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PubMed2006

The Postpartum Support Questionnaire: psychometric properties in adolescents.

PROBLEM: Receiving adequate social support has been associated with positive outcomes for the postpartum adolescent and her baby. Therefore, social support is an important variable to include in research studies of postpartum adolescents. However, instruments developed for use in adults cannot be assumed to reliably and validly measure health-related concepts such as social support in adolescents (Rogler, 1999; Yarcheski, Mahon, & Yarcheski, 1992) without psychometric evaluation. PURPOSE: Therefore, the purpose of this study was to describe the reliability and validity of the Postpartum Support Questionnaire (PSQ) (Logsdon, 2002; Logsdon, Usui, Birkimer, McBride, 1996) with adolescents. METHOD: The PSQ was revised for use with adolescents, based upon focus groups with adolescents and professionals. Then, the PSQ was administered to a convenience sample of postpartum adolescents (N = 109) recruited from the Teenage Parent Program. FINDINGS: High internal consistency reliability was demonstrated for the total instrument and subscales. Factor analysis supported four factors, in line with the PSQ data with adults, with some indication for an additional adolescent factor. However, in adolescents material support and emotional support tend to load on the same factor. CONCLUSIONS: Social support may be defined differently in postpartum adolescents, but further research with a larger sample is needed to substantiate this finding. Instruments with psychometric data specific to adolescents should be chosen by researchers who study this group.

Adaptation, Psychological↗
PubMed2005

Maternal anxiety: an emerging prognostic factor in neonatology.

UNLABELLED: Symptoms of anxiety in pregnant and postpartum women are of considerable concern due to their association with adverse obstetrical outcomes, postpartum depression, and emotional and behavioral problems in the children. Certain mothers are at particularly high risk for anxiety in the immediate postpartum period: those who have experienced preterm birth or other perinatal complications, as well as those lacking a satisfactory marital relationship or other forms of social support. CONCLUSION: Programs to detect and intervene with anxious mothers in the early postpartum period are warranted.

Adult↗
PubMed1983

The introduction of postpartum intrauterine devices in the People's Republic of China.

In China, which has a commitment to family planning and, in particular, to the one-child family, a postpartum IUD should be widely accepted and could have significant impact on the Chinese family planning program. This report presents the introduction of the Delta T and Delta Loop devices, with 200 immediate postpartum insertions. Fifty-two deliveries were by cesarean section. The 6-month expulsion rates were 13.3 and 17.2 for the Delta T and Delta Loop, respectively. There was one pregnancy reported. Analysis suggests that the two devices are suitable for use in the postpartum period for Chinese women.

Adult↗
PubMed1992

Contraceptive efficacy of lactational amenorrhoea.

Pregnancy is rare among breastfeeding women with lactational amenorrhoea. The lactational amenorrhoea method (LAM) is the informed use of breastfeeding as a contraceptive method by a woman who is still amenorrhoeic, and who is not feeding her baby with supplements, for up to 6 months after delivery. Under these three conditions, LAM users are thought to have 98% protection from pregnancy. It can be difficult, however, to determine when supplementation of the baby's diet begins. We have analysed data from nine studies of the recovery of fertility in breastfeeding women to assess the effectiveness of lactational amenorrhoea alone, irrespective of whether supplements have been introduced, as a fertility regulation method post partum. Cumulative probabilities of ovulation during lactational amenorrhoea were 30.9 and 67.3 per 100 women at 6 and 12 months, respectively, compared with 27.2 at 6 months when all three criteria of the LAM were met. Cumulative pregnancy rates during lactational amenorrhoea were 2.9 and 5.9 per 100 women at 6 and 12 months, compared with 0.7 at 6 months for the LAM. The probability of pregnancy during lactational amenorrhoea calculated from these studies is similar to that of other modern contraceptive methods, and it seems reasonable for a woman to rely on lactational amenorrhoea without regard to whether she is fully or partly breastfeeding. So that amenorrhoea and fertility suppression can be maintained, counselling about good breastfeeding and weaning practices remains important.

Actuarial Analysis↗
PubMed1991

Contraception with progestogens and progesterone during lactation.

