternity care guidelines, and provides a baseline for future evaluation and research.

Experiences of women with physical disabilities in labor and delivery assistance

OBJECTIVE

To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery.

METHODS

Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool.

RESULTS

Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery.

FINAL CONSIDERATIONS

Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.

Stakeholder's perspectives of postnatal discharge: a qualitative evidence synthesis

INTRODUCTION

Discharge preparation prior to leaving a health facility after childbirth offers a critical window of opportunity for women, parents and newborns to receive support for the transition to care at home. However, research suggests that the quality of discharge preparation following childbirth is variable. This review synthesises qualitative evidence on stakeholder perspectives of postnatal discharge.

METHODS

We conducted a thematic synthesis of qualitative studies included in a larger published scoping review on discharge preparedness and readiness (reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews). For inclusion, in the qualitative evidence synthesis, studies had to have used qualitative methods for data collection and analysis to capture the perspectives of women, parents and health workers. Key characteristics and findings were extracted, and thematic analysis was used to inductively develop a conceptual coding framework.

RESULTS

Of a total of 130 research documents (published research articles and grey literature), six studies met the inclusion criteria; five were conducted in high-income countries, five were published in English and one was published in Swedish. Studies reported on the experiences of women, fathers and midwives with the number of participants ranging from 12 to 324. Nine descriptive themes (findings) were identified. From these, three high-level analytical themes were generated: (1) health workers need support to optimise the postnatal discharge process; (2) the allocated time for, and timing of, discharge is rushed; (3) overlooking women's and fathers'/partners' needs leads to feelings of exclusion.

CONCLUSIONS

Findings suggest an overall feeling of dissatisfaction among women, parents and midwives with the current provision of discharge preparation. In particular, women and midwives expressed frustration at the lack of time and resources available for ensuring adequate quality of care prior to discharge. The perspectives of included stakeholders indicate a demand for increased focus on the emotional and social needs of women and families during discharge preparation as well as better engagement of fathers and other family members. The qualitative evidence available indicates the likely positive impact of adequate discharge preparation if the identified service and system barriers can be overcome. As the updated WHO recommendations on postnatal care become embedded in country health systems and policies, there may be renewed interest on values, preferences and perspectives at system, service and end-user level.

Women's Views on Factors that Influence Utilisation of Postnatal Follow-Up in Oman: A descriptive, qualitative study

Objectives

Postnatal follow-up care (PNFC) is critical for promoting maternal and newborn health and well-being. In Oman, women's utilisation of postnatal follow-up services has declined, with rates as low as 0.29 (mean visits) in some governorates, and fails to meet the recommendation of postnatal follow-up visits at two and six weeks for assessment of the mother and her newborn. The reasons for this low utilisation are not well understood. This study aimed to explore women's views on and identify factors that influence their utilisation of postnatal follow-up services.

Methods

Purposive sampling was employed and semi-structured telephone interviews were conducted with 15 women aged 20-39 years at six to eight weeks post-childbirth between May and August 2021. The data were analysed using Erlingsson and Brysiewicz's content analysis approach.

Results

The following six categories were identified as influencing PNFC utilisation: 1) need for information; 2) experiences and expectations; 3) family support, expectations and customs; 4) sociocultural beliefs and practice; 5) impact of the COVID-19 pandemic; and 6) the healthcare environment. Influencing factors derived from each category include the need to empower women, provide individualised care, address family and community expectations, offer alternatives to face-to-face clinic visits and provide organised and scheduled appointments.

Conclusion

Women in Oman identified the need for consistent information from healthcare providers and a more organised postnatal follow-up service that includes scheduled appointments and a woman-centred approach to PNFC.

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 effect of acupressure on postpartum fatigue in women delivering by caesarean section: A randomized controlled study

AIM

The aim of this study was to determine the effect of acupressure on postpartum fatigue in women who gave birth by cesarean section.

METHOD

This study is a randomized controlled experimental study. The study was conducted between August 2021 and January 2022 in the maternity wards of hospitals in Turkey. Multiparous women who gave birth by cesarean section were randomly assigned to acupressure (n = 60) and control (n = 62) groups. Acupressure was applied to the acupressure group for a total of four sessions on the points of LI4, ST36, and SP6, for an average of 15 min for each session. The application sessions continued for 48 h after the cesarean section. The data were collected with a Descriptive Information Form and the VAS-F.

