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PubMed2003

PRISM (Program of Resources, Information and Support for Mothers) Protocol for a community-randomised trial [ISRCTN03464021].

BACKGROUND: In the year after birth one in six women has a depressive illness, and 30% are still depressed, or depressed again, when their child is 2 years old, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support overall, more negative life events, and poorer physical health. Their perceptions of factors contributing to depression are lack of support, isolation, exhaustion and physical health problems. Fewer than one in three affected women seek help in primary care despite frequent contacts. METHODS/DESIGN: PRISM aims to reduce depression and physical health problems of recent mothers through primary care strategies to increase practitioners' response to these issues, and through community-based strategies to develop broader family and community supports for recent mothers. Eligible local governments will be recruited and randomised to intervention or comparison arms, after stratification (urban/rural, size, birth numbers, extent of community activity), avoiding contiguous boundaries. Maternal depression and physical health will be measured six months after birth, in a one year cohort of mothers, in intervention and comparison communities. The sample size to detect a 20% relative reduction in depression, adjusting for cluster sampling, and estimating a population response fraction of 67% is 5740 x 2. Analysis of the physical and mental health outcomes, by intention to treat, will adjust for the correlated structure of the data.

Adult↗
PubMed1990

The forty-day rest period and infant feeding practices among Negev Bedouin Arab women in Israel.

Four hundred and twelve Bedouin Arab women were interviewed within 48 hours of delivering a newborn in 1982 and two months later to examine the effect of social support during the forty-day postpartum rest period on the incidence of exclusive breast feeding at two months. Whereas the distribution of infant feeding practices at two months did not differ among women with and without support during the "forty days," the number of days of help during the "forty days" was significantly associated with type of feeding at two months. The longer the duration of help, the greater were the odds of maintaining exclusive breast feeding after adjustment for covariates by multinomial logistic regression analysis. The association between duration of help and infant feeding practices at two months was modified by the interview month and the feeding practices of the respondents' primary social supports. More respondents with infants who reached two months of age in May and June were exclusively breast feeding than respondents with infants who reached two months in the hot, dry months of July and August. Also, respondents with sisters-in-law who breast fed alone or in combination with the bottle were feeding their infants in the same way after adjustment for covariates. Given the beneficial effects of breast feeding on infant health and development, these findings identify potential avenues of intervention for programs promoting breast feeding.

Bottle Feeding↗
PubMed2006

Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483].

BACKGROUND: Preventing excessive weight gain during pregnancy is potentially important in the prevention of overweight and obesity among women of childbearing age. However, few intervention studies aiming at weight management during pregnancy have been performed and most of these interventions were not as successful as expected. In this paper the design of the New Life(style) study is described as well as the content of the individually tailored intervention program, which focuses on controlling weight development during pregnancy. METHODS: The effectiveness of the New Life(style) intervention program versus usual care by midwives is evaluated in a randomised controlled trial. Women who expect their first child and visit one of the participating midwifery practices are included. The intervention is standardised in a protocol and executed by trained counsellors with the women who are randomised in the intervention group. During 5 sessions--at 18, 22, 30 and 36 weeks of pregnancy and at 8 weeks postpartum--individual weight gain is discussed in relation to weight gain guidelines for pregnant women of the American Institute of Medicine. Counsellors coach the women to maintain or optimise a healthy lifestyle, in a period of drastic physical and mental changes. Data is collected at 15, 25, 35 weeks of pregnancy and at 6, 26, and 52 weeks after delivery. Primary outcome measures are body weight, BMI, and skinfold thickness. Secondary outcome measures include physical activity, nutrition and blood levels of factors that are associated with energy homeostasis. DISCUSSION: Results of the current RCT will improve the knowledge of determinants of weight gain during pregnancy, weight retention after childbirth and of the effectiveness of the intervention program that is described. Caregivers and researchers in the field of health promotion are offered more insight in specific elements of the New Life(style) intervention program.

Counseling↗
PubMed1996

Use of health services by children who were identified during the postpartum period as being at high risk of child abuse or neglect.

