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PubMed2006

Patient satisfaction with 3 methods of postpartum contraceptive counseling: a randomized, prospective trial.

OBJECTIVE: To compare patient satisfaction with 3 different postpartum contraceptive counseling methods. STUDY DESIGN: Randomized, prospective trial in an urban medical center. Patients were randomized to receive physician-patient counseling, written literature or an educational video. The main outcome variable was patient satisfaction with the contraceptive teaching method. Patient satisfaction was analyzed as a categorical variable and compared with chi2 tests. Secondary outcomes were compared with chi2 tests and ANOVA. RESULTS: Greater than 90% of patients in each arm were satisfied with the contraceptive counseling that they received. Patients receiving physician-patient counseling expressed a 99% satisfaction rate (p = 0.044). African American (98.2%) and Hispanic (93.5%) patients were more satisfied than Caucasian (83.3%) patients (p = 0.026). Satisfaction with contraceptive counseling decreased with age. CONCLUSION: An organized program of contraceptive counseling provides adequate information for patients to be comfortable with their decision about their postpartum contraceptive method. Patients were most satisfied with physician counseling.

Adolescent↗
PubMed1999

Obsessions and compulsions in women with postpartum depression.

OBJECTIVE: The quantity, content, and intensity of the obsessions and compulsions of women with postpartum onset major depressive disorder were compared with those of women with major depressive disorder with non-postpartum onset. METHOD: Sequential cases of women with postpartum onset major depression (N = 37) and major depression (N = 28) who presented to our Women's Mood Disorders program were included. Psychiatric examination using DSM-IV criteria and the Inventory to Diagnose Depression established the diagnosis of major depression. Obsessive thoughts and compulsions were reported on the Yale-Brown Obsessive Compulsive Scale and reviewed during the psychiatric examination. Comparisons between groups were performed with chi-square statistics, Fisher exact test and its extensions, and Mann-Whitney U test. RESULTS: Although more women with postpartum onset major depression (N = 21, 57%) than major depression (N = 10, 36%) reported obsessional thoughts, the difference between the groups was not significant (p = .13). However, for women who endorsed obsessions, those with postpartum onset had a higher median number (median = 7) than women without postpartum onset (median = 2, p = .00). Most of the difference in frequency of thoughts was owing to more women with postpartum onset major depression having aggressive thoughts (N = 20, 95%) than women with major depression (N = 6, 60%, Fisher exact p = .03). The most frequent content of the aggressive thoughts for women with postpartum onset major depression was causing harm to their newborns or infants. The presence or number of obsessional thoughts or compulsions was not related to severity of the depressive episode. CONCLUSION: Childbearing-aged women commonly experience obsessional thoughts or compulsions in the context of major depressive episodes. Women with postpartum onset major depression experience disturbing aggressive obsessional thoughts more frequently than women with non-postpartum major depression.

Adolescent↗
PubMed2005

Assisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties.

OBJECTIVE: To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. DESIGN: Systematic audit of consecutive medical records. SETTING: Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia. PATIENT(S): Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birth weight, and Edinburgh Postnatal Depression Scale scores. RESULT(S): A total of 745 records were audited, and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45/745) of the admitted infants had been conceived through assisted reproductive technologies compared with 1.52% in the general population (relative risk 4.0; 95% confidence interval, 3.0-5.4). Mothers who had conceived with assisted reproductive technologies were older and more likely to have had cesarean and multiple births than those who conceived spontaneously. CONCLUSIONS: Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support before and after their babies are born.

Adult↗
PubMedDate not supplied

Evaluation of substance use outcomes in demonstration projects for pregnant and postpartum women and their infants: findings from a quasi-experiment.