RESULTS

It was determined that the mean posttest score of the fatigue dimension of the VAS-F was found to be significantly lower in the acupressure group (p = 0.023). Additionally, in the acupressure group, while the differences between the pretest and posttest results of the both fatigue and energy dimensions of the VAS-F were statistically highly significant in the acupressure group (p = 0.000), only the difference in the energy dimension was found to be statistically significant in the control group (p = 0.016).

CONCLUSIONS

As a result, acupressure was found to be effective in reducing postpartum fatigue in women who gave birth by cesarean section, and its usability for healthcare professionals was demonstrated.

An integrative review on the maternal health literacy among maternal and child workers

AIMS

This study aim to capture the most comprehensive evidence-based dimensions of maternal health literacy, including summarizing the definitions, theoretical frameworks, measuring instruments, and the association between maternal health literacy and health behaviours.

BACKGROUND

Maternal health literacy has been recognized as an important approach to achieving high-quality maternal and child health; however, little is known about maternal health literacy comprehensively and scientifically.

EVALUATION

An integrative review retrieved articles from 11 databases, following the methodology of Whittemore and Knafl. Inductive content analysis and narrative synthesis were conducted, guided by the aim of this review.

KEY ISSUES

A total of 5580 articles were retrieved and 23 articles were finally identified. Existing definitions and theoretical frameworks took less consideration of maternal applicability and failed to summarize maternal health literacy from a dynamic and systematic perspective. Measurement instruments were set up with many items that make it difficult to quickly screen for poor maternal health literacy. Most articles proved the association between maternal health literacy and health behaviours through correlation analysis or regression analysis but less explored the influence pathways between them.

CONCLUSION

The definition and theoretical framework need to focus on maternal applicability and explain the process of individual mothers acquiring and understanding health knowledge and skills from a dynamic and systematic perspective. A rapid instrument for maternal health literacy should be developed and high-quality empirical research was conducted to understand the associated mechanisms between maternal health literacy and health behaviours.

IMPLICATIONS FOR NURSING MANAGEMENT

It is necessary to strengthen maternal and child health education of primary health care nurses and enhance their ability to help perinatal women use maternal and child health information effectively.

Teenage first-time mothers' perceptions about their health care needs in the immediate and early postpartum period in Uganda

Background

Teenagers have higher risks for complications during the intrapartum and postpartum periods. Although facility-based postpartum care focusses on preventing complications in mothers and babies, it is not understood what teenage-mothers’ perceptions are about their health care needs in the early postpartum period.

Methods

An exploratory descriptive qualitative study was conducted in four health facilities in Uganda. In-depth interviews with 42 first-time teenage mothers aged 14 to 19 years were conducted between March and April 2020. Thematic analysis was done.

Results

Two themes emerged, Health promotion and Rehabilitation and counseling. Teenage first time mothers desired to receive information about key issues like self and newborn care, breast feeding, immunization and family planning. They noted that health workers need to monitor their vital signs which aids in early diagnosis of complications, disease prevention/treatment of current conditions. Others felt that health workers are key in arbitrating between them and their estranged parents and also help to link them to community based organizations that can provide them with counseling and life skills.

Conclusions

Teenage first-time mothers have many health care needs during the immediate and early postpartum period. This is a missed opportunity to provide health education and link them to sexual reproductive health services including family planning, breastfeeding clinics and other community based programs which provide life skills or continuing education for girls. Focusing on these needs and integration of services is key in providing holistic care to the teenagers. We propose that further research be done to explore how their health care needs change at 6 months post-delivery.

A qualitative study of assessing learning needs and digital health literacy in pregnancy: Baby Buddy Forward Greek findings

INTRODUCTION

The purpose of this study was to explore the learning needs and the digital health literacy of pregnant women in Greece regarding perinatal health and care issues.

METHODS

This was a qualitative study involving thirteen Greek pregnant women, in two focus groups of primiparous and multiparous. The interview topic guide was developed by consensus during a training workshop of the European Baby Buddy Forward research program. The interviews were recorded, transcribed and inductively content analyzed.

RESULTS

Pregnant women described a range of learning needs and identify antenatal classes, health professionals, Internet, books, friends and relatives, as their main sources of information. Women expressed satisfaction in terms of their communication with midwives, but they expressed ambiguity regarding communication with doctors. With regard to the Internet, women highlighted their concern about the validity of information and point out the difficulties they face in order to access reliable scientific resources. Moreover, the process of seeking information online occurs in parallel and independently from healthcare providers, who discourage it, thus, many women were reluctant to discuss any information they retrieved from the Internet with health professionals.

