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PubMed1987

Providing professional lactation management consultation.

The probability of successful lactation and breastfeeding can be maximized by professional lactation management consultant services such as those provided by the San Diego Lactation Program. There are four distinct service components of the program: prenatal guidance; skilled immediate postpartum assistance; a telephone consultation service; and evaluation of lactation progress and problem solving in a special lactation clinic. To insure the best care for the mother-infant couple, these services must be provided by health care professionals with "hands-on" backgrounds in one of the perinatal specialties (M.D. or R.N.) as well as knowledge and skills in the specific area of lactation. Teaching hospital-based lactation programs such as the San Diego model can offer both consultant services and provide a much needed learning opportunity in lactation and breastfeeding management for such health professionals.

Breast Feeding↗
PubMed2006

Computer-tailored intervention program to promote breast-feeding.

The purpose of this study was to develop a computer-tailored intervention program to promote breast feeding. The education needs were measured with 100 pregnant or postpartum women. The types and scope of program contents were determined on the basis of the literature review and advice from experts. The materials to be included were collected and produced and a computer-tailored intervention program was produced through integration and computer programming of pathways. Then, an expert conducted the formative test and the program was modified by reflecting the results.

Breast Feeding↗
PubMed2001

Postpartum iron status in nonlactating participants and nonparticipants in the special supplemental nutrition program for women, infants, and children.

BACKGROUND: Iron deficiency, a pervasive problem among low-income women of childbearing age, threatens maternal health and pregnancy outcomes. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was designed to alleviate health problems and provides supplemental nutritious foods, nutrition education, and health care referrals. OBJECTIVES: The aim of this study was to examine the benefits associated with participation in WIC in terms of biochemical tests of postpartum iron status in nonlactating women. DESIGN: WIC participants (n = 57) and eligible nonparticipants (n = 53), matched by race and age, were followed bimonthly over 6 mo postpartum. Finger stick blood samples (500 microL) were collected for measurement of plasma ferritin, transferrin receptor (TfR), and hemoglobin (Hb). RESULTS: The mean (+/-SE) Hb concentration of participants exceeded that of nonparticipants from months 2 through 6. At 6 mo, the mean Hb concentration of participants was significantly higher than that of nonparticipants (8.01+/-0.12 and 7.63+/-0.12 mmol/L, respectively; P< 0.05) and the prevalence of anemia was significantly lower (17% and 51%, respectively; P<0.05). TfR and ferritin concentrations (consistently within the reference ranges) and dietary iron intakes did not differ significantly between participants and nonparticipants and were not correlated with Hb concentrations. CONCLUSIONS: Our results suggest that WIC participants were significantly less likely to become anemic if uninterrupted postpartum participation lasted for 6 mo. The lack of correlation among iron status indicators suggests that the lower mean Hb concentration in nonparticipants at 6 mo may not have been related to improved iron status in participants but to other nutrient deficiencies or differences in access to health care and health and nutrition education.

Adult↗
PubMed2000

An analysis of personal and social factors influencing initiation and duration of breastfeeding in a large Queensland maternity hospital.

This study aimed to determine the degree to which certain personal and social maternal factors, measured in the immediate postpartum period and during the next six months, were associated with the length of the breastfeeding experience. Qualitative and quantitative data were obtained from three questionnaires administered to 159 mothers, who delivered their infants within a three-month birth cohort at Royal Women's Hospital Brisbane during 1997. Interviews took place prior to hospital discharge, at three months postpartum and at six months postpartum. The study found that, while 91.1% of new mothers had breastfed their infants at least once, only 49.6% were breastfeeding at all by the time their infants were six months of age. Longer breastfeeding duration was most significantly associated with increased breastfeeding self-confidence, lower levels of anxiety and depression, increased self-esteem and coping capacity, and stronger social health. These findings have relevance to the content and process of antenatal and postnatal education programs undertaken with pregnant and postpartum women in all health care settings.

Adult↗
PubMedDate not supplied

The Parent-Baby Venture Program: prevention of child abuse.

TOPIC: The overwhelming obstacles adolescents face to successful achievement of the maternal role. PURPOSE: To describe an innovative, community-based program to support high risk adolescents during the early postpartum period. SOURCE: A review of the literature related to programs designed to promote maternal-role attainment and prevent child abuse/neglect. CONCLUSION: Interviews with participants indicate a positive response to the intervention but regression to maladaptive behavior in some following termination.

Adolescent↗
PubMed2001

The long-term effects of Medicaid managed care on obstetrics care in three California counties.

OBJECTIVE: To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California. DATA SOURCES/STUDY SETTING: Longitudinal administrative data on Medi-Cal enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties--two long-standing MMC counties and one traditional fee-for-service Medicaid county--in California between 1987 and 1992. STUDY DESIGN: We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medi-Cal enrollment prior to delivery, data censoring, and individual characteristics such as race and age. PRINCIPAL FINDINGS: Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. CONCLUSIONS: MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes.