OBJECTIVE: To examine the rates of hospitalizations of children identified as beingat high risk of maltreatment compared with a sociodemographically similar comparison group. DESIGN: retrospective study comparing a high-risk cohort with a sociodemographically matched comparison group at Yale-New Haven Hospital (New Haven, CT). PATIENTS: One huntred fourteen children who were identified from January 1979 through December 1981 by clinicians on the postpartum ward as being at high risk of abuse or neglect and 114 sociodemographically similar comparison children who were matched according to date of birth, race, gender, and method of payment for the hospitalization. MAIN OUTCOME MEASURER: During the first 4 years of life, the number of hospitalizations, reasons for admissions, and appropriateness of days in the hospital using the Pediatric Appropriateness Evaluation Protocol. RESULTS: Significantly more high-risk children wer hospitalized (40% vs 22%; risk ratio 1.84; 95% confidence interval, 1.23-2.74). High-risk children were hospitalized for 649 (mean, 9.0) days versus 124 (mean, 3.8) days in comparison children. For admissions for medical problems, 28% of hospital days in the high-risk group were considered inappropriate by the Pediatric Appropriateness Evaluation Protocol versus 8% in the comparison group. CONCLUSIONS: There are substantial differences in the rates of hospitalizations, lengths of stay, and appropriateness of days in children identified as being at hish risk of maltreatment compared with a sociodemographically similar, non-high-risk group. Preventive programs that are aimed at reducing rates of child maltreatment in high-risk young children also should examine the program's effects on the use of hospital care.

Adult↗
PubMed1977

Breastfeeding and abstinence among the Yoruba.

Contemporary patterns of breastfeeding and postpartum abstinence among the Yoruba of Nigera are examined. Quite extensive periods of postpartum abstinence are still observed by most rural and poorer urban women to prolong breastfeeding and increase child survivorship. Differentials in duration of breastfeeding and abstinence relate to both socioeconomic factors and age, suggesting the likelihood of large future reductions. Implications for family planning prospects and policies are noted.

Adolescent↗
PubMedDate not supplied

Retrospective study of the association of stress and smoking during pregnancy in rural women.

Women who continue to smoke during pregnancy put themselves and their fetuses at serious risk for complications. Various smoking cessation programs have been designed that specifically target pregnant smokers. Longitudinal studies, however, have shown that there is a group of women who are unable to quit smoking while pregnant. Women from a rural area of the Mid-West (N=299) were interviewed postpartum to determine the stresses these women experienced prenatally and the association of the stress with continuing to smoke during pregnancy. Subjects were divided into three groups: Nonsmokers, Quitters, Smokers. This study not only confirms other reports that these women are more stressed but also documents some of the major stressors. Statistically significant differences were found between groups for financial worries (P=.0002), problems with the family (P<.001), and domestic violence (P<.001). Assessing pregnant women for stress and, especially, domestic violence should be part of the implementation of the Clinical Practice Guidelines for Smoking Cessation.

Adolescent↗
PubMed2001

[Initiation and duration of breastfeeding in obstetrical hospitals of Aix-Chambery (France)].

UNLABELLED: Our objectives were to estimate duration of breastfeeding and to identify factors associated with initiation and weaning. METHODS: A prospective study was carried out among 353 mothers delivering in three obstetric hospitals at Aix-Chambery (Savoie, France). Breastfeeding was considered as survival data with censored observations. Univariate and multivariate analyses were performed. RESULTS: Breastfeeding was initiated by 70.8% (66.1-75.5) (exclusive breastfeeding = 39.9% and complementary breastfeeding = 30.9%). Respectively, 58.1% (52.9-63.3) and 12.2% (8.3-16.1) were continuing some breastfeeding at one and six months. The median duration of breastfeeding was 13 weeks (11.6-14.4). Shorter duration was associated with contact beyond one hour from birth (adjusted Hazard Ratio [aHR] = 1.25 [1.03-1.52] and with contact beyond eight hours aHR = 1.78 [1.66-1.92]), pacifier use (aHR = 1.72 [1.19-2.47]), breastfeeding at fixed hours (aHR = 1.78 [1.29-2.45]), and decision to breastfeed during pregnancy or the postpartum period (aHR = 1.70 [1.45-2.00]). CONCLUSION: Breastfeeding initiation and duration were higher in maternity hospitals of Chambéry than estimations measured in the 1998 French perinatal survey and in other ad hoc surveys. Identified factors should be used in order to plan future programs designed to increase duration of breastfeeding.