CONCLUSIONS

The content of antenatal classes should be tailored to address pregnant women learning needs more holistically. However, taking into consideration that a major source of information for pregnant women is the Internet, it is vital for health professionals to acknowledge this reality and provide pregnant women with trusted websites. It is also particularly important for health professionals to practice their communication skills and update their digital knowledge.

Scoping Review of Postpartum Discharge Education Provided by Nurses

OBJECTIVE

To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding.

DATA SOURCES

We conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020.

STUDY SELECTION

We included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria.

DATA EXTRACTION

We extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results.

DATA SYNTHESIS

Infant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses' knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information.

CONCLUSION

Postpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health-centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.

"There's a Lot of Like, Contradicting Stuff"-Views on Healthy Living during Pregnancy and Postpartum

The transition from pregnancy through early postpartum can be a particularly vulnerable time for women as they adjust to the changes of motherhood. This study aimed to provide a detailed account of additional health challenges that mothers are facing throughout motherhood during the pandemic. Data obtained can be utilized to create tailored interventions to aid women during their reproductive years. A sequential approach was utilized, collecting health-related information via survey and subsequent focus groups or interviews to further examine health experiences during pregnancy or postpartum. Fifty-seven participants completed the online survey, 73.5% were postpartum. The healthy eating index of the cohort was low, 50.5 ± 10.3%. Prior to pregnancy, 54.5% were classified as overweight/obese. Following pregnancy, 71.1% were classified as overweight or obese. Emergent qualitative themes from focus groups (n = 3) and interviews (n = 6) included (1) value and desire for healthy eating, (2) desire to make well-informed health-based decisions, and (3) role of social networks during pregnancy and postpartum. Pregnant/postpartum women desire to lead a healthy lifestyle but experience barriers to accomplishing intended goals. Upstream resources and policies that promote healthy living for pregnant/postpartum women can reduce chronic disease throughout the lifespan following childbirth.

Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature

BACKGROUND

Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman's concerns about herself and the parents' concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care.

METHODS

We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation.

RESULTS

The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge.

CONCLUSIONS

The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support.

PROTOCOL REGISTRATION DETAILS

The protocol for the review was registered with protocols.io on 23 November 2020: https://doi.org/10.17504/protocols.io.bpzymp7w.

Validation of the Korean version of the Perinatal Infant Care Social Support scale: a methodological study

Purpose

The purpose of this study was to develop and test the validity and reliability of the Korean version of the Perinatal Infant Care Social Support (K-PICSS) for postpartum mothers.

Methods

This study used a cross-sectional design. The K-PICSS was developed through forward-backward translation. Online survey data were collected from 284 Korean mothers with infants 1-2 months of age. The 19-item K-PICSS consists of functional and structural domains. The functional domain of social support measures infant care practices of postpartum mothers. Exploratory factor analysis (EFA) and known-group comparison were used to verify the construct validity of the K-PICSS. Social support and postpartum depression were also measured to test criterion validity. Psychometric testing was not applicable to the structural social support domain.

Results

The average age of mothers was 32.76±3.34 years, and they had been married for 38.45±29.48 months. Construct validity was supported by the results of EFA, which confirmed a three-factor structure of the scale (informational support, supporting presence, and practical support). Significant correlations of the K-PICSS with social support (r=.71, p<.001) and depression (r=-.40, p<.001) were found. The K-PICSS showed reliable internal consistency, with Cronbach's α values of .90 overall and .82-.83 in the three subscales. The vast majority of respondents reported that their husband or their parents were their main sources of support for infant care.

Conclusion

This study demonstrates that the K-PICSS has satisfactory construct validity and reliability to measure infant care social support in Korea.

The effects of co-parenting/intergenerational co-parenting interventions during the postpartum period: A systematic review

BACKGROUND

Co-parenting interventions have been offered, particularly to enhance paternal involvement in infant care. However, little is known about whether such co-parenting interventions can be effective in improving the psychological health of families and co-parenting outcomes during the postpartum period.

OBJECTIVES

The aim of this review was to examine the effects of interventions on the co-parenting relationship of families, the psychological health of members involved, and on co-parenting outcomes during the postpartum period.