We evaluated the impact of nine community-based drug prevention, education, and treatment projects for pregnant and postpartum women using a quasi-experimental design. Projects provided case management and referral to services or provided day treatment. Self-reported measures of six substances were collected (a) from intake to delivery and (b) delivery to 6 months postpartum. We hypothesized that women who received project services (n = 370) between intake and follow-ups would be more likely to deter or reduce substance use than women who received an alternative or no intervention (n = 288). Data showed that project clients had significantly lower 30-day use rates on four of the measures-alcohol, any illicit drug(s), marijuana, and crack-from intake to delivery, with preintervention alcohol and other drugs use controlled. However, none of these results was maintained from intake through 6 months postpartum. Findings are discussed in terms of the difficulty of detecting and documenting promising intervention program effects over time in this population.

Adult↗
PubMed2003

Characteristics of teenage mothers and predictors of breastfeeding initiation in the Michigan WIC Program in 1995. Women, Infants, and Children.

Although breast milk is recommended as the optimal source of infant nutrition, breastfeeding initiation is below recommended levels, especially among teenage mothers. Breastfeeding initiation rates among Michigan (US) teenage mothers (12-19 y) were compared by demographics and health behaviors. Multivariate analyses determined which factors were significant independent predictors of breastfeeding initiation among teenage mothers enrolled prenatally in the Michigan Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in 1995. Significant predictors independently associated with breastfeeding initiation were race/ethnicity, education, marital status, postpartum anemia status, parity, prenatal trimester of WIC enrollment, and smoking. The strongest predictor of breastfeeding initiation differed for white mothers (positive predictor: education beyond high school [OR = 3.13]) and black mothers (negative predictor: multiparous [OR = 0.25]). Initiation rates for this population of teenage mothers fall below the national average for mothers of all ages and the US Healthy People 2010 goals. Research is needed concerning how breastfeeding support and education can be improved to reach the US national health goals.

Adolescent↗
PubMed2005

The effect of synchronization on genetic parameters of reproductive traits in dairy cattle.

Genetic evaluation and selection is one strategy for improving female reproductive performance. Many producers use synchronization of ovulation or estrus to manage reproduction. The objective of this study was to examine the effects of reproductive synchronization on genetic parameter estimates of days to first breeding (DFB), days open (DO), and pregnancy rate at 120 d postpartum (PR120). Data were collected from 64 producers participating in an artificial insemination progeny testing program and using Dairy Comp 305 herd management software to record reproductive treatments and events. Data included 18,359 records for DFB and 16,379 records for DO and PR120. Synchronization was classified by breeding codes at time of insemination. The traits DFB and DO were analyzed using a linear model with age at calving, herd-year-season, and parity as fixed effects and sire and residual as random effects. For PR120, a threshold sire model was used with fixed effects as in the DFB and DO models. Three models were applied to the complete data sets of all traits; a base model with no synchronization effect, an expanded model with a fixed synchronization effect, and an interaction model with a random sire by herd management interaction. Herd management categories were based on an individual herd's use of synchronization protocols. Also, data subsets were analyzed separately based on cow synchronization treatment and herd management categories. Synchronized records for DFB had on average 40% higher sire variance and 60% lower residual variance than nonsynchronized records. Heritability for DFB ranged from 0.01 to 0.09. Sire variance was 40% lower for DO and 25% lower for PR120 in first synchronized records than either later-synchronized or nonsynchronized records. Residual variances for DO varied by 3% among cow treatment categories and 14% for herd management categories. Heritabilities ranged from 0.03 to 0.07 for DO and 0.10 to 0.26 for PR120. Including a fixed effect for synchronization in the DO model reduced sire variance by 33% and residual variance by 10%. Sire by herd management interactions were less than 2% of the total variance for all traits. Accounting for synchronization, especially for DFB, may improve accuracy of genetic parameter estimates and animal evaluations.

Analysis of Variance↗
PubMed2000

Maternal depressive symptoms affect infant cognitive development in Barbados.

