Social Support, Postpartum Depression, and Professional Assistance: A Survey of Mothers in the Midwestern United States

Limb-girdle muscular dystrophy in pregnancy: a narrative review

Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients' respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood.

Postpartum Excessive Social Support Scale: A Scale Development and Psychometric Testing Study

INTRODUCTION

In Turkey and other collectivist cultures, child-rearing is a communal effort provided by multiple family members, especially female relatives such as mothers-in-law, aunts, and sisters. Environments with excessively controlling social factors can adversely affect their maternal roles. This study was conducted to develop a measurement tool for determining postpartum excessive social support.

METHODS

This is a scale development and psychometric evaluation study. In the study, a draft of the Postpartum Excessive Social Support Scale (PESSS) was created, subsequently submitted to expert opinion, and administered to mothers in the postpartum period of 1 to 6 weeks online between March and December 2023 (n = 440). A factor analysis (including explanatory factor analysis [EFA] and confirmatory factor analysis) was conducted to determine the construct validity of the scale, while Cronbach's alpha was examined to establish its reliability. Response bias (Hotelling T2) and additivity (Tukey's test of additivity) of the scale were also determined in the study.

RESULTS

For the content validity of the scale, 10 experts from the field of midwifery were consulted (content validity index [CVI] = 0.80). As a result of the EFA, Kaiser-Meyer-Olkin value was found as 0.916. Through factor analysis using the direct oblimin rotation technique, a four-factor structure was identified for the scale, explaining 64.197% of the total variance (social pressure, effect of environmental factors on paternal role, effect of environmental factors on maternal role, and barriers in mother-infant interaction). The internal reliability coefficient of the scale was highly reliable (Cronbach's alpha = 0.936). There was no response bias in the scale (Hotelling's T2 = 433.558, p < .001) and it was additive (Tukey's Non-additivity = 0.000, p < .001).

DISCUSSION

The PESSS is a 20-item scale measuring excessive social support between 1 and 6 weeks postpartum. The PESSS serves as a guiding tool for health care professionals to identify excessive environmental pressure hindering mothers' maternal role and to provide care accordingly. In this context, health care professionals can readily utilize the PESSS in routine postpartum assessments for mothers.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

OBJECTIVE

To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.

DESIGN

A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).

SETTING

Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.

PARTICIPANTS

Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.

FINDINGS

The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.

CONCLUSIONS

Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

The effect of the Watson model-based psycho-educational intervention on preventing postpartum depression

RATIONALE

Psycho-education application is effective in reducing the risk of postpartum depression (PPD) and increasing the level of social support. The quality of care increases with the implementation of Watson's Theory of Human Caring Model (WTHCM)-based care programs to reduce the risk of PPD.

AIMS

This study aimed to evaluate the impact of a psycho-educational intervention based on the Watson model on pregnant women in preventing PPD. Additionally, the effect of the psycho-educational intervention on women's perceptions of social support in relation to PPD was evaluated.

METHODS

A randomized-controlled pretest-posttest control group intervention study design was used. The sample consisted of 91 women (intervention:45, control:46) in their 20th to 32nd gestational week. While all women received routine care at the family health centre the intervention group was additionally applied a psycho-educational intervention based on the WTHCM. Chi-square and t-test analysis methods were performed to determine the homogeneity of the intervention and control groups. The t-test method was used to compare group scores. Multiple regression analysis was employed to compare multiple variables.

RESULTS

Following the psycho-educational intervention, the total Edinburgh Postpartum Depression Scale of the intervention group was found significantly lower than that of the control group, but the total and friend subscale scores on the Multidimensional Scale of Perceived Social Support (MSPSS) were higher (p < 0.05). The regression analysis results indicate that friend and family support, which are sub-dimensions of the MSPSS, exhibited a significant decrease in both groups. Furthermore, this decline had a greater impact on reducing the PPD level in the intervention group compared to the control group. It was found that while the support of the significant other sub-dimension reduced the PPD level in the intervention group, it did not make a significant difference in the control group.

CONCLUSIONS

The Watson's Theory of Human Caring Model-based psycho-educational intervention program decreased women's risk of PPD and increased their social support levels. It is recommended to use approaches that include psycho-educational intervention in postpartum midwifery care.

Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers

Postpartum depression affects nearly a quarter of women up to a year after childbirth. Although it is treatable, significant barriers to help-seeking prevent women from being treated. This paper assesses key literature on the barriers for help-seeking among women with postpartum depression. The barriers identified have been mapped onto the socio-ecological model in addition to potential recommendations that professionals can use to address barriers on individual, interpersonal, organizational, community and societal levels. The recommendations provided are meant to serve as leverage points for professionals in efforts to create appropriate support and interventions. As such, this paper serves as a mapping tool for healthcare and public health professionals to assess obstacles to women's help-seeking and to guide multi-pronged interventions on various levels of the socio-ecological model that may increase help-seeking among women with postpartum depression. Holistically and comprehensively providing support to women will require significant effort throughout all sectors of society as opposed to isolated, siloed interventions.

In the Shadows of Motherhood: A Comprehensive Review of Postpartum Depression Screening and Intervention Practices

This comprehensive review delves into the multifaceted landscape of postpartum depression (PPD), exploring its prevalence, impact on maternal and infant well-being, and the efficacy of existing screening and intervention practices. PPD emerges as a critical concern, with implications extending beyond individual mental health to encompass the dynamics of mother-infant relationships and societal well-being. The analysis underscores the complexity of addressing PPD, emphasizing the challenges associated with screening tools and the importance of evidence-based interventions. A call to action resonates throughout, urging healthcare providers, policymakers, and stakeholders to prioritize mental health support for new mothers through enhanced screening protocols and improved accessibility to interventions. Furthermore, the review highlights the need for destigmatization and awareness campaigns to foster a supportive environment. Future research directions are outlined, emphasizing the refinement of screening tools, developing innovative interventions, and exploring cultural and socioeconomic influences on PPD outcomes. The review envisions a collaborative effort to dispel the shadows of PPD, striving for a future where mothers receive comprehensive support, ensuring optimal mental health and overall well-being.

Economic disadvantage and depressive symptoms among Arab and Jewish women in Israel: the role of social support and formal services

OBJECTIVES

Depression is a major public health concern due to its high prevalence and association with functioning. Ethnic minorities in Western countries are more likely to experience economic disadvantage and exposure to stressors that may put them at higher risk of developing depression. One major protective factor associated with reduced depressive symptoms is an existing support network. This study examined the associations between economic disadvantage, formal and informal social support, and depressive symptoms among two ethnicity groups in Israel: Arab and Jewish mothers of young children, as well as the potential mediating role of formal and informal social support in the associations between economic disadvantage and depressive symptoms.