METHODS

This was a systematic review with a meta-analysis. Randomized controlled trials of co-parenting intervention studies were selected following the standardized methods recommended by the Cochrane Handbook for Systematic Reviews of Interventions Version 6. The Cochrane Risk of Bias Assessment tool was used to assess the risk of bias in the included studies.

RESULTS

Twelve co-parenting randomized controlled trials were included in this review. Most studies reported positive effects in promoting at least one domain of co-parenting in mothers and/or fathers, especially in co-parenting support, couple communication, parent-child interactions and reducing co-parenting undermining. Meta-analysis showed that mothers in the intervention group showed significantly lower depressive symptoms compared to those in the control group. The only online co-parenting intervention identified produced similar effects to that of face-to-face interventions on improving co-parenting support, and reducing co-parenting undermining. Only one study focused on parent-grandparent co-parenting, which reported positive effects on 'family management' and 'cooperation in childcare between mothers with depressive symptoms and their 'mother-in-law'. Another study found that significantly more mothers continue to breastfeed in the intervention group compared to the control group at 12 weeks postpartum as a positive outcome in co-parenting.

CONCLUSION

Co-parenting interventions have demonstrated some positive effects on co-parenting support, co-parenting undermining, couple communication, parent-child interactions of parents and the depressive symptoms of mothers. Limited evidence was found on the overall effects on co-parenting, division of labor, childrearing agreement, the psychological health of fathers, parenting self-efficacy and baby feeding practices. Further studies are recommended to examine the effects of interventions for intergenerational (parent-grandparent) families on co-parenting, the psychological health in parenting, parenting self-efficacy and baby feeding practices during the postpartum period by adopting online approaches.

Experiences of primary care physicians managing postpartum care: a qualitative research study

BACKGROUND

The postpartum period is redefined as 12 weeks following childbirth. Primary care physicians (PCP) often manage postpartum women in the community after uneventful childbirths. Postpartum care significantly impacts on the maternal and neonatal physical and mental health. However, evidence has revealed unmet needs in postpartum maternal care.

AIM

The study aimed to explore the experiences of PCPs in managing postpartum mothers.

METHODS

Four focus group discussions and eleven in-depth interviews with twenty-nine PCPs were conducted in this qualitative research study in urban Singapore. PCPs of both gender and variable postgraduate training background were purposively enrolled. Audited transcripts were independently coded by two investigators. Thematic content analysis was performed using the codes to identify issues in the "clinician", "mother", "postpartum care" and "healthcare system & policy" domains stipulated in "The Generalists' Wheel of Knowledge, Understanding and Inquiry" framework.

FINDINGS

PCPs' personal attributes such as gender and knowledge influenced their postpartum care delivery. Prior training, child caring experience and access to resource materials contributed to their information mastery of postpartum care. Their professional relationship with local multi-ethic and multi-lingual Asian mothers was impacted by their mutual communication, language compatibility and understanding of local confinement practices. Consultation time constraint, awareness of community postnatal services and inadequate handover of care from the specialists hindered PCPs in the healthcare system.

DISCUSSION

Personal, maternal and healthcare system barriers currently prevent PCPs from delivering optimal postpartum care.

CONCLUSION

Interventions to overcome the barriers to improve postpartum care will likely be multi-faceted across domains discussed.

Evaluation of the clinical application of the Postpartum Depression Predictors Inventory-Revised for postpartum women in China

AIM

This study was designed to assess the clinical applicability of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) during the 1st month following delivery among women in China and to survey the prevalence of postpartum depression (PPD)-related risk factors included in the PDPI-R in this population.

METHODS

This was a cross-sectional study which recruited 447 women from the People's Liberation Army Hospital in Hefei of Anhui province. All participants completed the Chinese version of the PDPI-R (PDPI-R-C) and the Chinese version of the Edinburgh Postnatal Depression Scale (C-EPDS) within 1 month of delivery. The predictive ability of the PDPI-R was then evaluated through receiver operating characteristic (ROC) curve analyses.

RESULTS

The PDPI-R-C was able to accurately predict 73.2% of PPD cases (area under the ROC curve = 0.732; 95% CI 0.69-0.78) using a cut-off score of 5.5, as defined by a C-EPDS score of ≥10 (sensitivity = 62.8%; specificity = 73.5%; positive predictive value = 74.5%; negative predictive value = 61.5%). All 13 risk factors in the PDPI-R-C other than socioeconomic status and marital status were associated with the risk of PPD.