The growth and development of breastfed infants whose mothers used the contraceptive implants Norplant containing levonorgestrel and the injectable containing norethisterone enanthate were studied. Each group comprised of 120 women who initiated the use during the 5th to 7th week postpartum and were compared with a similar number of IUD using mothers. The breastfeeding performance did not differ between groups. The infants of the three groups performed similarly as regards their physical growth and health as well as the time of acquisition of the various milestones of psychomental development. A vaginal ring releasing 10 mg of the "natural" progesterone per 24 h was tested in breastfeeding mothers. The continuous use of the ring produced a serum level of progesterone around 4 ng/ml. This was effective in augmenting lactational infertility even through the later phases of breastfeeding when such an effect starts to wane off. The use of the ring proved to be acceptable and had no ill-effect on breastfeeding or infant growth or health. Using the natural progesterone as a contraceptive adds a new measure of safety, since the amount of the steroid secreted in the mother's milk will not be effectively absorbed from the infant's gut. These studies suggest the possibility of using two new methods for breastfeeding mothers; Norplant and the progesterone vaginal contraceptive ring. These can be initiated early postpartum, whenever this is considered needed.

Contraceptive Devices, Female↗
PubMed1999

Prediction by maternal risk factors of neonatal intensive care admissions: evaluation of >59,000 women in national managed care programs.

OBJECTIVE: Managed care plans have adopted risk assessment tools as part of pregnancy disease state management strategies to assist in reducing poor pregnancy outcomes and related costs. We evaluated the relationships of maternal risk factors to determine which pregnancy risk factors were associated with neonatal intensive care unit (levels II and III) admission. STUDY DESIGN: Risk assessments were performed through perinatal telephone interviews of nurses with 59, 861 pregnant women during 1996 and 1997 calendar years as part of managed care maternity risk screening and education programs. A series of 3 interviews was conducted, at 17 weeks and 28 weeks average gestational age and at 2 weeks post partum. Univariate chi(2) analysis was performed on >50 historical and pregnancy risk factors to determine the associations with neonatal intensive care unit admission. Significant factors were included in a stepwise logistic regression model. Receiver operating curves were generated for the use of significant factors in a risk scoring system in the prediction of neonatal intensive care unit admission, and the percentages of neonatal intensive care unit days attributable to significant risk factors were calculated. RESULTS: Among the participants most women (90%) had their prenatal visit during the first trimester. The mean maternal age was 30.2 +/- 5.2 years, with 74% of women reportedly of white ethnicity, 86% married, and 44.3% primigravid. The mean gestational age at birth decreased with increasing number of fetuses from singletons to quadruplets. The chi(2) analysis identified 26 significant risk factors associated with neonatal intensive care unit admission. Of these, 14 remained significant by logistic regression. Multiple gestation, preterm premature rupture of membranes, diabetes, abruptio placentae, pregnancy-induced hypertension, and preterm labor were independently associated with at least a 3-fold risk of neonatal intensive care unit admission. A modeled risk scoring system that used these and other significant factors was poorly predictive of neonatal intensive care unit admission. However, an analysis of neonatal intensive care unit length of stay attributable to significant risk factors concluded that 19% of all neonatal intensive care unit days in this population were associated with multiple gestations. Furthermore, 85% of neonatal intensive care unit days were the result of infant lengths of stay >/=1 week. CONCLUSION: This analysis of a managed care population showed similar risk factors to those traditionally associated with neonatal intensive care unit admission. Although many of these risk factors are not preventable, identification of neonatal intensive care unit admission risks with a screening program may be of use for focusing interventions, and earlier identification of these factors may allow maximum impact of interventions. Importantly, a reduction in the incidence of higher-order multiple gestations might help to reduce neonatal intensive care unit admissions and costs.

Adult↗
PubMedDate not supplied

Mother-infant interaction: achieving synchrony.