DESIGN

We recruited a representative sample of 837 Jewish and Arab mothers of children aged 2-6 years. We collected data via structured face-to-face interviews following approval of the university ethic committee. We used the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) scale to measure maternal perceived social support, and a measure designed for this study to quantify formal social support.

RESULTS

Compared to the Jewish mothers, Arab mothers reported more depressive symptoms, greater economic disadvantage, and fewer informal and formal support networks. Economic disadvantage was negatively associated with informal support but positively associated with formal support among both Jewish and Arab mothers. Results further revealed that informal and formal social support mediated the associations between economic disadvantage and symptoms of depression.

CONCLUSIONS

More attention should be paid to the associations between social determinants and mothers' mental health, with a possible shift of focus to macro-level factors, such as economic inequality and minority status.

Mapping high-risk clusters and identifying place-based risk factors of mental health burden in pregnancy

Purpose

Despite affecting up to 20% of women and being the leading cause of preventable deaths during the perinatal and postpartum period, maternal mental health conditions are chronically understudied. This study is the first to identify spatial patterns in perinatal mental health conditions, and relate these patterns to place-based social and environmental factors that drive cluster development.

Methods

We performed spatial clustering analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), and maternal mental disorders of pregnancy (MDP) using the Poisson model in SatScan from 2016 to 2019 in North Carolina. Logistic regression was used to examine the association between patient and community-level factors and high-risk clusters.

Results

The most significant spatial clustering for all three outcomes was concentrated in smaller urban areas in the western, central piedmont, and coastal plains regions of the state, with odds ratios greater than 3 for some cluster locations. Individual factors (e.g., age, race, ethnicity) and contextual factors (e.g., racial and socioeconomic segregation, urbanity) were associated with high risk clusters.

Conclusions

Results provide important contextual and spatial information concerning at-risk populations with a high burden of maternal mental health disorders and can better inform targeted locations for the expansion of maternal mental health services.

Early Postpartum Support in the Home: A Vital Link to Healthy and Safe Postpartum Recovery in the United States

Many newly postpartum women and birthing people are sent home from the hospital with their newborn babies, ill-prepared to care for themselves with little to no capacity to learn about newborn care and parenting. Women are often left to fend for themselves in the "black hole" of health care in 6 weeks post-birth that the United States calls postpartum care. Postpartum doulas can be the first line of defense, helping people identify potential postpartum physical and mental health issues, and in many places, they are doing it on the front lines and in the homes of newly postpartum women and families. In this guest opinion piece, the author discusses her personal experience with birth and how it led her to become an advocate for postpartum doulas.

Reproductive Experiences and Cardiovascular Disease Care in Pregnancy-Capable and Postmenopausal Individuals: Insights From the American Heart Association Research Goes Red Registry

To evaluate preconception health and adverse pregnancy outcome (APO) awareness in a large population-based registry. We examined data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry to questions regarding prenatal health care experiences, postpartum health, and awareness of the association of APOs with cardiovascular disease (CVD) risk. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk, significantly varying by race-ethnicity. Fifty-nine percent of participants were not educated regarding this association by their providers, and 37% reported providers not assessing pregnancy history during current visits, significantly varying by race-ethnicity, income, and access to care. Only 37.1% of respondents were aware that CVD was the leading cause of maternal mortality. There is an urgent, ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.

Postpartum depression and associated factors in Afar Region, northeast Ethiopia

Background

To effectively address the burden of postpartum depression (PPD), it is crucial to gain a comprehensive understanding of its magnitude and the factors associated with it in the pastoral and hot region of the Afar Region. This will help identify the progress made thus far and highlight areas that require further attention to accelerate efforts toward reducing the impact of PPD. Notably, no previous study has examined the prevalence and associated factors of PPD specifically in pastoral communities within Ethiopia, including the Afar Region. Accordingly, we investigated the prevalence and associated factors of PPD among postpartum women in the Afar Region, Northeast Ethiopia.

Methods

An institution-based cross-sectional study was conducted in the Awsi Rasu Zone of Afar Regional State from June to July 2021. The study employed a systematic random sampling method to select a total of 302 postpartum mothers who had visited the Expanded Program of Immunisation (EPI) clinics in public health facilities within the Awsi Rasu Zone of the Afar Region. The measurement of PPD was performed using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable binary logistic regression modelling was used to investigate associations between sociodemographic, obstetric and health service, and psychosocial factors with PPD.

Results

The overall prevalence of PPD was 37.4% with a 95% confidence interval (CI) from 32.0% to 43.0%. Postpartum women who attained high school education were associated with a lower odds of PPD compared to those who did not attain formal schooling (adjusted odds ratio [AOR] = 0.31; 95% CI: 0.12, 0.82). Postpartum women with a family history of mental illness (AOR = 2.34; 95% CI: 1.24, 4.41), those who had trouble in infant feeding (AOR = 4.26; 95% CI: 2.32, 7.83), and those who experienced intimate partner violence (AOR = 3.09; 95% CI: 1.58, 6.04) were positively associated with PPD.

Conclusion

The results of our study revealed that the prevalence of PPD in the Awsi Rasu Zone of the Afar Region is higher than both the national and global averages. The findings also highlighted the need for targeted interventions addressing the needs of pastoral postpartum women who experience various stressors, such as feeding difficulties and intimate partner violence.

A Comprehensive Review of Motherhood and Mental Health: Postpartum Mood Disorders in Focus

The journey of motherhood encompasses a profound array of emotions, experiences, and challenges that extend beyond the surface of joy and elation. This review delves into the crucial yet often underexplored realm of postpartum mood disorders, aiming to illuminate their significance and foster understanding. Postpartum mood disorders, including postpartum depression, anxiety disorders, and psychosis, impact the mental well-being of mothers during a pivotal phase of their lives. Through a comprehensive exploration, this review elucidates the various dimensions of these disorders, from their definitions and classifications to their prevalence and impact on both mothers and families. Identifying and diagnosing postpartum mood disorders is discussed in detail, shedding light on the emotional, cognitive, and physical symptoms that warrant attention. Screening and assessment tools are highlighted as essential instruments for early detection, while challenges in diagnosis, including the overlap with typical postpartum experiences and the influence of stigma, are explored. The review further delves into treatment and intervention, underscoring the importance of psychotherapy, pharmacological interventions, and individualised treatment plans. The roles of healthcare providers and mental health professionals in offering support and guidance are emphasised, emphasising the significance of a collaborative approach. Cultural and societal influences are crucial in shaping perceptions of motherhood and mental health. The review explores how these influences can create barriers to seeking help and highlights the importance of destigmatising postpartum mood disorders. It underscores the urgency of raising awareness and fostering a supportive environment that empowers mothers to seek assistance without fear of judgment. Looking toward the future, the review points to potential research directions, such as advances in understanding hormonal influences and exploring the long-term effects on maternal mental health. The overarching call to action resonates - increased awareness, support, and dismantling stigma are imperative. A hopeful vision is presented: a future where all mothers receive appropriate mental health care, no mother stands alone in her motherhood journey, and societal understanding and compassion thrive.