This longitudinal study is part of a series examining the relationships between maternal mood, feeding practices, and infant growth and development during the first 6 months of life in 226 well-nourished mother-infant dyads in Barbados. In this report, we assessed maternal moods (General Adjustment and Morale Scale and Zung Depression and Anxiety Scales), feeding practices (scales describing breast-feeding and other practices associated with infant feeding in this setting), and infant cognitive development (Griffiths Mental Development Scales). Multivariate analyses, with and without controlling for background variables, established significant relationships between maternal moods and infant cognitive development. Infants of mothers with mild moderate depression had lower Griffiths scores than infants of mothers without depression. Maternal depressive symptoms and lack of trust at 7 weeks predicted lower infant social and performance scores at 3 months. Maternal moods at 6 months were associated with lower scores in motor development at the same age. Although no independent relationships emerged between feeding practices and infant cognitive development, the combination of diminished infant feeding intensity and maternal depression predicted delays in infant social development. These findings demonstrate the need to carefully monitor maternal moods during the postpartum period, in order to maximize the benefits of breast-feeding and related health programs to infant cognitive development.

Adult↗
PubMed2002

Challenges of the working breastfeeding mother. Workplace solutions.

1. The number of women who breastfeed their infants after returning to work is disappointingly low. Many women stop breastfeeding soon after they return to work because of lack of preparation and support. 2. Continued breastfeeding provides health and psychosocial benefits for both mother and infant. 3. The employer experiences a cost saving benefit by keeping the postpartum employee working and by keeping her infant healthy as a result of breastfeeding. 4. Occupational and environmental health nurses can help bridge the gap between the postpartum employee and her primary health care provider. One strategy is to develop a lactation program for the work setting as described in a stepwise approach.

Breast Feeding↗
PubMed2004

How can more smoking suspension during pregnancy become lifelong abstinence? Lessons learned about predictors, interventions, and gaps in our accumulated knowledge.

UNLABELLED: Maintenance of abstinence from cigarettes during pregnancy yields important benefits for both women and children, yet only 20%-30% of pregnancy cessation lasts 1 year postpartum. This paper reviews accumulated knowledge about factors that influence restarting smoking and the effectiveness of interventions to decrease it. Evidence from six trials and six multivariate predictor studies is provided, supplemented by qualitative and more focused quantitative studies. Studies were international, with diverse candidate predictors, intensity and timing of interventions, theory, designs, and measures of quitting and of maintenance postpartum. RECOMMENDATIONS: (a). Partner smoking must be addressed in interventions with cessation messages. (b). Intervention studies should include women of lower socioeconomic status and Black women. (c). Program developers and researchers should adopt a consistent standard for cessation. (d). Communication laboratory methods should test ways to increase intrinsic reasons for abstinence and success attributions to stable, internal causes. (e). Staging for postpartum smoking should supplant relapse prevention alone. (f). Among those whose intention it is to maintain nonsmoking postpartum, standard relapse prevention treatment is insufficient to combat environmental cues that also have been suspended for the pregnancy and typical problems of sleeplessness, stress, depression, and weight concern. (g). Interventions ideally should begin in late pregnancy, when postpartum smoking goals can be revised and plans made to manage postpartum issues. (h). Innovative methods for reducing postpartum problems should be tested. (i). Study of incentives for pregnancy cessation should include varying patterns, carryover to early postpartum months, and focus on their impact on long-term change.

Adult↗
PubMed2000

Using complete breastfeeding and lactational amenorrhoea as birth spacing methods.

The aim of this study was to evaluate the effectiveness of lactational amenorrhoea and to determine the relationship between extended breastfeeding and the return of fertility. Breastfeeding pattern, basal body temperature, cervical mucus, salivary ferning, vaginal blood discharge, frequency of sexual intercourse, and the presence of ovulation in the first cycle after the resumption of menses with ultrasonography were evaluated in 40 women. All subjects completed the study with only one case of incomplete breastfeeding. No pregnancies were observed. The mean number of feeding sessions and mean interval between sessions decreased significantly (p <0.01) during the first six months postpartum (7.5 +/- 1.3 after 60 days postpartum vs. 5.7 +/- 2.1 after 180 days, and 3.6 +/- 0.8 vs. 5.1 +/- 0.9, respectively). Eight women (20%) menstruated before weaning, but none had an adequate thermal shift, while 32 (80%) had their first vaginal bleeding after weaning with 12 (37.5%) registering an adequate thermal shift. Both basal body temperature and salivary ferning proved to be suggestive of ovarian activity, while mucus characteristics were not reliable in identifying fertile periods. Our study showed that breastfeeding associated with lactational amenorrhoea proved to be a good method of postpartum fertility control. Since the importance of supplementation is still debated, it is recommended that a "complete" breastfeeding program be used.