BACKGROUND: Interventions that promote positive mother-infant interactions may reduce the risk of poor developmental outcomes for the child. OBJECTIVE: To examine the effect of infant communication education presented prenatally to first-time mothers on the quality of interaction that occurs between the mother-infant dyad in the first 24 hours following birth. METHOD: Twenty-nine first-time mothers were randomly assigned to either an intervention or control group. The intervention group received education on infant behaviors, states, and communication cues. A specific mother-infant interaction was videotaped and scored using the Nursing Child Assessment Teaching Scale (NCATS). The scores between groups were compared to determine the effect of education on the interaction that occurred between the dyads. RESULTS: Significant intervention effect was found in the overall totals (t(27)= 1.69; p = .05) as well as the contingency scores related to sensitivity to cues (t(27)= 1.93; p = .05) and social-emotional growth-fostering behaviors (t(27)= 1.93; p = .05). CONCLUSION: A videotaped educational intervention on infant communication implemented prenatally resulted in significant differences between the intervention and control groups on NCATS scores (totals, sensitivity to cues, and social-emotional growth-fostering behaviors). The use of videotaped educational information facilitates very early mother-infant interaction.

Adolescent↗
PubMed1992

Family planning for women with bipolar disorder.

Women with bipolar disorder often ask their treating clinician for information about family planning, as they are concerned about the impact of their illness on offspring. Three areas that should be included in discussions with patients and their partners are heritability of the disorder, risks during pregnancy, and risks during the postpartum period. The author summarizes information about genetic transmission of bipolar disorder, effects on bipolar patients of stress associated with pregnancy and childrearing, and effects of medication on the fetus and newborn. Discussion of these issues is most relevant for a women patient who is planning a pregnancy, but may also be useful for couples before marriage, for a women patient who finds that she is pregnant, and for men with bipolar disorder who want to become fathers.

Bipolar Disorder↗
PubMed2003

Peer counselors for breastfeeding mothers in the hospital setting: trials, training, tributes, and tribulations.

Boston Medical Center (BMC), an inner-city, Baby-Friendly teaching hospital with approximately 2000 births per year, has employed breastfeeding peer counselors since 1998. The Breastfeeding Center frequently receives requests for information on our peer counselor program. This article reviews program models, training methods, practicalities, benefits, and challenges associated with employing breastfeeding peer counselors in the hospital setting. Specifically, it focuses on 3 different models of peer counseling programs used at BMC: the telephone model, the postpartum model, and the neonatal intensive care model, and it considers the benefits and issues associated with each model.

Boston↗
PubMed1997

A five-factor model of personality and addiction, psychiatric, and AIDS risk severity in pregnant and postpartum cocaine misusers.

The relationship between addiction severity, psychiatric symptoms, AIDS risk behaviors, and an alternative five-factor measure of personality, the Zuckerman-Kuhlman Personality Questionnaire, was assessed in 92 cocaine-misusing pregnant and postpartum women in an inner city outpatient treatment program. Three of the personality traits (Neuroticism-Anxiety, Impulsive Sensation Seeking, Aggression-Hostility) were significantly related to different subscales of the Addiction Severity Index, Beck Depression Inventory, various psychiatric symptoms, and high HIV risk sexual activity. Of these traits, Neuroticism-Anxiety seemed to be the most powerful predictor of symptom severity for this sample of women. Scores on the personality dimensions were not related to recency, frequency, amount, or duration of drug use or to treatment outcomes.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Management of HIV infected pregnant women in Chonburi Hospital.

This study on birth control methods used, and HIV infection protection of the HIV infected pregnant women in the obstetrics-gynecology department of Chonburi Hospital from 1 January 1990 to 31 December 1993 revealed that there were 27 HIV infected women with less than 24 weeks gestational age, using birth control methods as such 12 women (44.44%) had tubal resection after abortion, 8 women (29.62%) oral contraceptive pills, 5 women (15.51%) injectable contraception, and 2 women (7.40%) norplants. The 106 HIV infected women with more than 24 weeks gestational age were allowed to deliver. The birth control methods were as follows: 19 women (17.92%) tubal resection, 38 women (35.84%) oral contraceptive pills, 49 women (46.22%) injectable contraception. They were all encouraged to use a condom while having sexual intercourse. Only 40 women of this group are still seen in the follow-up clinic and all are found to be healthy, the birth control is effective and HIV infection is in the early stage. The new born babies were not allowed to be breast fed and were followed-up periodically to 18 months old. Twenty five babies received HIV blood test; 7 babies (28%) were found to be HIV infected. The birth control and HIV infection protection used in this study demonstrate no adverse effects on the disease, and the unexpected problems of these women, as well as the health personnel concerned are reduced both economically and socially. This study provides the guidelines of good care for HIV infected pregnant women.