Challenges in Accessing Mental Health Care during Pregnancy and Postpartum in Rural Montana

PURPOSE

Postpartum depression is a well-known maternal health care concern. For women using substances or experiencing underlying mental health conditions, incidence of postpartum depression is higher than that of the general population. The purpose of this study was to identify barriers and facilitators associated with seeking mental health care among women with substance use disorder or mental health concerns.

STUDY DESIGN AND METHODS

Qualitative methods using interviews were conducted via the narrative inquiry approach. Women receiving care at a clinic in rural Montana and reporting substance use or mental health concerns were referred to the research team by the care manager. Participants were at least 18 years of age, English speaking, and pregnant or within 12 months postpartum at time of referral.

RESULTS

Twenty-five women met inclusion criteria and were referred for potential study participation. Seven women were interviewed. Four themes on family history, stigmatization, lack of postpartum depression awareness, and isolation were identified.

CLINICAL IMPLICATIONS

Our findings provide a better understanding of barriers and facilitators to seeking mental health care during pregnancy and postpartum among women living in rural areas with mental health concerns or perinatal substance use. An environment where opportunities for women to receive mental health care in a location that is free of stigma and judgment, while understanding the effects of familial trauma and limited or inconsistent social support, is essential to promote optimal outcomes.

Mental health and sleep quality of low-income mothers of one-year-olds during the COVID-19 pandemic

The COVID-19 pandemic and subsequent social restrictions created an unprecedented context for families raising young children. Although studies have documented detrimental effects of the pandemic on maternal well-being, less is known about how the pandemic specifically impacted low-income mothers. We examined depression, anxiety, and sleep quality among low-income mothers of one-year-olds during the early months of the pandemic using data from the Baby's First Years study. Focusing on the control group (n = 547), we compared mothers interviewed before March 14th, 2020 (n = 342) to mothers interviewed between March 14th and June 30th, 2020 (n = 205) to determine whether the pandemic was associated with differences in mental health and sleep quality. Mothers were recruited from four cities in the United States, and most of the sample identified as Hispanic (42.2%) or Black, non-Hispanic (38.6%). We found that mothers interviewed during the pandemic reported better mental health and sleep quality. While we cannot speak to longer-term impacts of the pandemic, it is possible low-income mothers experienced relief from daily stressors during the initial shelter-in-place orders, which may have led to improvements in well-being. These results have implications for understanding how complex life stressors influence mental health and sleep quality among low-income mothers raising young children.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

Death doula working practices and models of care: the views of death doula training organisations

BACKGROUND

The role of death doula has emerged in recent years, arguably as a result of overwhelming demands on carers, healthcare professionals and service providers in end-of-life care. Death doulas work independently without governing oversight and enact the role in various ways. The main driver of this evolving role is the organisations that train them. The aim of this study was to examine death doula training organisations' views with regard to DD business models, incorporating the death doula role into other existing models of care, and role enactment.

METHODS

An electronic survey was administered to 15 death doula training organisations in 5 countries asking additionally that they disseminate the survey. Responses were received from 13 organisations, based in Australia (n = 4), the US (n = 4), Canada (n = 2), the UK (n = 1), Sweden (n = 1) and New Zealand (n = 1). This paper provides the qualitative findings from four open-text questions posed within the survey related to models of care.

RESULTS

Qualitative data analysis was inductive, themes were determined in relation to: (1) standardised business model for death doulas, (2) death doulas incorporated into existing models of care or existing funding options, (3) death doulas who volunteer their services rather than charge money, and (4) role specialisation such as has occurred with birth doulas.

CONCLUSIONS

The death doula role has the potential to be formally recognised in the future under national registration schemes, accompanied by death doula training required via certification. Until such time the death doula role will continue to evolve much as the birth doula role has, organically and unstructured. How and if death doulas are incorporated into existing models of health or social care remains to be seen as the organisations that train them push for independence, flexibility and fiscal independence.

Investigating Maternal Stress, Depression, and Breastfeeding: A Pregnancy Risk Assessment Monitoring System (2016-2019) Analysis

Breastfeeding is invaluable for postpartum physical healing and mental wellbeing, but psychosocial stress and depression impede such recovery processes. To inform future interventions and policies, associations between breastfeeding, maternal stress, and depression were examined. Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed (2016-2019). Logistic regression models were used to calculate adjusted odds ratios with 95% confidence intervals. Of the total sample (n = 95,820), approximately 88% of participants attempted breastfeeding. Our findings indicate that participants who experienced any form of stress had a slightly higher likelihood of breastfeeding compared to those without stress. Specifically, partner-related and financial-related stressors were significantly associated with increased odds of breastfeeding. However, no significant associations were observed trauma-related or emotional-related stressors and breastfeeding. Additionally, no significant association was found between depression at different stages (preconception, prenatal, and postpartum) and breastfeeding. A significant interaction effect was noted between having experienced any of the 13 stressors and Black race/ethnicity on breastfeeding odds. Similarly, significant interaction effects were observed between partner-related, trauma, financial, or emotional stressors and Black race/ethnicity. These findings emphasize the importance of considering various factors when promoting breastfeeding in diverse populations, and screening for psychosocial stress during postpartum visits. Our study recommends tailoring breastfeeding interventions to address the needs of Black mothers which could significantly improve maternal health and breastfeeding outcomes.

Burden and Risk Factors of Postpartum Depression in Southwest Saudi Arabia

OBJECTIVES

The burden of postpartum depression (PPD) is significant because it remains unrecognized, and it not only affects the mother adversely but also has a negative consequence on the family life and the development of the infant. The aim of the study was to measure the prevalence of PPD and identify the risk factors of PPD among mothers attending the well-baby clinic of six Primary Health Care centers in Abha city, Southwest Saudi Arabia.

MATERIALS AND METHODS

A total of 228 Saudi women having a child aged between two weeks to one year were recruited in the study by using a consecutive sampling technique. The Arabic version of the Edinburgh Postnatal Depression Scale (EPDS) was used as a screening tool to measure the prevalence of PPD. The mothers were also inquired about their socio-demographic characteristics and risk factors.

