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PubMed2000

[Nursing school of the University of Sao Paulo and the Sao Paulo state health department: partners in the obstetric nursing specialization].

The School of Nursing at the University of São Paulo and the São Paulo State Health Department established a proposal to qualify nurses by a Specialization Program in Midwifery, which purposes were: to analyse the midwifery care problems in the context of the family and the National Health System; to qualify the nurse to give care to the woman in the pregnancy, delivery and postpartum, on clinical, epidemiological and humanistic bases; to qualify the nurse to delivery babies. The Program was concluded by 19 students, whom delivered the rate of 35 childbirth/nurse.

Brazil↗
PubMed2000

Does team midwife care increase satisfaction with antenatal, intrapartum, and postpartum care? A randomized controlled trial.

BACKGROUND: Although policymakers have suggested that improving continuity of midwifery can increase women's satisfaction with care in childbirth, evidence based on randomized controlled trials is lacking. New models of care, such as birth centers and team midwife care, try to increase the continuity of care and caregiver. The objective of this study was to evaluate the effect of a new team midwife care program in the standard clinic and hospital environment on satisfaction with antenatal, intrapartum, and postpartum care in low-risk women in early pregnancy. METHODS: Women at Royal Women's Hospital in Melbourne, Australia, were randomly allocated to team midwife care (n = 495) or standard care (n = 505) at booking in early pregnancy. Doctors attended most women in standard care, and continuity of the caregiver was lacking. Satisfaction was measured by means of a postal questionnaire 2 months after the birth. RESULTS: Team midwife care was associated with increased satisfaction, and the differences between the groups were most noticeable for antenatal care, less noticeable for intrapartum care, and least noticeable for postpartum care. The study found no differences between team midwife care and standard care in medical interventions or in women's emotional well-being 2 months after the birth. CONCLUSION: Conclusions about which components of team midwife care were most important to increased satisfaction with antenatal care were difficult to draw, but data suggest that satisfaction with intrapartum care was related to continuity of the caregiver.

Continuity of Patient Care↗
PubMedDate not supplied

A light in the fog: caring for women with postpartum depression.

It is estimated that at least 1 in 10 women will experience postpartum depression, yet systematic screening for it in clinical practice is too often neglected. The foggy unreality of this affective disorder leads women to believe they are losing their minds, and their efforts to find help can be elusive. Women with postpartum depression who go undetected and untreated are at risk for immediate harm and potential lifelong sequelae for themselves and their families, and especially for their children. This article provides 1) an understanding of the woman's experience of postpartum depression, 2) a review of two instruments, developed through a focused program of research to screen for the disorder, 3) triage in clinical practice, and 4) an overview of the three dimensions of treatment: psychopharmacology, psychotherapy, and psychosocial care. Practical guidance and client information are provided to assist midwives and primary care providers to incorporate systematic screening into clinical practice, to identify effective interdisciplinary treatment teams, and to muster family and community resources to help with this commonly hidden childbearing crisis.

Child↗
PubMed1991

Predictors of breast-feeding duration among WIC and non-WIC mothers.

Many women cease breast-feeding during the first eight weeks after childbirth. Few studies have assessed the relationship of social status to the duration of breast-feeding. This research identified variables that predicted breast-feeding duration for the first eight weeks postpartum among mothers enrolled in the Women, Infants, and Children (WIC) program and those not enrolled. Participation in the WIC program was used as a criterion for measuring socioeconomic status. A total of 400 mothers completed the survey: 200 WIC and 200 non-WIC. A combination of five variables--introduction of formula, maternal perceived success, frequency of breastfeeding, income, and time of initiation of breast-feeding after delivery--explained 48% of the variance in the duration of breast-feeding. The best predictor, introduction of formula, alone accounted for 30% of the variance. There was no difference between aggregates with respect to breast-feeding duration. Findings suggest that a number of variables can be used to identify those at risk for unsuccessful or curtailed breast-feeding, with introduction of formula being the most detrimental.

Adolescent↗
PubMed2006

Pelvic floor muscle exercise by biofeedback and electrical stimulation to reinforce the pelvic floor muscle after normal delivery.