Abortion, Therapeutic↗
PubMed1996

The problem of post-partum fistulas in developing countries.

Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery.

Adolescent↗
PubMed1999

Cognitive adaptation: a women's health perspective for reducing stress during childbearing.

The purpose of this study is to evaluate psychological changes in women of three minority ethnic groups in a program of psychosocial services that promoted positive cognitive adaptation to childbearing throughout pregnancy and the postpartum period. In this prospective longitudinal study, both cognitive adaptation and generalized stress were measured at each trimester of pregnancy as well as after birth and 3 months postpartum. The mean scores at each time are first compared with first trimester scores for women in the program and then with scores for comparable women in a cross-sectional sample tested before the program. For women in the program, results of the psychological adaptation measures and the stress measures had improved from their first trimester value by the time of birth. Stress levels of women in the program were less than for women in the corresponding comparison sample from the third trimester on. Enhanced perinatal services that include interventions and monitoring strategies aimed at improving the cognitive adaptation of women to childbearing are important in promoting stress reduction in women and infants.

Adaptation, Psychological↗
PubMedDate not supplied

Acceptance of hepatitis B vaccination by pregnant adolescents.

PURPOSE: To determine (1) the rate of prenatal hepatitis B virus (HBV) vaccine acceptance in HBV nonimmune pregnant adolescents, (2) if postulated behavioral and attitudinal factors are associated with HBV vaccine, and (3) the rate of actual receipt of HBV vaccine postpartum in eligible subjects. DESIGN AND METHODS: During 1999-2000, at an inner-city tertiary-care center prenatal clinic, 160 HBV nonimmune adolescents <18 years who were receiving prenatal and delivery care at the center were identified. The research nurse provided an HBV information pamphlet and offered immediate in-hospital postpartum HBV vaccination. Risk factors for nonacceptance of the vaccine were measured with structured questionnaires and medical record review documenting care attendance. Subsequently, all subjects, irrespective of prenatal acceptance of vaccine, were offered vaccine before postpartum discharge, and the rate of actual acceptance was determined. RESULTS: In these predominantly African American (95%) adolescents, the rate of vaccine acceptance was 91%. Actual vaccination rate was 86%, but it was not associated with prior acceptance of vaccination or behavioral or attitudinal factors. CLINICAL IMPLICATIONS: Acceptance of vaccination and actual vaccination were high in this population of high-risk adolescents. The authors found that reoffering vaccine was a successful intervention, even with adolescents who had less-than-optimal attendance at prenatal visits. Given the high rate of acceptance and vaccination in this setting, the authors would encourage public health programs to implement vaccination programs in adolescent prenatal clinics and to offer vaccination postpartum to those who do not receive it prenatally.

Adolescent↗
PubMed1994

Effects of a community health nursing parent-baby (ad)venture program on depression and other selected maternal-child health outcomes.

This pilot study measured the effects of a community health nursing parent-baby (ad)venture program for first time mothers who were at risk for child abuse or neglect and depression. A quasi-experimental pretest-posttest design was used. Fifteen high-risk mothers in the program were compared with 15 similar mothers who received home visits from the community health nursing staff. Measures of depression, health behaviors, self-esteem, state anxiety, and maternal-infant adaptation were measured in both groups when the mothers were 4 and 16 weeks postpartum. After controlling for pretest differences, the findings showed that program mothers reported significantly higher levels of self-esteem at the three-month period than those receiving home visits (P < 0.013). In addition, over time these mothers had significantly decreased levels of depression (P < 0.009) and significantly improved their health habits (P < 0.003). Those who received home visits showed no significant changes over time.

Adolescent↗