RESULTS

The prevalence rate of postpartum depression was 43.4%. Family conflict, and lack of support by spouse and family during pregnancy were found to be the strongest predictors of developing PPD. Women who had reported family conflict were at six times higher risk for developing PPD compared to those who did not have a family conflict (aOR = 6.5, 95% CI = 2.3-18.4). Women who reported a lack of spousal support during pregnancy encountered 2.3 fold increased risk for PPD (aOR = 2.3, 95% CI = 1.0-4.8) and women who had not received family support during pregnancy period were more than three times (aOR = 3.5, 95 % CI 1.6-7.7) likely to experience PPD.

CONCLUSION

The risk of PPD among Saudi postnatal women was high. PPD screening should be an integral part of postnatal care. Awareness of women, spouses and families about potential risk factors can be a preventive strategy. The early identification of high-risk women during the antenatal and post-natal period could help to prevent this condition.

To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening

This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation "against instrument-based depression screening using a questionnaire with cut-off score to distinguish 'screen positive' and 'screen negative' administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth)." While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for "de-implementation" of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.

Reproductive Experiences and Cardiovascular Disease Care in Pregnancy Capable and Post-Menopausal Individuals: Insights from the American Heart Association Research Goes Red Registry

Background

Information on reproductive experiences and awareness of adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD) risk among pregnancy-capable and post-menopausal individuals has not been well described. We sought to evaluate preconception health and APO awareness in a large population-based registry.

Methods

Data from the Fertility and Pregnancy Survey of the American Heart Association Research Goes Red Registry (AHA-RGR) were used. Responses to questions pertaining to prenatal health care experiences, postpartum health, and awareness of the association of APOs with CVD risk were used. We summarized responses using proportions for the overall sample and by stratifications, and we tested differences using the Chi-squared test.

Results

Of 4,651individuals in the AHA-RGR registry, 3,176 were of reproductive age, and 1,475 were postmenopausal. Among postmenopausal individuals, 37% were unaware that APOs were associated with long-term CVD risk. This varied by different racial/ethnic groups (non-Hispanic White: 38%, non-Hispanic Black: 29%, Asian: 18%, Hispanic: 41%, Other: 46%; P = 0.03). Fifty-nine percent of the participants were not educated regarding the association of APOs with long-term CVD risk by their providers. Thirty percent of the participants reported that their providers did not assess pregnancy history during current visits; this varied by race-ethnicity ( P = 0.02), income ( P = 0.01), and access to care ( P = 0.02). Only 37.1% of the respondents were aware that CVD was the leading cause of maternal mortality.

Conclusions

Considerable knowledge gaps exist in the association of APOs with CVD risk, with disparities by race/ethnicity, and most patients are not educated on this association by their health care professionals. There is an urgent and ongoing need for more education on APOs and CVD risk, to improve the health-care experiences and postpartum health outcomes of pregnant individuals.

The Power and Promise of Postpartum Self Care: Evaluation of a Web-Based Tool for Underserved Women

OBJECTIVES

Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care.

METHODS

We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population.

RESULTS

Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures.

CONCLUSIONS FOR PRACTICE

This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated.

Development of a family-community interaction programme in the treatment of women with postpartum depression: protocol for a randomised controlled trial

INTRODUCTION

Postpartum depression has great harm and becomes a serious public health problem. Most women stay at home after childbirth, so the support from community and family is particularly important in the treatment of postpartum depression. The cooperation between family and community can effectively improve treatment effect of patients with postpartum depression. It is imperative to conduct a study on the collaboration and interaction among patients, family and community in the treatment of postpartum depression.

METHODS AND ANALYSIS

The aim of this study is to determine the experience and demands of patients with postpartum depression, family caregivers and community providers for the interaction, construct an interaction intervention programme bettween family and community and promote the rehabilitation of patients with postpartum depression. From September 2022 to October 2022, this study will select postpartum depression patient families from seven communities in Zhengzhou City, Henan Province in China. The researchers, after training, will conduct semi-structured interview to collect research data. According to the integration results of qualitative research and literature review, the interaction intervention programme will be constructed and revised using the Delphi expert consultation method. Then the participants will be selected to accept the intervention of the interaction programme and evaluated through questionnaires.

ETHICS AND DISSEMINATION

The study is approved by the Ethics Review Committee of Zhengzhou University (ZZUIRB2021-21). The results of this study will contribute to clarify the responsibilities of family subjects and community subjects in the treatment of postpartum depression, more effectively promote the rehabilitation of patients with postpartum depression and reduce the burden of family and society. Moreover, this research will be a profitable exploration at home and abroad. And the findings will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ChiCTR2100045900.

The effect of COVID-19 lockdowns on women's perinatal mental health: a systematic review

BACKGROUND

Risk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown.

AIMS

This systematic review explores how periods of COVID-19 lockdown impacted women's perinatal mental health.

METHODS

Searches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020-25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized.

FINDINGS

Sixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention.

CONCLUSION

Developing resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.

Prevalence and Factors Associated with Maternal Postpartum Depression among Mothers in Saudi Arabia: A Cross-Sectional Study

Postpartum depression (PPD) is a serious public health problem in many Middle Eastern countries. Mothers with PPD experience various extreme symptoms that affect their daily lives. This study aims to discover how common PPD is in the Jazan region, the most significant risk factors, and how likely depressed women are to seek help. An observational cross-sectional survey targeting a sample of 444 mothers in their first year after delivery using a pre-tested and validated EDPS standard tool to evaluate the prevalence of postpartum depression amongst them has been conducted. The data was collected and then analyzed using SPSS. Descriptive statistics and inferential statistics were used for data analysis. Multivariate logistic regression was used to assess the risk factors associated with PPD. The results indicate an extremely high prevalence of PPD in Jazan (75.7%). The prevalence of mothers having suicidal ideation was 6.3% quite often, 5.0% sometimes, and 7.9% hardly. Regarding the duration of depression symptoms, 34.78% were less than a month, 20.72% were less than six months, and 13.06% were less than one year. The study shows that the development of depression symptoms occurred within less than a week for 30.4% of the women. The most significant association with PPD was a lack of family support, which significantly increased the risk of PPD (OR = 5.9; p-value < 0.001). The mothers who had unexpected pregnancies had a risk of PPD (OR = 2.5; p-value < 0.001). Current research has revealed a high prevalence of postpartum depression among mothers in the Jazan region and that it is associated with different risk factors that increase the probability of PPD development. Pregnant women need to raise their awareness about PPD and learn how to avoid or deal with it.

The home environment and its relation to bottle feeding outcomes in the first year of life

BACKGROUND

The home environment and caregiver interactions have an impact on infant development. However, there is a paucity of research surrounding the home environment and its relation to early feeding outcomes within the first year of life. Therefore, the aim of this study was to examine the relationship between the home environment and infant bottle feeding outcomes at 3 and 12 months of age.