PURPOSE: This study was conducted to investigate the effectiveness of pelvic floor muscle exercise using biofeedback and electrical stimulation after normal delivery. METHODS: The subjects of this study were 49 (experimental group: 25, control group: 24) postpartum women who passed 6 weeks after normal delivery without complication of pregnancy, delivery and postpartum. The experimental group was applied to the pelvic muscle enforcement program by biofeedback and electrical stimulation for 30 minutes per session, twice a week for 6 weeks, after then self-exercise of pelvic floor muscle was done 50-60 repetition per session, 3 times a day for 6 weeks. Maximum pressure of pelvic floor muscle contraction (MPPFMC), average pressure of pelvic floor muscle contraction (APPFMC), duration time of pelvic floor muscle contraction (DTPFMC) and the subjective lower urinary symptoms were measured by digital perineometer and Bristol Female Urinary Symptom Questionnaire and compared between two groups prior to trial, at the end of treatment and 6 weeks after treatment. RESULTS: The results of this study indicated that MPPFMC, APPFMC, DTPFMC were significantly increased and subjective lower urinary symptoms were significantly decreased after treatment in the experimental group than in the control group. CONCLUSIONS: This study suggested that the pelvic floor muscle exercise using biofeedback and electrical stimulation might be a safer and more effective program for reinforcing pelvic floor muscle after normal delivery.

Adult↗
PubMedDate not supplied

Childbirth and the Canadian military family.

Living with a spouse in the military involves a lifestyle with unique stresses. These can become even more difficult when a woman becomes pregnant and her husband has been deployed thousands of miles away. Recognizing that many military families lacked adequate support during their pregnancy, labor and delivery, and postpartum experience, Jeanette McMillan collaborated with the military to establish a program that provides support to these families.

Canada↗
PubMed2004

[Clinical trial of aromatherapy on postpartum mother's perineal healing].

PURPOSE: This study was designed to verify the effect of aromatherapy on a postpartum mother's perineal healing. METHOD: The research design was a clinical trial. The methods of aromatherapy were applied sitz bath or soap application using essential oils with Lavender, Myrrh, Neroli, Rose, Grapefruit, Mandarin, Orange, and Roman Chamomile. The subjects of this experiment were postpartum mothers who delivered vaginally with an episiotomy. They were allocated to one of three groups; the aroma-sitz bath group, aroma-soap application group or control group. To evaluate the effect of aromatherapy, the perineal healing status was measured using the REEDA scale and smears of episiotomy wound were obtained. The data were analyzed by repeated measures of ANOVA, ANCOVA, chi2-test, and multiple response analysis via SPSS program. RESULT: The REEDA scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed 'few'(5-10 bacteria per field) bacteria in the smears of episiotomy wound. The one bacteria was identified in the 50.8% of subjects in pretest and two bacteria in the 60.3% in posttest. Most frequently identified bacteria were Escherichia coli and Enterococcus faecalis. CONCLUSION: In conclusion, these findings indicate that postpartum aromatherapy for perineal care could be effective in healing the perineum perineal care could be effective in healing the perineum.

Adult↗
PubMedDate not supplied

Baby boot camp: facilitating maternal role adaptation among military wives.

BACKGROUND: Current research suggests that women married to military service members may experience difficulty during the transition to motherhood attributable to the additional stressors of military life and inability to access traditional support systems. OBJECTIVE: To test the effects of a nursing intervention on prenatal and postpartum maternal role adaptation among military wives. METHODS: Primigravid military wives were assigned randomly to either a traditional childbirth education program (n = 47) or Baby Boot Camp (n = 44). The Baby Boot Camp is a 4-week childbirth-parenting preparation program based on a resilience paradigm. The strategies of Baby Boot Camp include identification of nontraditional external resources and development of internal resources to facilitate maternal role adaptation. The Prenatal Self-Evaluation Questionnaire, Personal Resource Questionnaire, and Resilience Scale were administered at baseline (32 to 37 weeks gestation), immediately after the intervention, and at 6 weeks postpartum. RESULTS: The outcomes suggest that Baby Boot Camp strategies to enhance external and internal resources may have been successful in facilitating maternal role adaptation. An independent t-test showed that, as compared with the military wives who attended traditional childbirth education courses, the Baby Boot Camp participants experienced significantly greater prenatal and postpartum adaptation. As demonstrated by repeated measure analysis of variance, the Baby Boot Camp participants experienced an increase in external and internal resources immediately after the intervention. However, these differences in resources were not sustained at 6 weeks postpartum. CONCLUSIONS: The findings may lead to wider development and use of childbirth-parenting programs designed to meet the unique strengths and needs of the childbearing military wife.

Adaptation, Psychological↗
PubMed1987

Early and late discharge after hospital birth. Health of mother and infant in the postpartum period.

