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PubMed2004

Differential response to breastfeeding peer counseling within a low-income, predominantly Latina population.

This study aims to identify those most responsive to breastfeeding peer counseling (PC) using data from a US-based randomized trial. The authors ran a series of logistic regression models to identify differential responses to PC, using breastfeeding status at 0, 1, 3, and 6 months postpartum as the dependent variables. Three subgroups were found to be most responsive to breastfeeding PC. Multiparae receiving PC were 6 times more likely to initiate breastfeeding than were multiparous controls (odds ratio [OR] = 6.4; 95% confidence interval [CI] = 1.9-20.8). Similarly, those with uncertain prenatal breastfeeding intentions in the PC group were 7 times (OR = 7.4; 95% CI = 1.5-37.0) more likely to initiate breastfeeding than their control group counterparts. Among subjects partially breastfeeding on day 1 postpartum, those receiving PC were 12 times (OR = 11.9; 95% CI = 1.2-111.1) more likely to breastfeed through 3 months postpartum than were controls. These findings have important implications to the Supplemental Food Program for Women, Infants and Children.

Adult↗
PubMed2000

Smoking cessation counseling with pregnant and postpartum women: a survey of community health center providers.

OBJECTIVES: This study assessed providers' performance of smoking cessation counseling steps with low-income pregnant and postpartum women receiving care at community health centers. METHODS: WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program staff, obstetric clinicians, and pediatric clinicians at 6 community health centers were asked to complete surveys. Smoking intervention practices (performance), knowledge and attitudes, and organizational facilitators were measured. Factors associated with performance were explored with analysis of variance and regression analysis. RESULTS: Performance scores differed significantly by clinic and provider type. Providers in obstetric clinics had the highest scores and those in pediatric clinics had the lowest scores. Nurse practitioners and nutritionists had higher scores than other providers. Clinic type, greater smoking-related knowledge, older age, and perception of smoking cessation as a priority were independently related to better counseling performance. CONCLUSIONS: Mean performance scores demonstrated room for improvement in all groups. Low scores for performance of steps beyond assessment and advice indicate a need for emphasis on the assistance and follow-up steps of national guidelines. Providers' own commitment to helping mothers stop smoking was important.

Adult↗
PubMed2002

Treating nicotine dependence during pregnancy and postpartum: understanding clinician knowledge and performance.

This study investigated the relationship of clinicians' knowledge of treatments for nicotine dependence during pregnancy and postpartum and explored what provider characteristics are associated with knowledge levels. Survey data from community health center (CHC)-based prenatal, pediatric (PED), and WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children) providers participating in a randomized clinical study were used. Providers reported low awareness of the health risks of smoking to the developing fetus/child of pregnant and postpartum women and of the effectiveness of nicotine replacement therapy (NRT) for doubling quit rates. Obstetric (OB) and WIC providers were more aware than PED providers that provider-delivered interventions are effective. Confidence in using counseling steps was significantly associated with general and NRT-related knowledge. NRT-related knowledge, but not general knowledge, was associated with higher performance of intervention steps. Educational programs targeting OB, WIC, and PED providers' knowledge about effective smoking cessation counseling strategies and their confidence in being effective with patients are needed.

Adult↗
PubMed1985

Compliance with postpartum Rh isoimmunization prophylaxis in Alberta.

A retrospective review of obstetric records for 1979 in two major Calgary hospitals was undertaken to determine the rate of compliance with postpartum Rh isoimmunization prophylaxis in Alberta. The charts of 4528 women ranging in age from 13 to 46 years were reviewed. The prevalence rate of Rh negativity was found to be 16%. Of the 710 Rh-negative women 490 (69%) were eligible to receive Rh immune globulin (RhIG); that is, they had no anti-D antibodies, and the baby/fetus was Rh-positive or Rh-unknown. RhIG had been administered to 93.6% of the eligible women; the compliance rate ranged from 66.7% for obstetric emergencies (i.e., spontaneous abortion, antepartum or early-pregnancy hemorrhage, or ectopic pregnancy) to 98.2% for postpartum diagnoses. In more than half (54.7%) of the women who underwent amniocentesis Rh type was not determined; the implications of this finding are discussed. Although poor compliance with postpartum RhIG administration is not a reason for withholding antepartum administration of RhIG, maximum compliance with the more cost-effective programs should be attained before antepartum programs are fully implemented.

Adolescent↗
PubMed1976

Education for adolescent mothers in a hospital setting.

This paper describes an innovative service program designed to help adolescent mothers become more effective parents. Mother-infant pairs are recruited in the postpartum unit of Cincinnati (Ohio) General Hospital, and weekly classes are held in a pediatric clinic waiting room until infants are approximately six months of age. Medical consultation and/or treatment and education for parenthood in the areas of health, nutrition, and infant stimulation are the foci of the program. The interest and participation of the mothers, the opinion of professionals, tests of maternal knowledge, and measurements of maternal-infant interaction attest to the value and success of this program.