METHODS

Seventy-two full-term infants completed this study at 3 months of age and fifty-five infants completed the study at 12 months. Data in the current study were collected from a larger, ongoing study completed in the infant's home at 3 and 12 months of age. The Infant-Toddler Home Observation for Measurement of Environment Inventory (IT-HOME) was utilized to assess the infant's home environment. The Oral Feeding Skills (OFS) scale was completed while the infant was observed during a bottle feed. Caregivers completed a questionnaire about their infant's feeding abilities via the Neonatal Eating Assessment Tool (Neo-EAT) at 3 months and Pediatric Eating Assessment Tool (Pedi-EAT) at 12 months.

RESULTS

At 3 months of age, the IT-HOME Involvement subscale was associated with an increase in the amount of milk provided in the infant's bottle. There were no significant associations between the IT-HOME and caregiver report of feeding at 3 months of age. At 12 months of age, the IT-HOME Acceptance subscale was associated with an increase in oral transfer rate and the IT-HOME Variety subscale was associated with a decrease in oral transfer rate. Additionally, the IT-HOME Organization subscale was associated with caregiver report of feeding on the following Pedi-EAT scales: Mealtime Behaviors, Selective Restrictive Eating, and Oral Processing at 12 months.

CONCLUSIONS

These findings reveal that the home environment is significantly related to different infant bottle feeding outcomes over the first year of life. At 3 months, IT-HOME Involvement was associated with the amount of milk offered in the bottle, whereas at 12 months of age, subscales of the IT-HOME were associated with oral feeding transfer rate and caregiver report of feeding. Clinically, these findings point to the importance of considering the infant's bottle feeding skills in conjunction with certain aspect within the infant's environment. Additional research is needed to further explore these relationships in greater detail, with a larger sample size and across patient populations.

Preterm birth and postpartum depression within 6 months after childbirth in a Brazilian cohort

Preterm birth (PTB) and postpartum depression (PPD) are important public health issues, and although literature mainly supports the association between them, some reviews have highlighted methodological limitations in the studies in this field, restricting the interpretation of such finding. This study aimed at assessing the association between PTB and PPD, by comparing groups of preterm and full-term mothers in two Brazilian cities with contrasting sociodemographic indicators. This prospective convenience cohort study assessed 1421 women during pregnancy, at childbirth, and in the postpartum period. The Edinburgh Postnatal Depression Scale (EPDS) was administrated to assess PPD within 6 months after delivery and women were considered probably depressed if scores were EDPS ≥ 12. PTB was defined as the delivery before 37 completed weeks of pregnancy. A multivariate Poisson regression was used to estimate relative risk for PPD in mothers of preterm infants, and the final analysis models were adjusted for psychosocial variables, selected according to the directed acyclic graph (DAG) approach. Frequencies of PPD were not significantly different in mothers of preterm and full-term infants, in neither city. In the final adjusted model, PTB was not associated with PPD. The association between PTB and PPD was not confirmed in two large samples from two Brazilian cities with contrasting socioeconomic profile. However, maternal health during pregnancy plays an important role in predicting PPD. Prenatal care should promote maternal mental health as an effort towards decreasing unfavored outcomes for mothers, infants, and families.

Promotion and Prevention of Perinatal Mood and Anxiety Disorders: Doulas’ Roles and Challenges

Doulas are uniquely positioned to support women during birth and the postpartum period and can serve as a great asset to identify symptoms of perinatal mood and anxiety disorders (PMADs) and refer women to treatment. The goal of this study is to increase knowledge of doulas’ training on PMADs and their work with women who experienced symptoms. Results from a survey of 156 doulas and interviews with 27 doulas indicate that they felt ill-prepared to identify PMAD symptoms. They struggled in referring patients to the appropriate services and finding professional support related to supporting clients with PMADs. The study concludes that there is a need to develop a standardized model for postpartum doula care that explicitly addresses PMADs.

Maternal Self-Efficacy Buffers the Effects of COVID-19-Related Experiences on Postpartum Parenting Stress

OBJECTIVE

To examine the associations of maternal self-efficacy (MSE) and perceived social support with parenting stress during the postpartum period during the COVID-19 pandemic and whether these two psychosocial factors account for variance in parenting stress in addition to the effects of COVID-19-related experiences and sociodemographic factors.

DESIGN

Cross-sectional survey.

SETTING

Online survey, the Perinatal Experiences and COVID-19 Effects (PEACE) study, launched in May 2020.

PARTICIPANTS

Participants included 310 women who gave birth in the past 24 weeks.

METHODS

The survey included self-report quantitative measures of MSE, social support, COVID-19-related experiences, parenting stress, symptoms of depression and anxiety, and a range of sociodemographic factors.

RESULTS

Hierarchical multiple regression analysis indicated that MSE and social support were negatively associated with postpartum parenting stress in addition to the effects of COVID-19-related experiences, maternal symptoms of depression and anxiety, and a range of demographic factors. Furthermore, MSE interacted with COVID-19-related experiences such that higher levels of MSE mitigated the effects of COVID-19-related experiences on parenting stress.

CONCLUSION

Our findings underscore the importance of protective factors at the individual and interpersonal levels and provide insights for prevention and intervention programs aimed at mitigating postpartum parenting stress during a wide-scale disaster such as the COVID-19 pandemic.

A meta-analysis on burden of postpartum depression and its predictors among lactating women in East African countries from 1998 up to 2018

Objective:

Postpartum depression is a common mental illness that affects lactating women. This not only makes daily activities difficult for them, but it also affects child’s future lives. There is little evidence of about postpartum depression and its factors in East African countries, which piqued the authors’ interest in conducting a study on this matter for future decision- and policy-making.

Methods:

The protocol for Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. To identify published articles, all major databases such as PubMed/MEDLINE, WHOLIS, Cochrane Library, Embase, PsycINFO, ScienceDirect, Web of Science, and reference lists were used. In addition, shelves, author contact, Google and Google Scholar were also used to identify unpublished studies. Joanna Briggs Institute—Meta-Analysis of Statistical Assessment and Review Instrument was used for critical appraisal of studies. STATA software version 14 was used for the analysis. The random-effect model was used to estimate postpartum depression with 95% confidence interval, while subgroup analysis and meta-regression were used to identify potential sources of heterogeneity and associated factors, respectively. Furthermore, Egger’s test and trim-and-fill analysis were used to check for publication bias.

Results:

Postpartum depression was found in 24% of lactating women in East African countries (95% confidence interval: 17.79–30.20). Postpartum depression was associated with being married (odds ratio = 2; 95% confidence interval: 1.05–3.81), domestic violence (odds ratio = 6.34; 95% confidence interval: 4:11–9.78), a lack of support (odds ratio = 6.59; 95% confidence interval: 1.98–21.89), and a lack of empowerment (odds ratio = 2.79; 95% confidence interval: 1.12–6.92).