Early discharge, defined as hospital leave 24-48 hours after birth, was introduced at Falun Hospital in 1984. 164 women interested in participating in an evaluative study of the program were randomly allocated in late pregnancy to an Experimental group (EG) offered early discharge, and a Control group (CG) offered the regular postpartum care in hospital. After medical and other withdrawals 24 h after the birth, 50 women remained in EG and 54 in CG. Infant morbidity and number of prescribed medicaments during the first 6 months after the birth were lower in EG than in CG, but the difference was not statistically significant. EG mothers made fewer visits to the Child Health Centre nurse than did CG mothers (p less than 0.05). No significant difference in puerperal complications was demonstrated, but the intake of sedatives by EG mothers was smaller than that of CG mothers during the first puerperal week (p less than 0.01).

Analgesics↗
PubMedDate not supplied

First Steps: participants and outcomes of a maternity support services program.

OBJECTIVE: To describe characteristics and pregnancy outcomes of participants in a maternity support program and to compare these characteristics and outcomes with those for women who were eligible for, but did not participate in, the program. DESIGN: Descriptive, ex post facto. SETTING: An inland northwest city. PARTICIPANTS: Two hundred twenty postpartum patients who received Medicaid during their pregnancy. MAIN OUTCOME MEASURE: Quantitative data were obtained from a structured interview that gathered demographic information. Subjects also completed the Social Support Apgar, an investigator-designed instrument. RESULTS: Demographic characteristics and overall pregnancy outcomes were similar for program participants and nonparticipants; however, more program participants than nonparticipants quit smoking during their pregnancy. CONCLUSIONS: Findings are consistent with results documented by other researchers on the effectiveness of similar programs in different locales. The findings support the need for continued efforts to better define appropriate target populations, interventions, and expectations for these programs.

Adolescent↗
PubMed1993

Adolescent mothers and repeated childbearing: effects of a school-based intervention program.

This study examined the effectiveness of a public school program for pregnant teenagers in preventing rapid repeated childbearing. Students permitted to attend longer than seven weeks postpartum were much more likely to avoid having another child in the next five years than were students required to return to their regular schools. The results indicate the potential of school-based programs to improve life outcomes for adolescent mothers and their children.

Adolescent↗
PubMed1999

Maternal moods predict breastfeeding in Barbados.

This study was designed to identify psychosocial variables affecting early infant feeding practices in Barbados. The sample included 93 healthy women and infants born at the Queen Elizabeth Hospital who were extensively evaluated 7 weeks, 3 months, and 6 months after birth. Maternal moods were assessed with the Zung Depression and Anxiety Scales and the General Adjustment and Morale Scale. Feeding practices were evaluated using a questionnaire developed for this population. The prevalence of mild depression in this population was 16% at 7 weeks and increased to 19% at 6 months, whereas there were very few cases of moderate-to-severe depression. Disadvantaged environmental conditions, including less information-seeking by the mother, lower family income, and poor maternal health, were closely associated with increased symptoms of depression and anxiety in all women. However, significant predictive relationships between mood and feeding practices remained even when the effects of the home environment were controlled. Specifically, depressive symptoms at 7 weeks postpartum predicted a reduced preference for breastfeeding at current and later infant ages. Conversely, feeding practices did not predict maternal moods at later ages. These findings have important implications for public policy dealing with programs promoting breastfeeding. Early interventions designed to treat mild postnatal depression should be instituted early in the postpartum period to improve the chances for successful breastfeeding.

Adult↗
PubMed1990

A randomized evaluation of smoking cessation interventions for pregnant women at a WIC clinic.

Pregnant smokers attending a local health department WIC clinic were randomly assigned to one of two self-help smoking cessation programs or usual care. The multiple component program resulted in larger quit rates than usual care during the last month of pregnancy (11 percent vs 3 percent) and postpartum (7 percent vs 0 percent). Achieving quit rates in WIC similar to those in studies conducted at prenatal care settings, suggests that smoking cessation programs for low-income pregnant WIC clients are feasible.

Adult↗
PubMed1993

High dose vitamin A supplementation of breast-feeding Indonesian mothers: effects on the vitamin A status of mother and infant.