CONCLUSIONS

The PDPI-R-C was found to be an effective and easy-to-implement tool that has promise as a means of screening for PPD in Chinese populations.

Impact of mobile health interventions during the perinatal period on maternal psychosocial outcomes: a systematic review

OBJECTIVE

The objective of this review was to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries.

INTRODUCTION

The perinatal period is an exciting yet challenging period for mothers that requires physical, emotional and social adjustment to new norms and expectations. In recent years, there has been an increase in the use of mHealth by new mothers who are seeking health information through online or mobile applications. While there have been systematic reviews on the impact of mHealth interventions on maternal and newborn health in low- and middle-income countries, the impact of these interventions on maternal psychosocial health outcomes in high-income countries remains uncertain.

INCLUSION CRITERIA

This review considered studies of mHealth education interventions targeting mothers in high-income countries (as defined by the World Bank) during the perinatal period. Interventions must have started between the antenatal period (conception through birth) through six weeks postpartum. All experimental study designs were included. Outcomes included self-efficacy, social support, postpartum anxiety and postpartum depression.

METHODS

PubMed, CINAHL, PsycINFO and Embase were searched for published studies in English on December 16, 2018. Gray literature was also searched for non-peer reviewed articles, including Google Scholar, mHealth intelligence and clinical trials databases. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. All conflicts were solved through consensus with a third reviewer. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan. Where statistical pooling was not possible, findings were reported narratively.

RESULTS

Of the 1,607 unique articles identified, 106 full-text papers were screened and 24 articles were critically appraised, with 21 included in the final review. Eleven were quasi-experimental and 10 were randomized controlled trials. The mHealth intervention approach varied, with text message and mobile applications being the most common. Length of intervention ranged from four weeks to six months. The topics of the mHealth intervention varied widely, with the most common topic being postpartum depression. Mothers who received an mHealth intervention targeting postpartum depression showed a decreased score on the Edinburgh Postnatal Depression Scale when measured post-intervention (odds ratio = -6.01, 95% confidence interval = -8.34 to -3.67, p < 0.00001). The outcomes related to self-efficacy, social support and anxiety showed mixed findings of effectiveness (beneficial and no change) across the studies identified.

CONCLUSIONS

This review provides insight into the effectiveness of mHealth interventions targeting mothers in high-income countries in the perinatal period to enhance four psychosocial outcomes: self-efficacy, social support, anxiety and depression. Despite a wide variety of outcome measurements used, the predominant findings suggest that there are insufficient data to conclude that mHealth interventions can improve self-efficacy and anxiety outcomes. Potential benefits on social support were related to interventions targeting postnatal behaviors. Postpartum depression was the mostly commonly reported outcome. Findings related to the comparison of pre-post outcomes and intervention versus control demonstrated that mHealth interventions targeting postpartum depression were associated with a reduction in postpartum depression.

Sexual educational needs of Jordanian women after giving birth

BACKGROUND

Pregnancy and birth entail many bodily changes, including changes in sexual activity. The postpartum period is a time of considerable recovery and adaptation for women, yet women do not always receive adequate information, especially in countries where such topics may be considered taboo. The purpose of this project was to explore the sexual educational needs of Jordanian women after giving birth.

METHODS

A qualitative, phenomenological approach was used. A purposive sample of 25 women were recruited from two health care centers. Semi-structured, in-depth interviews were conducted in person in Arabic between August and November 2015. Transcripts were independently analyzed and coded by each researcher.

RESULTS

Two major themes with six subthemes emerged. Theme 1, sexual education, included discussions about the women's needs for scientific information and the husband's involvement, and their psychological needs. Theme 2, professional approaches, involved discussions about the most appropriate person to deliver education, preferred place and time for education, and effective educational approaches to be used.

DISCUSSION

Congruent with previous studies, findings indicated that issues related to sexuality are often ignored in this population.

CONCLUSIONS

Jordanian women have many unmet educational needs with respect to sexuality after giving birth. More efforts are needed from health care professionals and other stakeholders to help improve Jordanian women's sexual health education after giving birth. These should include greater access to classes, websites with scientific information, and informational handouts that target husbands, and postpartum women themselves.