Conclusion:

In East Africa, the prevalence of postpartum depression among lactating women is high and rising, as per global postpartum depression estimates. Therefore, the primary focus should be on women’s domestic violence prevention mechanisms. Existing national policies and development agendas must prioritize strategies for women’s support and empowerment. Future research into the relationship between marriage and postpartum depression is required.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

BACKGROUND

The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores.

METHODS

This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey.

RESULTS

Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05).

CONCLUSIONS

The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.

The Impact of Perceived Social Support During Pregnancy on Postpartum Infant-Focused Anxieties: A Prospective Cohort Study of Mothers in Northern Jordan

Objective

This study aimed to evaluate the association between perceived social support during pregnancy and levels of anxiety among postpartum women using an anxiety-specific screening instrument.

Methods

Using a prospective cohort design, a two-stage methodology was conducted to collect data from women seeking maternal care at the King Abdullah University Hospital in northern Jordan. In the first stage, perceived social support was assessed among pregnant women using the Medical Outcomes Study Social Support Survey. During the first six months after childbirth, postpartum women were contacted to complete the second stage, wherein their perceptions of infant-focused anxieties were assessed using the Postpartum Specific Anxiety Scale. In our study, two types of infant-focused anxieties were investigated among a final sample of 419 mothers: infant safety and welfare anxieties and practical infant care anxieties.

Results

The results of multivariate linear regression analysis indicated that providing pregnant women with high levels of emotional support from close social networks (β= −0.08, p= 0.01) and perceiving informational support from health care providers (β= −0.71, p< 0.01) were protective factors for reducing the levels of postpartum anxiety concerning infant safety and welfare. Our findings also demonstrated that pregnant mothers who perceived high informational support from health care providers had a lower level of postpartum anxiety about practical infant care (β= −0.20, p< 0.01). In contrast, mothers who reported receiving high tangible support from close social networks during pregnancy had a significantly higher level of perceived anxiety concerning practical infant care after delivery (β= 0.13, p= 0.02).

Conclusion

Our study suggests that postpartum anxiety would be reduced if effective informational support were readily available for pregnant women. There is a clear need for building bridges between women, their families, and providers to distinguish the specific type and amount of support that should be provided to mothers during pregnancy.

Becoming an adolescent mother: The experiences of young Indonesian new mothers living with their extended families

OBJECTIVE

Adolescent motherhood brings many challenges. While much is written about young mothers' transition to motherhood and their support needs, there is little from South-East Asian countries such as Indonesia. The aim of this study was to understand the new motherhood experiences of Indonesian adolescent females living with their extended families.

DESIGN

Eleven semi-structured interviews were conducted with new adolescent mothers.

SETTING

a large women and children's hospital in Makassar, South Sulawesi, Indonesia.

PARTICIPANTS

Purposive sampling was undertaken. Eleven adolescent mother participated in this study. The mean age of the mothers was 17 years, ranging from 16 to 19 years of age.

FINDINGS

Four themes emerged: demonstrate transfer of knowledge between generations, sharing tasks with extended family, feeling blessed with extended family and local myth and cultural practice related to caring for the baby. Findingsdemonstrated that transfer of knowledge between generations was important for these adolescent mothers. They shared responsibilities with and felt blessed having their extended families, along with local beliefs and cultural practice related to caring fortheir babies.

DISCUSSION AND IMPLICATIONS FOR PRACTICE

Our findings contribute to understandings of experiences to becoming mothers among Indonesian adolescents living with extended family. Results can be used by healthcare providers, especially nurses and midwives, to develop cultural care interventions and educational program for maternity and psychosocial care for adolescent mothers and their families towards success in the transition period and maternal role attainment.

Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research

There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.

What are the factors affecting parents' postnatal sense of security?

INTRODUCTION

The postpartum period is part of an important process for mothers and fathers. A sense of security is central as it might influence a parent's journey towards becoming a successful parent. The aim was to determine factors affecting parents' postnatal sense of security (PPSS) before postpartum discharge from a hospital in Konya, Turkey.

METHODS

A descriptive study was conducted. From January 2019 to March 2019, a questionnaire was given to a convenience sample of 188 couples discharged from a regional hospital in Turkey. The sense of security was assessed using the PPSS instrument, with low scores defined as those less than the mean.

RESULTS

Low and high sense of security was based on the mean in the population, for mothers 49.36 and for fathers 34.90. It was found that 43.6% of mothers and 69.7 % of fathers had a low score, which was linked to some specific factors in the postpartum period. These were the type of birth, being ready to take responsibility for baby care, being ready to be discharged, being healthy, having any concern about the baby's health, social support presence, having professional support, and presence of a sense of security.

CONCLUSIONS

Many parents, particularly fathers, have a low postnatal sense of security. In the postpartum period, it is very important for midwives, who are always with the family, to identify the risks for a low sense of security during this period and provide effective care. More studies in different settings with larger samples are recommended.

Examining the Role of Psychosocial Influences on Black Maternal Health During the COVID-19 Pandemic

Introduction

Due to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities.

Methods

We examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people.

Results

Even prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women.

Conclusion

We recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene.

Motherhood and COVID-19: a Digital Psychoeducational Booklet for the Coping with the Pandemic Stressors

During the pandemic of COVID-19, the Brazilian Health Ministry declared that 2-week postnatal women are a high-risk population that demands special assistance. Considering that women at the postnatal period are more susceptible to anxiety and stress symptoms, our objective is to present a digital psychoeducational booklet analyzing its validity to help this target population to cope with the stress from the new coronavirus crisis. Based on the dispositional coping theory and positive psychology, this proposal was developed as a digital booklet to promote the maternal mental health and well-being based on informational and psychoeducational approaches. Information about the COVID-19, as well as coping strategies and positive practices, were presented to provide support for the coping with pandemic stressors. To validate the booklet, 12 women answered a Google Form via WhatsApp that included a free and informed consent form, a general data protocol, and a questionnaire with validity criteria (clarity of written, practical pertinence, theoretical relevance, and presentation). Content validity coefficients (CVC) were calculated for all criteria. The participants were on average 30 years old (A.V.=23–43), and half of them had a high school degree; 50% of them self-declared white and 25% black, and 2 of them declared themselves brown and 1 yellow. All CVC were ≥ 0.96. These findings confirmed that our booklet can be considered a viable, useful, and efficient tool to help puerperium women during the pandemic, providing support for a resilient coping face to this new and critical moment.