Adolescent↗
PubMed2002

Effect of vitamin A administered at Expanded Program on Immunization contacts on antibody response to oral polio vaccine.

OBJECTIVE: Vitamin A supplementation to mothers in the postpartum period and to their infants at routine immunization contacts is being considered to reduce vitamin A deficiency in infancy. This study was conducted to determine the impact of maternal and infant vitamin A supplementation on antibody response to oral polio vaccine (OPV). DESIGN: Randomized, double blind, placebo-controlled trial. INTERVENTIONS: Mothers in the intervention group received 60 mg retinol equivalent (RE) vitamin A 3-4 weeks after delivery and their infants 7.5 mg RE with each OPV dose at 6, 10 and 14 weeks of age. The control group mothers and their infants received a placebo at each of these contacts. MAIN OUTCOMES: Geometric mean (GM) titer of neutralizing antibodies and proportion of children with protective titer to the three polioviruses at 26 weeks of age. RESULTS: Vitamin A supplementation increased the proportion of infants with protective antibody titer against poliovirus type 1 (relative risk (RR) 1.15, 95% confidence interval (CI) 1.03-1.28) and the GM antibody titer (ratio of GM 1.55, 95% CI 1.03-2.31) following immunization. The proportion of infants with protective antibody titer against poliovirus type 2 (RR 0.99, 95% CI 0.94-1.05) or type 3 (RR 1.05, 95% CI 0.96-1.15) was not significantly different in vitamin A and placebo groups. The GM antibody titer for poliovirus type 2 (ratio of GM 0.99, 95% CI 0.64-1.54) or poliovirus type 3 (ratio of GM 1.10, 95% CI 0.69-1.75) also did not differ across groups. CONCLUSIONS: Vitamin A given to the mothers in the postpartum period and their infants with OPV did not interfere with the antibody response to any of the three polioviruses and enhanced the response to poliovirus type 1.

Adult↗
PubMedDate not supplied

[Differences in the use of family planning methods by adolescent females according to the education model utilized during pregnancy. Monterrey, Mexico].

BACKGROUND: The objective was to compare the use of family planning methods during the immediate postpartum period and two years following childbirth among the adolescent females who had followed two different intervention programs during their pregnancies. METHODS: A quasi-experimental study was designed. A total of 62 pregnant adolescents were selected to comprised two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95% confidence intervals estimated. RESULTS: The average starting knowledge in the MCS groups was 69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI 86.24-93.17), while the starting knowledge for the PRECEDE group was 49.39 points (95% Cl 42.24-56.54) and ending 75.25 points (95% CI 71.12-79.38). IN the immediate postpartum, 93% (95% CI 83.5-100) of the adolescents in the PRECED group accepted the use of a family planning method similar to that employed by the MCS group, of 94.2 (95% CI 86.3-100). As regards the continued use of the method, that is, two years later, the PRECEDE strategy had a greater effect that the MCS strategy, respectively 92% (95% Cl 82-100) and 72% (95% CI 56.9-87.1). CONCLUSIONS: A difference was found to exist between models as regards the use of family planning methods 2 years following childbirth. The PRECEDE program is proposed as the education strategy for preventing a second pregnancy among adolescent females.

Adolescent↗
PubMed1997

Postpartum contraception: the lactational amenorrhea method.

Breastfeeding still accounts for a significant proportion of all fertility reduction, the average birth interval being longer among populations that breastfeed. However, per se it is not reliable for individual fertility suppression. The lactational amenorrhea method (LAM) is a highly efficient tool for the individual woman to utilize physiology to space births. Suckling induces a reduction in gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone release, resulting in amenorrhea, through an intracerebral opioid pathway: beta-endorphins inhibit gonadotropin releasing hormone and dopamine secretions, which, in turn stimulates prolactin secretion and milk production. Reduced suckling precipitates the return of ovulation. During lactation, menses before 6 months are mostly anovulatory, and fertility remains low. The lactational amenorrhea method is based on three simultaneous conditions: (1) the baby is under 6 months; (2) the mother is still amenorrheic; and (3) she practises exclusive or quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM extended to 9-12 months are ongoing. We use a standardized algorithm to present LAM. The lactational amenorrhea method is a way both to space births and to support breastfeeding, which should be replaced by a contraceptive method in due course. A 'Breastfeeding-LAM-Family Planning' team is very helpful in maternity wards for promoting modern breastfeeding, LAM, and contraception, and for alleviating barriers and misconceptions. The lactational amenorrhea method is at least 98% effective, comparing favorably with other contraceptive methods. Acceptability and continuity are not very well known; as with other 'natural' methods the figures are probably low in a general population but high for motivated couples. The lactational amenorrhea method avoids double protection, and thus saves resources, is especially (but not exclusively) suitable for couples interested in natural family planning and is accepted by religious authorities. The lactational amenorrhea method gives time to decide upon a long-term method of contraception. Unwanted pregnancies, although infrequent, conceived while using LAM result in very short, high-risk birth intervals. Introduction of LAM in family planning programs demands training, attention to be given to working mothers, positive attitudes of health personnel, close links between postpartum and family planning teams, situation analysis, budgets, evaluations, follow-up activities, modifications of record keeping systems and computing programs, and of national family planning guidelines. In conclusion, LAM is an efficient family planning method which should be promoted. The lactational amenorrhea method should always include the shift to another method when its criteria are no longer implemented.