"Resumption of Sexuality and Health Education in Postpartum Period: From Jordanian Health Care Professionals' Perspectives"

Objective: to explore Jordanian health care professionals' perspectives about sexual education after giving birth. Methods: a descriptive qualitative approach was used to address the study aim. A purposive sampling method was used to recruit seven midwives, 13 nurses and two obstetricians from three Primary Health Centres. The inclusion criteria were: midwives, nurses or obstetricians with at least two years' experience and currently working at a maternity health centre. Focus group discussions were used to collect data. A manual Thematic Content Analysis Tool was used to analyse the data. Results: five major themes emerged. Silence; resumption of sexuality after giving birth/area of conflict; men's authority in resumption of sexuality; the importance of sexual education (what, when and whom) and suggestions for sexual education approaches. Conclusions: Healthcare professionals were hesitant to open sexuality topic with the women during antenatal and postnatal visits due to cultural limitations and lack of knowledge. Therefore, in a time of global migration, the healthcare professionals have the need to understand cultural differences in attitude towards health care issues involving sexuality.

The experiences of early postpartum Shenzhen mothers and their need for home visit services: a qualitative exploratory study

Background

The early postpartum period is the most stressful period for a new mother, who is assuming new roles and responsibilities in life, and must deal with the demands from her newborn baby and her own care needs. Little is known about whether the current postnatal care services provided by hospitals and community centers meet the needs of women. The aim of this study was to identify the experiences of women in Shenzhen and the problems that they encountered during the first 6 weeks after giving birth; and to explore their expressed needs with regard to postnatal care services.

Methods

This is a qualitative exploratory study. Data were collected in November 2018 through in-depth, semi-structured, face-to-face interviews. A purposive sample was recruited from a tertiary maternal hospital in Shenzhen, China. The dataset was analyzed using content analysis.

Results

Twenty-two mothers were interviewed during their postpartum body check on the 30th or 42nd day after giving birth. Six themes were identified: “the self-care needs of women,” “proficiency in infant care,” “involvement of family in postpartum and infant care,” “family conflicts over postpartum and infant care,” “preparing for the transition to parenthood / grandparenthood,” and “the need for comprehensive postpartum home visit services.”

Conclusions

The concerns expressed by the women during the postpartum period were related to their need to recover physically and to their desire to be perceived as proficient in infant care. Support from husbands and grandmothers could facilitate or impede a woman’s transition to motherhood, and the family’s transition to parenthood / grandparenthood. There were disagreements arising from intergenerational beliefs about postpartum and child care. In providing postpartum care services to women in situations where the family is involved in their care, health professionals should consider the family as a whole.

Nurses- puerperal mothers interaction: searching for cultural care

OBJECTIVE

To identify the importance of the cultural care dimension in the nurse-puerperal mother interaction.

METHOD

Qualitative study based on content analysis. To collect data, 36 semi structured interviews were applied (21 nurses and 15 women who had recently given birth). The participants' free and informed consent was ensured and all ethical requirements were respected. Data analysis was supported by NVivo 10 software.

RESULTS

The following categories were considered the most relevant: (i) nurses' attitudes that puerperal mothers consider crucial in health care provision; (ii) nurses' cultural competence; (iii) language resources used by nurses in their interaction with people from other cultures; (iv) the limitations that were observed during nurses-new mothers interactions.

CONCLUSION

Evidence shows that, generally speaking, nurses claim to provide personalized health care assistance. However data revealed that the kind of interaction observed between nurses and women who had just given birth has not always been the most effective and that the former often show they lacked the appropriate cultural competence to deal with the latter's expectations and needs.

Consensus on priorities in maternal education: results of Delphi and nominal group technique approaches

Background

Maternal education is wide-ranging and covers many areas from pregnancy to the immediate postpartum period and childrearing. However, for it to be effective, more resources need to be assigned to key topics. The goal of this study was to identify and prioritize the most important issues in maternal education, so that specific objectives could subsequently be set and learning outcomes evaluated.

Methods

We drew up a comprehensive list of topics addressed in existing maternal education programs, based on a systematic review of information obtained from the Internet and the experience of the research team. The topics were presented to a multidisciplinary panel whose members were asked to rate them from 1 to 9, and consensus of opinion was reached using a two-round Delphi survey, with consensus defined beforehand as 80% agreement among panelists in awarding a score of 7, 8 or 9. The most highly-rated topics were then discussed and again prioritized by a multidisciplinary team of healthcare and non-healthcare experts, using a nominal group technique.