For regions where vitamin A deficiency is common, high dose vitamin A supplementation of lactating mothers is currently recommended, but the effects of this intervention have not been carefully evaluated. We conducted a randomized, double-blind trial in which 153 Indonesian mothers 1-3 wk postpartum received either a capsule containing 312 mumol of vitamin A as retinyl palmitate or a placebo. Mothers' serum retinol concentrations in the vitamin A group tended to be lower than in the placebo group at baseline but higher at 3 mo postpartum (1.39 vs. 1.24 mumol/L, P = 0.03) and 6 mo postpartum (1.23 vs. 1.08 mumol/L, P < 0.01). The milk retinol concentrations of the vitamin A group were higher than those of the placebo group by 0.48 to 1.18 mumol/L at 1-8 mo postpartum (P < 0.05). Among the infants at 6 mo of age, the prevalences of low serum retinol concentration (< 0.52 mumol/L) were 36 and 15% in the placebo and vitamin A groups, respectively (P < 0.005), and the prevalences of low vitamin A stores (assessed by relative dose response) were 23 and 10%, respectively (P < 0.03). High dose vitamin A supplementation of lactating mothers is an efficacious way to improve the vitamin A status of both mother and breast-fed infant.

Adolescent↗
PubMed2006

[Effectiveness of smoking cessation interventions for pregnant women--meta-analyses of randomized trials and description of the study performed in Poland].

OBJECTIVES: The aim of the study was to evaluate the effectiveness of smoking cessation interventions for pregnant women. DESIGN: The study including meta-analyses of randomized trials and description of the study performed in Poland. MATERIALS AND METHODS: The anti-smoking counseling for pregnant women was performed in the maternity centers in Lódź. This study consisted of two stages. At the first stage which was performed between 1 December 2000 and 31 December 2001, 149 current smokers and 56 spontaneous quitters were randomized into the smoking cessation intervention and 144 current smokers and 37 spontaneous quitters were included into the control group. The intervention program included four midwife visits during pregnancy and one after delivery. The control units received standard written information about the health risk from maternal smoking to the fetus. The second stage of the study included collection of data on smoking relapse one year postpartum. RESULTS: The chance of quitting smoking by the women who agree to participate in the program was significantly higher in the intervention group than in the control group (OR=5.8; p<0.001). The chance to maintain smoking abstinence one year after delivery was four times higher in intervention than control group (3.7, p=0.03). CONCLUSIONS: The midwife-assisted smoking cessation intervention preformed in Lodz region seems to be an effective tool to help pregnant smoker make a decision to quit smoking and maintain smoking abstinence after delivery.

Adult↗
PubMedDate not supplied

Barriers to postpartum depression prevention and treatment: a policy analysis.

Public policy erects two barriers to adequate prevention and treatment of postpartum depression (PPD) in the United States: 1) the lack of parity between insurance coverage for mental and physical illness decreases access to care and 2) the current model of postpartum care fails to incorporate screening and follow-up. Treatment for PPD falls into the insurance category of mental health. But many insurance companies either do not cover mental illness at all or provide coverage that is far below that for physical ailments. Because cost-benefit analyses have shown the benefits of parity laws, legislation to achieve parity between mental and physical health insurance is crucial in addressing this problem. Meanwhile, the U.S. model of post-partum care should follow the example of care provided in the United Kingdom where nurse-midwives visit new mothers at home to check on their physical and emotional status. In one program that produced positive psychological health outcomes, midwifery visits were tailored to individual needs and extended to 10-12 weeks postpartum. Encouraging developments in the United States include 1) an effective program that screens new mothers with signs of PPD and provides telephone follow-up and rapid treatment referral and 2) proposed legislation to fund organizations working to reduce the incidence of PPD.

Adult↗
PubMed1994

Relationship between milk acetone and milk yield in individual cows.

Correlations between acetone in milk and milk production during the first nine weeks postpartum were calculated in ten individual cows and for a whole herd. The decrease in milk production due to ketonaemia was evaluated using a mathematical model of the KaleidaGraph integrate area program. For determination of milk components, a milk sample was obtained twice a week from one to nine weeks postpartum. Milk yield was negatively correlated with acetone concentration in milk. In non-clinical ketotic cows the calculated loss of milk yield due to elevation of milk acetone was 2-9% and in clinical ketotic cow it was as high as 26%. The correlation between milk components and acetone level varied at different stages of ketosis. Thus the stage of lactation and of ketosis should be taken into consideration when the correlation between milk parameters and milk production is evaluated. Prior to clinical ketosis, milk acetone was negatively correlated with milk yield, percentage of protein and percentage of lactose, whereas it was positively correlated with percentage of fat and urea concentration. In addition, high levels of acetone tended to be associated with high cell count. It is concluded that 1) ketotic cows do not achieve the maximum potential milk yield and 2) high levels of milk acetone are harmful to the udder. For high milk production, the concentration of acetone in milk should not exceed 0.05 mmol/l at any stage of lactation.

Acetone↗