Cesarean Section Can Be Related With Postpartum Depression: A Cross-sectional Study

Objectives: Depression is highly prevalent during pregnancy and after childbirth, and many factors, including the type of delivery, can contribute to developing this condition. Considering the increased use of remifentanil in painless labor and the need for conducting more studies on the consequences of this method this study aimed to determine the mean score of postpartum depression in women giving birth by either remifentanil-induced painless delivery or elective cesarean section. Materials and Methods: The present study was a longitudinal investigation conducted on140 women referred to private hospitals, Tabriz, Iran, between 2020 and 2021 in two groups: women with elective cesarean delivery and women with vaginal delivery with remifentanil analgesia (n=70/each). Depression during pregnancy was assessed at 35-37th weeks’ gestation, and postpartum depression was determined four weeks after childbirth using the Edinburgh Postnatal Depression Scale (EPDS). Independent t test and paired t test were used to compare depression scores. Results: Postpartum depression was significantly higher in women who had undergone a cesarean section than in those giving birth by remifentanil-induced painless vaginal delivery (P = 0.009). Conclusions: The prevalence of postpartum depression was higher in women who underwent elective cesarean section than women who underwent painless vaginal delivery with remifentanil. Considering the steady rise in worldwide cesarean section rate and the health burden and consequences of postpartum depression on mothers and children, health legislators should take measures to reduce women’s tendency towards the cesarean section in the long run.

Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses

Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized.

Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software.

Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers.

Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.

Factors affecting the neonatal intensive care unit stay duration in very low birth weight premature infants

INTRODUCTION

Improved survival of very low birth weight (VLBW) premature infants requires urgent intensive care, professional nursing and medical care. On the other hand, long hospital stay period imposes emotional and economic burdens on the family and society. Therefore, it is necessary to clarify the most important factors affecting their hospitalization duration to lessen unwanted outcomes of premature birth and to eliminate or relieve the problems.

METHODS

In a descriptive-analytical study, 170 low birth weight premature infants were assessed in a regular daily follow-up in Alzahra Hospital, Tabriz, Iran. Probable factors affecting NICU (neonatal intensive care unit) stay, such as birth age and weight, time of trophic feeding initiation, time of regain birth weight, and duration of parenteral nutrition, were evaluated. Data was analyzed using descriptive statistics and linier regression model in SPSS14. Statistical significance was considered at 0.05.

RESULTS

Mean birth weight and age of infants were 1310.26 ± 804.26 g and 30.51 ± 0.34 weeks, respectively. Duration of NICU stay was 14.51 ± 10.12 days. Intrauterine growth retardation, positive C-reactive protein (CRP) and blood culture during hospitalization stay, bloody or bile stained gastric remnants, days to regain birth weight, and total enteral nutrition intolerance were the most important factors affecting NICU stay among the studied infants.

CONCLUSION

It seems that eliminating risk factors of intrauterine growth retardation during pregnancy, preventing perinatal and nosocomial infections and taking suitable and tolerable feeding strategies will be effective on NICU stay duration in low birth weight premature infants. Therefore, required policies, especially early trophic feeding, are suggested to eliminate the existing difficulties.