Results

Initially, 650 topics were identified and grouped into 80 categories which were then prioritized by 54 healthcare and non-healthcare experts using a Delphi survey with a study participation rate of around 20%. 63 topics were considered very important, so criteria were restricted and only the 24 highest-scoring selected (95% of agreement on scores ≥7 or 80% of agreement on scores ≥8). Using the nominal group technique, a group of 12 experts identified the following priorities: initiation and establishment of breastfeeding, development of a birth plan, identification of problems and self-care postpartum, nutrition and a healthy lifestyle, options for pain management in labor and birth and characteristics of a normal newborn/looking after a newborn baby.

Conclusion

This study, with a Delphi study and the Consensus among Experts: the nominal group technique, has succeeded in identifying priority topics in maternal education. We need to assess women’s needs in relation to these topics, design an intervention to respond to these needs and evaluate its effectiveness.

The use of an automated call to elicit and characterize postpartum concerns after hospital discharge

BACKGROUND

The postpartum period is a high-risk time for women, but most women do not have an opportunity to discuss concerns with providers until 4-6 weeks after delivery.

OBJECTIVE

The purpose of this study was to evaluate the use of an automated call system to contact postpartum patients within 72 hours of hospital discharge and to identify characteristics that are associated with postpartum concerns.

STUDY DESIGN

A prospective cohort of 2948 women in the postpartum period were contacted via an automated call within 72 hours of discharge to elicit concerns. We compared likelihood of successful call and presence of concerns by maternal demographic and medical characteristics using univariate analysis and multivariable logistic regression.

RESULTS

Of the participants, 2479 (84.1%) responded to a call after discharge, and 723 (29.1%) reported a concern. Primiparous women were more likely to be contacted successfully than were multiparous women (87.8% vs 79.0%; P<.005) and more likely to have an issue (31.5% vs 25.6%; P=.002). White women were more likely to be contacted successfully than were black, Latina, and Asian or Pacific Islander women (87.1% white, 72.1% black, 80.6% Latina, 85.8% Asian/Pacific Islander; P<.001) but were less likely to report a concern (25.2% white, 33.9% black, 26.5% Latina, 38.3% Asian/Pacific Islander; P<.001). Women with public insurance and those whose neonates were admitted to the intensive care nursery were less likely to be contacted, but these factors were not associated with increased concerns once a successful call was made. When controlling for cofounders, being primiparous and identifying as white were positive predictors of being contacted; having a neonate in the intensive care nursery was a negative predictor. Being primiparous and identifying as non-white were predictors of having a concern.

CONCLUSION

Most women responded to a call after hospital discharge, and nearly one-third of them had concerns. The system was not as effective at reaching women with public insurance, women with neonates in the intensive care nursery, and women of color, despite equal or greater numbers of concerns in these groups.

Research Article Women's experience of maternity high-dependency care following a complicated birth: A cross-sectional study

OBJECTIVE

There is limited evidence around childbearing women's experience following a complicated birth requiring maternity high-dependency care. Our objective was to explore women's experience and wellbeing following a complicated birth within this context.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional study captured women's experience through a postal survey four weeks post birth.

SETTING

A convenience sample of 112 women who received care in the first 24 hours of their stay in a Western Australian maternity high dependency unit.

MAIN OUTCOME MEASURES

A validated tool designed to explore patients' intensive care experience was modified and six items were added based upon the literature and in consultation with clinicians.

RESULTS

Women felt they were given choice (78%; n = 86); were not glad to be transferred to a ward (62%; n = 68) and were in pain during the first 24 hours of their admission (70%; n = 78). Women who did not feel scared were more likely than those who felt scared to have a clinician explain what had happened (95% vs 78%, P = 0.007); were more likely to feel in control (94% vs 75%, P = 0.006); and were less likely to feel helpless (27% vs 62%, P = <0.001).

CONCLUSION

The transfer experience to a postpartum ward requires further investigation as does the management of pain for these childbearing women regardless of their birth mode.

Postnatal women's perspectives on the feasibility of introducing postpartum home visits: a Jordanian study

In Jordan, there is a deficiency in postnatal care provided to women and their newborns. This study investigated the feasibility of initiating postnatal home visits in Jordan. Thirty Jordanian mothers who had recently given birth were recruited from two governmental hospitals in the northern region of Jordan to participate in a qualitative study through face-to-face, voice-recorded interviews. The findings revealed that initiating postnatal home visits as part of postnatal care was well-received by the participants. Mothers' views and perceptions regarding postpartum home visits play an integral role in finding areas to improve postnatal services.