Algorithms↗
PubMedDate not supplied

CenteringPregnancy: a new approach in prenatal care.

CenteringPregnancy is an innovative model of prenatal care that emphasizes risk assessment, education, and support within a group setting. Created by a nurse midwife and encompassing a midwifery focus on women's health, the CenteringPregnancy program allows prenatal care providers and the women they serve to accomplish care goals by allowing more than 20 hours of contact time throughout pregnancy and early postpartum. Amid new studies revealing traditional prenatal care's lack of effectiveness in reducing low birthweight and calls from public health sectors for more comprehensive prenatal care programs, the CenteringPregnancy model is one new approach in response to these challenges.

Comprehensive Health Care↗
PubMed1987

Effects of sixty-day milk yield on postpartum breeding performance in holstein cows.

The relationship between breeding performance and postpartum milk yield was evaluated using data collected in a prospective field project from 33 New York Holstein herds. Herds selected were enrolled in the New York Dairy Herd Improvement Cooperative program and received monthly or biweekly herd health visits from the New York State College of Veterinary Medicine. Factors other than milk yield (e.g., postpartum reproductive disorders, inseminator, housing) that influence breeding performance were controlled in multiple regression analyses. Milk yield had a slight linear antagonistic relationship with conception at first service, services per conception, and days open but not with interval from parturition to first service, interval between first and second services, or interval between second and third services. Services per conception and days open increased by .009 and .6, respectively, for each 100-kg increase in cumulative milk yield during the first 60 d of lactation. Postpartum reproductive disorders, service method (artificial vs. natural), inseminator (farmer vs. technician), and calving interval of the previous lactation had more important relationships than milk yield with measures of breeding performance.

Animals↗
PubMed2005

Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum.

STUDY DESIGN: A randomized assessor-blinded clinical trial was conducted. OBJECTIVE: To compare 3 different physical therapy treatments with respect to pain and activity in women with pelvic girdle pain during pregnancy and 3, 6, and 12 months postpartum. SUMMARY OF BACKGROUND DATA: In spite of the high prevalence of back pain during pregnancy, documented treatment programs are limited. METHODS: Based on a clinical examination, 118 women with pelvic girdle pain diagnosed during pregnancy were randomized into 3 different treatment groups: Information Group, use of a nonelastic sacroiliac belt and oral/written information about pelvic girdle pain (n = 40); Home Exercise Group, same as in the Information Group, with the addition of a home exercise program (n = 41); and the In Clinic Exercise Group, same as in the Information Group, plus participation in a training program (n = 37). Pain intensity was rated on a visual analogue scale (0-100 mm) and marked on a pain drawing concerning localization. The activity ability was scored using the Disability Rating Index, covering 12 daily activity items. Outcome measures were obtained at inclusion, on average in gestation week 38, and 3, 6, and 12 months postpartum. RESULTS: There was no significant difference among the 3 groups during pregnancy or at the follow-ups postpartum regarding pain and activity. In all groups, pain decreased and the activity ability increased between gestation week 38 and at 12 months postpartum. CONCLUSIONS: Women with pelvic girdle pain seemed to improve with time in all 3 treatment groups. Neitherhome nor in clinic exercises had any additional value above giving a nonelastic sacroiliac belt and information.

Exercise Therapy↗
PubMed1984

Haiti seminar discusses voluntary sterilization.