Aid to Families with Dependent Children↗
PubMed2005

Adapting smoking relapse-prevention materials for pregnant and postpartum women: formative research.

OBJECTIVE: To decrease smoking relapse among pregnant and postpartum women by adapting existing, validated relapse-prevention materials to meet the unique needs of pregnant and postpartum women. METHODS: A series of semi-structured interviews and learner verification activities were conducted with pregnant abstinent, postpartum abstinent, and postpartum relapsed women. Results were used to create new relapse-prevention materials, specific to the needs of pregnant and postpartum women, which are currently being used in a randomized clinical trial. RESULTS: Findings are consistent with the recurrent themes in the literature regarding smoking cessation among pregnant and postpartum women and revealed exceptional needs for coping and stress reduction strategies related to remaining abstinent postpartum. Conflict levels were also high in areas of identity, social support, and reasons for quitting. CONCLUSION: By interviewing women about their cessation related needs, the current study was able to produce smoking relapse-prevention materials specific to this population. Having pregnant and postpartum women review the modified program materials before starting the clinical trial enhanced the quality, dependability, and validity of the materials. We await the results of the clinical trial to determine if this intervention is indeed more efficacious than previous attempts to intervene with this population.

Female↗
PubMed2003

Incidence and treatment of urinary retention postpartum.

The aim of this clinical study was to examine the incidence of postpartum urinary retention, to investigate the relationship between different obstetric parameters, and to find out whether our proposed treatment program fulfilled our needs. The incidence of urinary retention postpartum was 0.7%. The incidence of instrumental delivery, sphincter rupture, and larger lacerations of the perineum was significantly increased in the group with urinary retention. Our program for detecting and treating patients with postpartum urinary retention seemed to work efficiently.

Adult↗
PubMedDate not supplied

Preventing smoking relapse in postpartum women.

BACKGROUND: Although many women quit smoking during pregnancy, the majority resume smoking shortly after giving birth. OBJECTIVES: To test a program to prevent smoking relapse in the postpartum period by comparing the rates of continuous smoking abstinence, daily smoking, and smoking cessation self-efficacy in treatment and control groups. METHODS: In a randomized clinical trial, nurses provided face-to-face, in-hospital counseling sessions at birth, followed by telephone counseling. The target population included women who quit smoking during pregnancy and who gave birth at one of five hospitals. The 254 participating women were interviewed 6 months after delivery and assessed biochemically to determine smoking status. RESULTS: The 6-month continuous smoking abstinence rate was 38% in the treatment group and 27% in the control group (odds ratio [OR] = 1.63, 95% confidence interval [CI] .96 - 2.78). Significantly more control (48%) than treatment (34%) group participants reported smoking daily (OR = 1.80, 95% CI = 1.08 - 2.99). Smoking cessation self-efficacy did not vary significantly between the groups. CONCLUSIONS: Smoking cessation interventions focusing on the prenatal period have failed to achieve long-term abstinence. Interventions can be strengthened if they are extended into the postpartum period.

Adolescent↗
PubMed1998

Outcomes tracking prototype follows OB patients from conception to postpartum.

Tracking outcomes across the continuum of care: A pilot OB/Neonatology computer system prepares a large health care network for developing a comprehensive automated outcomes management program. The system tracks prenatal, inpatient, and postpartum outcomes, and allows clinicians to keep an eye on the effects of a new 23-hour normal vaginal delivery LOS and an accompanying home health program.

Adult↗
PubMed2000

Postpartum depression: a comparison of screening and routine clinical evaluation.

OBJECTIVE: This study compared the efficacy of routine clinical evaluation with that of screening with the Edinburgh Postnatal Depression Scale for the detection of postpartum depression in a residency training program practice. STUDY DESIGN: Three hundred ninety-one patients during a period of 1 year were assigned according to delivery date to screening for postpartum depression with the Edinburgh Postnatal Depression Scale or to a control group who had only spontaneous detection during routine clinical evaluation. The incidences of postpartum depression detection and demographic characteristics were compared between 79 patients in the Edinburgh Postnatal Depression Scale group and 96 patients in the clinical evaluation group by means of chi(2) analyses. RESULTS: The incidence of postpartum depression detection with the Edinburgh Postnatal Depression Scale was significantly higher than the incidence of spontaneous detection during routine clinical evaluation (35.4% and 6.3%, respectively; P =.001). CONCLUSIONS: The Edinburgh Postnatal Depression Scale is an effective adjunct to clinical interview for diagnosis of postpartum depression and should be considered in residency training.

Adult↗
PubMedDate not supplied

An assessment of the nine-month lactational amenorrhea method (MAMA-9) in Rwanda.