Adult↗
PubMed1997

[Use of tubal sterilization by minilaparotomy after vaginal delivery in a developing country. A retrospective analysis of 347 cases at the Yaoundé University Gynecologic Clinic (Cameroon)].

The authors report the results of a retrospective study of 347 cases of tubal ligation collected between January 1985 and December 1991 in the maternity unit of the Yaoundé teaching hospital group. The tubal ligations were performed through minilaparotomy with local anesthesia using the method of Pomeroy. The frequency of tubal ligation evaluated by 3.8 per cent did not change during the period of this study. The authors note that the majority of patients in this study asked for a tubal ligation only when they had 5 or more surviving children. The authors conclude that because of poorly equiped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted by the contraceptive methods in family planning programs.

Adult↗
PubMed1995

Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program.

OBJECTIVE: To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women. DESIGN: Women who expressed a willingness to participate in the breast-feeding educational program were randomly assigned to one of two groups: an intervention group and a control group who received usual breast-feeding education. SETTING: Clinics of the Special Supplemental Food Program for Women, Infants, and Children in Flagstaff, Ariz. SUBJECTS: Sixty-eight primiparous pregnant women with expected due dates between May 1992 and December 1992 were willing to participate in the study. Of these, 34 were randomly assigned to the intervention group and 34 to the control group. Approximately 81% of the women completed the study: 29 in the control group and 26 in the intervention group. INTERVENTION: The intervention consisted of special incentives (prizes) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth. Women were also encouraged to use a breast-feeding support program in which peers serve as role models. MAIN OUTCOME MEASURES: The primary outcome measure was infant feeding method. Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks, 6 weeks, and 3 months postpartum. STATISTICAL ANALYSES PERFORMED: Binomial proportional analyses of the feeding data were performed. RESULTS: Women in the intervention group reported a higher percentage of breast-feeding at all measurement times. APPLICATIONS: These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.

Adolescent↗
PubMedDate not supplied

Against the odds: breastfeeding experiences of low income mothers.

This qualitative study asked low income mothers about their experiences of breastfeeding care in the health system and about integrating breastfeeding into their daily lives. Focus group interviews were conducted with urban and rural nursing mothers who participated in the WIC Program and were supported by breastfeeding peer counselors. Mothers said that helpful breastfeeding care providers knew correct information, established supportive personal relationships, referred women to breastfeeding specialists for problems, showed enthusiasm for nursing, and facilitated breastfeeding through concrete actions during the prenatal, intrapartum, and postpartum periods. Unhelpful providers missed opportunities to discuss breastfeeding, gave misinformation, encouraged formula supplementation, provided perfunctory or routine breastfeeding care, and were hard to contact when problems arose. Women valued their breastfeeding peer counselors for responding promptly to distress calls, making home visits, being knowledgeable about breastfeeding, providing hands-on assistance, and acting personal and caring. Incorporating breastfeeding into daily activities was a challenge for many mothers. Ambivalence about the physical bond of nursing, personal modesty, and getting on with life at home, work, or school were identified as important issues. Listening to the thoughts and experiences of low income nursing mothers can help health workers to provide more culturally sensitive, effective breastfeeding care to this population.

Adolescent↗
PubMed2002

Health promotion for childbearing women in Rubanda, Uganda.

A train-the-trainer intervention, based on the World Health Organization's Safe Motherhood Initiative, was successful in changing some health beliefs and health practices among village men and women of childbearing age in a remote area of Uganda. Specifically, more villagers reported attending postpartum care and beginning prenatal care earlier in pregnancy. Some beliefs were not changed (eg, belief in bewitchment), but some beliefs (eg, use of herbal medicines during labor) were not as widely held as a result of this cost-effective and easily sustainable program.

Adult↗
PubMed1998

[Omphalocele and gastroschisis in Tirol-incidence and epidemiology 1985-1996].