Expectations of Motherhood and Quality of Life

PURPOSE

The purpose of this study was to examine 1) discrepancies between expectations of motherhood and the experience of motherhood in the first 6 to 12 weeks postpartum, 2) relationships between maternal quality of life, mood, parental attitudes, and expectations, and 3) predictors of quality of life.

STUDY DESIGN AND METHODS

We used a descriptive, correlational design. The sample consisted of first-time mothers who were at or beyond 34 weeks pregnant with no reported history of anxiety or depression. The following questionnaires were administered during pregnancy and 6 to 12 weeks postpartum: Parenting Expectations Measure, General Anxiety Disorder 7, Edinburgh Postnatal Depression Screen, Intensive Parenting Attitudes Questionnaire, and Ferrans and Powers Quality of Life Index.

RESULTS

Sixty-one mothers participated. Based on scores from the Parenting Expectations Measure, 44% of participants had expectations of motherhood that were not met. Expectations were a significant predictor of quality of life during pregnancy and postpartum.

CLINICAL IMPLICATIONS

Unmet expectations are important to understand when identifying modifiable risk factors of postpartum anxiety and depression in women without other risk factors. A discussion of expectations during antepartum care may minimize poor quality of life which is associated with anxiety and depression in women without anxiety and depressive symptoms.

A Comprehensive Conceptual Framework to Guide Clinical Practice and Research About Mental Health During the Perinatal Period

Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence ("becoming a mother") plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.

Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City

The mental health effects of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the Coronavirus Disease 2019 (COVID-19) pandemic on postpartum women are of increasing concern among mental health practitioners. To date, only a handful of studies have explored the emotional impact of the pandemic surrounding pregnancy and none have investigated the consequence of pandemic-related social restrictions on the postpartum mood of those living among different socioeconomic status (SES). All postpartum patients appearing to the Mount Sinai Health System for their postpartum appointment between January 2, 2020 and June 30, 2020, corresponding to before and during pandemic imposed social restrictions, were screened for mood symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Each patient's socioeconomic status (high/low) was determined by their location of clinical service. A total of 516 postpartum patients were screened. While no differences in EPDS scores were observed by SES prior to social restrictions (U = 7956.0, z = - 1.05, p = .293), a significant change in mood symptomatology was observed following COVID-19 restrictions (U = 4895.0, z = - 3.48, p < .001), with patients living in lower SES reporting significantly less depression symptomatology (U = 9209.0, z = - 4.56, p < .001). There was no change in symptomatology among patients of higher SES (U = 4045.5, z = - 1.06, p = .288). Postpartum depression, the most common complication of childbearing, is a prevalent, cross-cultural disorder with significant morbidity. The observed differences in postpartum mood between patients of different SES in the context of temporarily imposed COVID-19-related social restrictions present a unique opportunity to better understand the specific health and social support needs of postpartum patients living in urban economic poverty. Given that maternal mental illness has negative long-term developmental implications for the offspring and that poor mental health reinforces the poverty cycle, future health policy specifically directed towards supporting postpartum women living in low SES by ameliorating some of the early maternal burdens associated with balancing employment-family-childcare demands may assist in interrupting this cycle while simultaneously improving the long-term outcomes of their offspring.

Perinatal depression: Heterogeneity of disease and in animal models

Perinatal depression (PND) can have either an antepartum or postpartum onset. Although the greatest risk factor for PND is previous depression history,de novoPND occurs with the majority of cases occurring in the postpartum. Timing of depression can impact etiology, prognosis, and response to treatment. Thus, it is crucial to study the impact of the heterogeneity of PND for better health outcomes. In this review, we outline the differences between antepartum and postpartum depression onset of PND. We discuss maternal physiological changes that differ between pregnancy and postpartum and how these may differentially impact depression susceptibility. We highlight changes in the maternal steroid and peptide hormone levels, immune signalling, serotonergic tone, metabolic factors, brain morphology, and the gut microbiome. Finally, we argue that studying the heterogeneity of PND in clinical and preclinical models can lead to improved knowledge of disease etiopathology and treatment outcomes.

Professional support during the postpartum period: primiparous mothers' views on professional services and their expectations, and barriers to utilizing professional help

Background

Primiparous mothers who lack of experience and knowledge of child caring, are usually overwhelmed by multifarious stressors and challenges. Although professional support is needed for primiparas, there is a gap between the necessary high-quality services and the currently provided poor services. This study aimed to explore Chinese primiparous mothers’ views on professional services, identify barriers to utilizing professional support, and further understand mothers’ expectations of and preferences for the delivery of professional services.

Method

A descriptive phenomenological study design was utilized in this study, and semi-structured interviews were conducted with 28 primiparous mothers who had given birth in the first year period before the interview and were selected from two community health centres in Xi’an city, Shaanxi Province, Northwest China. Each conversational interview lasted between 20 and 86 min. Colaizzi’s seven-step phenomenological approach was used to analyse the data.

Results

Three major themes were identified: (a) dissatisfaction with current professional services for postpartum mothers, (b) likelihood of health care professional help-seeking behaviour, (c) highlighting the demands for new health care services. The related seven sub-themes included being disappointed with current hospital services; distrusting services provided by community health centres, private institutes and commercial online platforms; preferring not seeking help from professionals as their first choice; hesitating to express their inner discourse to professionals; following confinement requirement and family burden prevents mothers from seeking professional help; experiencing urgent needs for new baby-care-related services; and determining the importance of mothers’ needs. The necessity of professional support in the first month after childbirth was strongly emphasized by the participants. Online professional guidance and support were perceived as the best way to receive services in this study.

Conclusion

The results of this descriptive phenomenological study suggested that the current maternal and child health care services were insufficient and could not meet primiparous mothers’ need. The results also indicated that identifying barriers and providing services focused on mothers’ needs may be an effective strategy to enhance primiparous mothers’ well-being, and further suggested that feasibility, convenience, and the cultural adaptability of health care services should be considered during the delivery of postpartum interventions.

Perinatal mental health in Ireland: A scoping review

BACKGROUND

The international literature clearly indicates that perinatal mental health issues affect many women, and can have profound negative consequences for both the mother, infant and family, and that the causes of perinatal mental health issues are multifaceted and complex.

AIM

This scoping review explores the existing research on perinatal mental health in Ireland to provide a baseline and to guide further research as well as inform the implementation of the recent policy strategies.

DESIGN

Scoping Review METHODS: We conducted a structured literature search on Science Direct, Web of Science, PubMed, PsychInfo and Scopus, using key words to search for publications up to December 2018. All publications based on empirical studies on perinatal mental health in Ireland (regardless of research design, sample size, and methods used) were included. Exclusion criteria were: study location not the Republic of Ireland; not relating to the perinatal period (pregnancy up to the first 12 months after birth); not relating to mental health; and not relating to maternal mental health, not relating to human subjects; not an empirical study; international study with generalised results. Data were mapped onto a charting form, allowing us to a) conduct a basic numerical analysis of prevalent research questions and designs, and b) to identify key themes within the data, utilising Braun and Clarke's (2006) thematic analysis.