This report presents a secondary data analysis based on prospectively collected records gathered during a field assessment that was carried out in Rwanda in August 1993. The assessment used service statistics and follow-up interviews to evaluate the efficacy of a modified lactational amenorrhea method (LAM) as a nine-month introductory postpartum natural family planning method. The program, carried out by Action Familiale Rwandaise (AFR), reflects high efficacy of the method in a compliant sample that sought this method followed by another form of family planning. These results are promising and provide guidance for the extended use of LAM past six months. Programmatic findings suggest that studies be conducted of the contribution of extended LAM to improved weaning practices, the high efficacy of continued reliance on substantial lactation and amenorrhea beyond nine months, and male involvement in LAM and breastfeeding.

Algorithms↗
PubMed2005

Early intervention for perinatal depression.

OBJECTIVE: This study was undertaken to design a process that effectively identifies and facilitates early intervention for women in an obstetrics clinic who are at risk for postpartum depression. STUDY DESIGN: Under this new program, labeled ISIS (Identify, Screen, Intervene, Support), we educated our new obstetric patients and clinic staff about postpartum depression through patient education classes, departmental lectures, and handouts. Then, we implemented simple procedures to identify risk factors for depression at intake and screened for depressive symptoms at the 32-week visit using the Edinburgh Postnatal Depression Scale (EPDS). In addition, we facilitated treatment of at-risk or symptomatic patients with the introduction of a social work consultant in the clinic setting. RESULTS: In an obstetric chart review, 75% of our patients were screened for depression in pregnancy. Ten percent of these women demonstrated symptoms of depression warranting further evaluation. CONCLUSION: Preliminary data from our multidisciplinary approach suggest that educating, screening, and appropriately treating or referring these women can take place in a busy obstetric clinic.

Depression↗
PubMed1998

Vaginal weights for assessment and training of the pelvic floor.

Urinary incontinence is a common problem for women. A trial of conservative treatment is frequently suggested before considering other treatment options. One method involves the use of vaginal weights for retraining the pelvic floor muscle. This review examines articles and abstracts on vaginal weights published in English or with abstracts in English between 1985 and 1997. It concludes that, despite some practical and theoretic concerns, there is adequate clinical evidence to support the use of weights in selected populations. Weights may be an effective training aid for women with mild to moderate stress incontinence, particularly in the absence of severe pelvic organ prolapse. They also may be useful for pelvic floor strengthening during the immediate postpartum period, as a behavioral program for continence maintenance, and for self-management programs. Suggestions for further research to refine treatment parameters and client selection are also presented.

Exercise Therapy↗
PubMed1997

Helping to make birth a happy event.

For women and their families the world over, the birth of a baby they want is a happy event. Birth is a time for joy and celebration, a time for congratulations, good wishes and gifts. Sadly, not all births are happy occasions. Birth and the days and weeks immediately following (known as the postpartum period) are a crucial time for the health and well-being of mother and child. Complications may arise and things may go wrong. In fact, most maternal deaths take place in the postpartum period. Women and their babies need all the help they can get a this time to protect them from illness and to build up their strength for the future. The special feature in this issue of "Safe motherhood" looks specifically at the provision of postpartum care. It describes the problems that mothers and babies may encounter and the services that need to be on hand both to prevent these problems from occurring and to provide solutions if they do occur. The feature in this newsletter looks at postpartum care particularly from the point of view of the health worker. But the protection of the health of women and their babies at this critical time of life cannot be achieved by health workers alone. Postpartum care is the responsibility of all of us--health workers, family members, and the wider community.

Child Welfare↗
PubMed2004

A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum.

We report results from a pilot study examining the use of vouchers redeemable for retail items as incentives for smoking cessation during pregnancy and postpartum. Of 100 study-eligible women who were still smoking upon entering prenatal care, 58 were recruited from university-based and community obstetric practices to participate in a smoking cessation study. Participants were assigned to either contingent or noncontingent voucher conditions. Vouchers were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence. In the noncontingent condition, vouchers were earned independent of smoking status. Abstinence monitoring and associated voucher delivery was conducted daily during the initial 5 days of the cessation effort, gradually decreased to every other week antepartum, increased to once weekly during the initial 4 weeks postpartum, and then decreased again to every other week for the remaining 8 weeks of the postpartum intervention period. Contingent vouchers increased 7-day point-prevalence abstinence at the end-of-pregnancy (37% vs. 9%) and 12-week postpartum (33% vs. 0%) assessments. That effect was sustained through the 24-week postpartum assessment (27% vs. 0%), which was 12 weeks after discontinuation of the voucher program. Total mean voucher earnings across antepartum and postpartum were 397 US dollars (SD=414 US dollars) and 313 US dollars (SD=142 dollars) in the contingent and noncontingent conditions, respectively. The magnitude of these treatment effects exceed levels typically observed with pregnant and recently postpartum smokers, and the maintenance of effects through 24 weeks postpartum extends the duration beyond those reported previously.

Adult↗