Devising strategies to meet the growing demand for voluntary sterilization in Haiti was a major topic of discussion during a week-long seminar November 28-December 2 organized by the Division of Family Hygiene (DHF) of the Haitian Department of Public Health and Population. More than 30 physicians trained in laparoscopy and minilap who provide services through the DHF program met to summarize progress and discuss problems of the program to date, review technical aspects of female sterilization, introduce technical aspects of vasectomy, and set goals for 1984. FHI provided 2 consultant-speakers for the seminar, Dr. Lise Fortier, medical director of Planned Parenthood of Los Angeles, and Dr. Liliane Toumi, consultant for training in male and female sterilization. The DHF has given high priority to its voluntary sterilization program, which has recorded a slow but steady increase in the number of individuals sterilized since its beginning in 1979. Postpartum minilaps account for the highest percentage of procedures (69%) of cases reported to the DHF in the 1st 1/2 of 1983), with most of the remainder consisting of laparoscopy. In 1983, there was also an increasing emphasis on vasectomy, accounting for 5% of all cases reported in the 1st 6 months. 3 physicians attending the seminar had just returned from Sao Paulo, Brazil, where they were trained in vasectomy by Dr. Marcos de Castro. An additional 3 are scheduled for training in Sao Paulo early this year. These 6 physicians will form the basis of an in-country vasectomy training program for their colleagues. Data from an ongoing FHI Maternity Care Monitoring pilot project at Hopital Universitaire de l'Etat d'Haiti support the observation of physicians at that center that 65%-70% of potential candidates for sterilization there are not sterilized. Discussion at the seminar identified the following possible reasons for the unmet need for sterilization: requirements for laboratory tests, lack of space for procedures and recovery, irregular supplies, and need for better patient education and motivation during the prenatal period. 1 suggestion to increase the access of rural populations outside of Port-au-Prince was to offer sterilization services through mobile clinics operating out of health centers around the country. FHI is continuing its assistance to the DHF program by helping to establish reporting and to maintain data on sterilizations performed throughout Haiti. Initially, the Division will use FHI female sterilization and male sterilization patient summary forms for monitoring cases in the 6 centers doing a large proportion of the procedures. The consensus of those attending the seminar was that a strong voluntary sterilization program is of the utmost importance in meeting Haiti's family planning needs.

Americas↗
PubMed2002

Association between smoking during pregnancy and breastfeeding at about 2 weeks of age.

Maternal smoking during pregnancy may decrease breastfeeding, in part perhaps by decreasing milk supply; furthermore, prenatal smoking is a predictor of postpartum smoking. In this study, birth certificate data, including maternal smoking, for 1998 Oregon resident live births were linked to newborn screening data obtained from Oregon's Newborn Screening Program (NSP), allowing study of risk factors for failure to breastfeed. NSP collects information on infant feeding before newborn discharge and again at about 2 weeks postpartum. Feeding data and risk factor data were available after a probability match of the newborn screening and birth certificate data sets, respectively, for 36,324 (80.3%) of the 45,228 resident live births. Prenatal maternal tobacco use was significantly associated with failure to exclusively breastfeed at about 2 weeks of age (adjusted odds ratio = 2.08, 95% confidence interval = 1.94, 2.21). Women who smoked during pregnancy were less likely to breastfeed than women who did not smoke during pregnancy.

Adult↗
PubMed2005

Adolescent motherhood and postpartum depression.

Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation and role restriction), maternal competence, weight/shape concerns, and depression. The sample was quite diverse, and no ethnic differences in base rate levels of the variables were detected. Regression analyses indicated that social isolation, maternal competence, and weight/shape concerns predicted unique variance associated with depression level. The findings are discussed in light of future work and the continued need to inform prevention and treatment programs for young mothers.

Adolescent↗
PubMed2006

Correlates of first-time mothers' postpartum stress.

The purpose of this study was to examine first-time mothers' postpartum stress and its correlates following discharge from the hospital or clinic after vaginal delivery. One hundred and eighty-three first-time mothers were enrolled from hospitals and clinics in Kaohsiung City. All first-time mothers reported normal pregnancies and vaginal deliveries, delivered healthy infants at term, and were surveyed during their postpartum periods after discharge from hospitals or clinics. The Hung Postpartum Stress Scale was used to examine first-time mothers' postpartum stress and stressors during their postpartum periods. The top ten postpartum stressors perceived by the women were: "the baby getting sick suddenly", "the flabby flesh of my belly", "the unpredictability of the baby's schedule", "interrupted sleep", "the shape of the baby's head due to the sleeping position", "not sleeping enough", "lack of information regarding infant's growth and development", "the baby's crying", "my life is restricted", and "the baby choking during feeding". There were no significant differences between the first-time mothers' demographic characteristics and their postpartum stress and its three components (negative body changes, maternal role attainment, lack of social support), respectively. Insight into the study results of first-time mothers' postpartum stress and stressors provides a reference for health professionals that the development of programs and resources addressing primiparous women's unique needs are required.

Adult↗
PubMed1993

Postpartum tubal sterilisation: an international perspective on some programmatic issues.

The demand for postpartum sterilisation (performed within 42 days after delivery), is increasing both in developed and developing countries. The incidence of regret after postpartum sterilisation is important, but it could be minimised by carefully screening risk factors. Using trained paramedical personnel to perform postpartum sterilisation via minilaparotomy where physicians are in short supply appears to be safe and acceptable, under close medical supervision. Including postpartum sterilisation information in the antenatal counselling services effectively strengthens postpartum services and simultaneously helps to minimise subsequent regret.

Cross-Cultural Comparison↗