Adult↗
PubMed2005

Evaluating programs to prevent mother-to-child HIV transmission in two large Bangkok hospitals, 1999-2001.

The 2 largest maternity hospitals in Bangkok implemented comprehensive programs to prevent mother-to-child HIV transmission in 1998. We conducted a cross-sectional survey of post-partum HIV-infected women in 1999 through 2001 to evaluate these programs. Women were given structured interviews at 0 to 3 days, 1 month, and 2 months postpartum. Medical records of women and their newborns were reviewed. Of 488 enrolled women, 443 (91%) had antenatal care: 391 (88%) at study hospitals and 52 (12%) elsewhere. The HIV diagnosis was first known before pregnancy for 61 (13%) women, during pregnancy for 357 (73%) women, during labor for 22 (5%) women, and shortly after delivery for 48 (10%) women. Antenatal zidovudine (ZDV) was used by 347 (71%) women, and intrapartum ZDV was used by 372 (76%) women. Twelve (55%) of the 22 women who first learned of their HIV infection during labor took intrapartum ZDV. All 495 newborn infants started prophylactic ZDV; the first dose was given within 12 hours for 491 (99%) children. Ten (2%) children were breast-fed at least once by their mother, and 10 (2%) were breast-fed at least once by someone else. Although uptake of services was high, inconsistent antenatal care, fear of stigmatization, and difficulty in disclosing HIV status prevented some women from using services.

Anti-HIV Agents↗
PubMed1991

Does infant feeding method influence maternal postpartum weight loss?

We conducted a retrospective study of 411 women to determine whether a significant relationship existed between method of infant feeding (breast vs bottle) and postpartum weight loss at 6 weeks and 12 months. In addition to method of infant feeding, the variables parity, gravidity, mode of delivery, maternal age, maternal prepregnancy weight, infant sex, and payment status (whether receiving assistance from the Aid to Dependent Children [ADC] program) were studied in terms of their association with weight loss. In general, no consistent relationship was found between method of infant feeding and postpartum weight loss. However, in the ADC group at 6 weeks and in the non-ADC group at 12 months, nonlactating women had lost more weight than had their lactating counterparts, in spite of the theoretical energy deficiency of breast-feeding women. Women who gained more weight during pregnancy consistently lost more weight following delivery, regardless of their prepregnancy weight. These results indicate that infant feeding method was not related to differences in postpartum weight loss between lactating and nonlactating counterparts.

Adolescent↗
PubMedDate not supplied

Evaluation of a smoking cessation program for pregnant minority women.

The purpose of this project was to develop and test culturally appropriate, low literacy, smoking cessation intervention materials designed to increase quit rates and prevent relapse postpartum for low-income African American and Hispanic women. A quasi-experimental, pretest-posttest design was used. Four Women, Infants, and Children (WIC) clinic sites in south and central Los Angeles were identified, pair-matched based on ethnic mix, and randomized to intervention (2 sites) or control status (2 sites). Participants were 18 years of age or older and either current or exsmokers (stopped smoking in the past year). The intervention group received the "Time for a Change: A Program for Healthy Moms and Babies" program including a 15-minute one-to-one counseling session and self-help guide, incorporating behavior-change strategies, booster postcard, and incentive contest. All materials were designed to match the cultural, language, and literacy needs of the target population. The smoking cessation intervention had a positive impact on both quit-smoking behavior during pregnancy and relapse prevention postpartum. Almost twice as many smokers in the intervention group (43%) reported quitting smoking at 9 months, compared to the control group (25%) (P < 0.01). At 6 weeks postpartum, 25% of the intervention baseline smokers were abstinent, compared to 12% of the control group (P < 0.01). Although no significant differences were observed for relapse during pregnancy among exsmokers at 6 weeks postpartum, a significantly higher proportion of intervention exsmokers were still abstinent (79%), compared to control exsmokers (62%) (P < 0.01). For the exsmokers, relapse prevention rates remained significant when adjusted for cotinine validated abstinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Designing a care pathway for a maternity support service program in a rural health department.