There are basic differences between the Dutch and the Austrian systems of prenatal care, care during birth and postpartum care: whereas in the Netherlands every effort is made to keep care within the bounds of the eerste lijn - primary health care with midwives and general practitioners as primary providers - in Austria the federal 'family relief fund' and the 'mother and child passport' program have created an elaborate system in which care during pregnancy is not only free but providing antenatal care brings extra payments to the doctor and taking it brings extra money to the pregnant woman. The workings of both systems and the roles of midwives, doctors, hospitals and health insurers are explained and discussed.

Adolescent↗
PubMed1983

Influence of buffering early lactation rations with sodium bicarbonate and magnesium oxide and subsequent withdrawal or addition effects.

Eighty animals (16 first lactation) were assigned alternately at calving to one of four treatments: A) corn silage, B) corn silage + 1.5% sodium bicarbonate and .5% magnesium oxide in the grain mix, C) 50% hay crop silage and 50% corn silage, and D) 50% hay crop silage and corn silage plus 1.5% sodium bicarbonate and .5% magnesium oxide. All rations contained 50% forage and 50% concentrate (dry) fed as a total mixed ration. During the first 8 wk of lactation no differences were detected in mean performance or in weekly patterns for forage programs alone or buffer treatments alone on average daily intake of dry matter, body weight loss, milk yield, or composition. Addition of buffers to hay crop silage and corn silage rations resulted in a milk yield profile with a smaller increase beyond wk 3 postpartum. Cows fed all corn silage rations yielded more milk on the average than cows on hay crop silage and corn silage, regardless of buffer treatments. From wk 9 through 12 of lactation, buffers either were added or withdrawn. Addition or withdrawal of buffers did not alter significantly patterns of milk yield or composition.

Animals↗
PubMedDate not supplied

A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: an examination of breastfeeding rates, maternal confidence and utilization and costs of health services.

OBJECTIVES: To determine whether the outcomes of routine home visiting by public health nurses (PHN) after early obstetrical discharge differ from those of a screening telephone call designed to identify mothers who need further intervention. METHODS: Primiparas delivering a singleton infant and eligible for postpartum follow-up were randomized to a home visit or screening telephone call. Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario. Outcomes included maternal confidence at two weeks, health problems of the infants between discharge and four weeks postpartum, breastfeeding rates at six months and costs of the two models. RESULTS: Differences between the samples at the two sites necessitated stratified analyses. No differences were detected between the groups in maternal confidence (p = 0.96), health problems of infants (p = 0.87), or rates of breastfeeding at six months (p = 0.22). However, at both sites the cost of routine home visits was found to be higher than that of screening by telephone. CONCLUSION: Although universal access to postpartum support is important, the results suggest that a routine home visit is not always necessary to identify the women who need it. These results can be generalized only to low-risk women and infants.

Adult↗
PubMed1991

Breast-feeding among women attending women, infants, and children clinics in Georgia, 1987.

Breast-feeding is an important determinant of the health and nutritional status of children, particularly in lower socioeconomic populations. A major goal of the Georgia Special Supplemental Food Program for Women, Infants, and Children (WIC) is to increase the practice of breast-feeding among the women it serves. Breast-feeding practices were determined among a random sample of 404 women from a cohort of 2010 who attended WIC prenatal clinics in Georgia in 1986 and were expected to deliver in February 1987. Respondents were interviewed 6 months postpartum. Of these women, 24% initially breast-fed, but only 6% continued for 6 months or longer. The initiation of breast-feeding was associated with greater maternal education and with being married. The adjusted odds of breast-feeding for mothers who were married or living as married were 3.0 (95% confidence interval, 1.7 to 5.3) times greater than for mothers who were not married or living as married. Mothers with more than 12 years, 12 years, or 10 to 11 years of education were 5.2 (1.8 to 15.3), 2.7 (1.0 to 6.9), and 2.5 (0.9 to 6.9) times more likely, respectively, to breast-feed than mothers with 9 or fewer years of education. After adjustment was made for marital status and education, the remaining variables (ethnicity, parity, age, and employment status) did not influence the initiation of breast-feeding in this low-income population. The need for vigorous promotion of breast-feeding by the Georgia WIC program is emphasized by the low rate of initiation and short duration of breast-feeding in this low-income population.

Black or African American↗