RESULTS

The search resulted in 623 unique references. 29 publications were included in this review. Our analysis resulted in three main findings. (1) A significant number of women in Ireland are affected by perinatal mental health problems, but prevalence rates vary significantly between studies. (2) A history of mental health problems and lack of social support were identified as key risk factors. (3) The existing perinatal mental health services in Ireland are generally inadequate. We further noted a focus on quantitative approaches and a medicalisation of perinatal mental health, resulting in an absence of women's voices and their lived experiences, particularly those of women of colour, migrant women and ethnic minorities.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We conclude that in order to further the vision of woman-centred maternity care, we need to conduct woman-centred research that puts women's subjective experiences of perinatal mental health and well-being at the centre, including those of marginalised women in an increasingly diverse Irish society.

First-time mothers' perceptions of social support: Recommendations for best practice

Research indicates social support is imperative for postpartum well-being. The types of social support and access to preferred supports are less understood. This article considers first-time mothers' perceptions of the effectiveness of social supports and perceived barriers to accessing support and provides recommendations for best practice. A search of the literature for terms related to postpartum social support was conducted. Major themes were identified and synthesised. A critique and analysis of the literature is presented with recommendations for best practice. Much of the research around postnatal support fails to distinguish the specific type of support, meaning creating support solutions for the postpartum period may not be effectively targeted. Recommendations for individualised support are made.

Consolidation of Guidelines of Postpartum Care Recommendations to Address Maternal Morbidity and Mortality

Rates of maternal morbidity and mortality in the United States represent an urgent crisis. The purpose of this article is to consolidate current postpartum care guidelines to provide a comprehensive approach to care in the postpartum period. We include a critical examination of the reasons for some women's lack of attendance at postpartum visits, the current state of postpartum care, and the unmet needs of women. We review several postpartum care programs and suggest possible solutions for the postpartum period, including clinical implications for continuity of care for women with comorbidities including gestational diabetes, hypertension, and depression.

The relationship between breastfeeding attitudes and perceived stress levels of Turkish mothers

AIMS

In the present study, it was aimed to investigate the relationships between breastfeeding attitude and perceived stress levels of Turkish mothers.

METHODS

In this descriptive study, the Personal Information Form prepared by the researchers, Perceived Stress Scale (PSS) and Iowa Infant Feeding Attitude Scale (IIFAS) were used to collect the study data. The present study included 788 mothers having 0-6 month-old infants. The data obtained were with the independent t-test, one-way ANOVA and Pearson correlation analyses.

FINDINGS

The mean scores of the participants obtained from the PSS and IIFAS were 25.60 ± 7.3 and 61 ± 6.6, respectively. At the end of the correlation analysis, it was observed that breastfeeding attitude decreased as the perceived stress level increased in mothers.

CONCLUSIONS

The results of the research indicated that as the perceived stress levels of mothers in the postpartum period increased, their breastfeeding attitudes decreased. It is suggested that nurses should support women by providing education and counselling during pregnancy and postpartum period.

The role of social support in the psychological illness of women

OBJECTIVE

to analyze the relationship between perception of social support and emotional and physical symptoms associated with psychiatric conditions among women.

METHOD

a cross-sectional, quantitative study was carried out with a randomized random sample of 141 women attended at a Family Health Unit of the city of Ribeirão Preto/SP. A sociodemographic questionnaire, the Social Support Questionnaire and the Self-Report Questionnaire were used.

RESULTS

there was no association between sociodemographic characteristics and mental disorder, but between aspects such as low income and schooling. The exercise of professions culturally considered as of low prestige gave rise to some reflections related to gender inequality. There was a significant difference in the satisfaction scores between the women who reported or not the symptoms of tiredness and sadness and the number of supporters among those who reported or not the symptom of fatigue. Spouses and children were the most mentioned supporters, and having mental disorder was significantly associated with having no friends in the support network.

CONCLUSION

issues related to gender equity and satisfaction with social support are important aspects of care. For the promotion of mental health, efforts must be made to make women feel more connected and supported by the supporters available in their social environment.

Improving Postpartum Depression Screening and Referral in Pediatric Primary Care

INTRODUCTION

Postpartum depression (PPD) affects up to 20% of American mothers and, if left untreated, can have serious, lifelong effects on women and their children. The American Academy of Pediatrics recommends that pediatric practices screen for PPD at the 1-, 2-, 4-, and 6-month well-child checks; however, few pediatric practices oblige.

METHODS

This project standardized the PPD screening schedule and developed a novel referral algorithm that was concurrently implemented in a rural primary care pediatric practice.

RESULTS

The project significantly increased the clinic's screening rate from 33% to 80% (p < .001) and improved referral rates from 66% to 79%.

DISCUSSION

By standardizing PPD screening and implementing a referral algorithm in the ambulatory pediatric setting, more PPD cases can be identified, further evaluated, and, hopefully, treated to improve maternal and infant health outcomes.

History of postpartum depression as a contributor to the severity of NAS

Currently, there are no clinical tools available to accurately predict the severity of neonatal withdrawal. Studies of non-exposed neonates suggest that maternal depression and anxiety are predictive of negative short and long-term neonatal outcomes, but research is lacking in the addicted population. We studied of 109 pregnant women in medication-assisted treatment (MAT) and their neonates to determine if psychiatric conditions co-occurring with Substance Use Disorder (SUD) contributed to the severity of neonatal withdrawal. The need for pharmacological intervention, Finnegan scores, length of methadone treatment, and length of hospital stay were used to assess withdrawal severity. Categorical variables were analyzed in Stata14 using Chi Square and continuous variables were analyzed using Wilcoxon Rank Sum. Among the 110 neonates whose outcomes were reviewed, a maternal history of Postpartum Depression (PPD) was found to be correlated with increased severity of withdrawal. The neonates born to mothers with past diagnoses of PPD had more consecutive days of high Finnegan scores (95% confidence interval [CI], P = 0.003), longer length of treatment (95% CI, P = 0.006), and length of hospital stay (95% CI, P = 0.014). There was no apparent relationship between NAS severity and other psychiatric disorders. In a study of pregnant women with SUD and their neonates, we uncovered a relationship between the severity of NAS and maternal history of PPD. Our findings demonstrate that further research into these deleterious outcomes is warranted. Until then, we suggest collection of maternal history of PPD and careful screening for new cases in the SUD population.