Today's heath care system in the United States faces many financial dilemmas related to the country's current economic status. Despite dwindling resources, the health care system must continue to provide high quality care to meet ever-increasing demands (Ferguson, 1993). Care pathways are an example of case management tools which provide care coordination. With an interdisciplinary approach, pathways increase communication and continuity of care between service disciplines, as well as improve efficient resource utilization. The purpose of this paper was to review: (1) the literature related to the benefits of using care pathways to enhance client care; (2) the benefits of public health nurse home visitation to pregnant and postpartum women; and (3) to describe the process to design a care pathway for the Maternity Support Service (MSS) program at a rural health department. This health department provides MSS to a county with a population of 65,000, with over 900 births per year. The county is 100 miles wide and 28 miles long. Thus, the MSS staff cover a large area, and needed a method to maximize efficient use of staff time. Care pathways have tremendous appeal because they accommodate interdisciplinary teams of care, focus on process, reduce unnecessary variation in care, and attend to quality and client outcomes.

Critical Pathways↗
PubMedDate not supplied

Effectiveness of a pregnancy smoking cessation program.

OBJECTIVE: To evaluate two nursing approaches to promoting smoking cessation during initial antenatal visits. DESIGN: Experimental, with assignment to interventions using a random, alternate-day strategy and blind assessment of smoking at baseline, 1 month postintervention, 36 weeks' gestation, and 6 weeks postpartum. SETTING/PARTICIPANTS: 224 daily smokers, fewer than 31 weeks gestation, during first prenatal visit, at a teaching hospital antenatal clinic. INTERVENTIONS: An evening class providing guidance on a self-help program for 2 hours on a group basis or 20 minutes on an individual basis during the prenatal appointment. MAIN OUTCOME MEASURE: Smoking cessation, confirmed by urinary cotinine levels. RESULTS: All women assigned to the referral intervention received a referral, but none attended the classes. In contrast, 93% assigned to the immediate intervention received the intervention. The group receiving immediate intervention had two to three times higher rates of cessation at all follow-up periods, with significant differences at the 1-month follow-up. There were certain similarities between the groups. CONCLUSION: Cessation interventions should be administered during the first prenatal visit.

Adult↗
PubMed1999

The effect of a peer counseling program on breastfeeding initiation and longevity in a low-income rural population.

Breastfeeding rates among low-income women in the east-south-central United States are among the lowest in the country. This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee. A postpartum survey and chart review were conducted with WIC clients at nine health departments. Response rate was 99% (291/293). Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group (n = 156) compared with women in the no-peer counselor group (n = 135) (53% vs. 33%, p < 0.001, and 26% vs. 13%, p = 0.006, respectively). Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding (OR = 2.43, 95% CI = 1.23-4.67) and to be breastfeeding at 6 weeks (OR = 2.78, 95% CI = 2.08-9.51), than those in the no-peer counselor group.

Adolescent↗
PubMed1994

The effect of a culture-specific education program to promote breastfeeding among Vietnamese women in Sydney.

The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam. To counteract this trend, a language and culture specific education program was developed. An experimental design was used to test the effectiveness of this program. The sample consisted of 182 prenatal Vietnamese women. Data collection included questionnaires and interviews. Results suggested that the education program had significant effects on knowledge, attitudes, planned and actual behaviour towards breastfeeding. However, the effect did not sustain until 6 months postpartum. Implications for nursing practice and further research are discussed.

Adult↗