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PubMed1981

Postpartum sterilization by operating-room nurses in Thailand.

A training project to assess the performance of experienced operating room nurses as operators in postpartum sterilization was conducted in 1977-1978. The results for over 1000 nurse-operated clients and a comparison group of approximately 300 physician-sterilized clients show that nurses achieved comparable success with physicians in postpartum sterilization, as judged by clinical and attitudinal follow-up. No serious complications were recorded in either group. Minor infections in both groups were treated routinely. A stitch abscess for one nurse-operated client resulted in hospitalization; the client was released after 3 days. The clients in both groups returned to routine chores at home rapidly, and client satisfaction with the procedure was virtually unanimous in each group. This study lends support to the use of nurses in performing contraceptive surgery. The need for increased service coverage in this area is of high priority, and nurses provide a readily available and easily trained cadre of support staff.

Clinical Competence↗
PubMed2004

Effectiveness of long-term residential substance abuse treatment for women: findings from three national studies.

The effectiveness of residential substance abuse treatment for women was examined using data from the Center for Substance Abuse Treatment's Residential Women and Children/Pregnant and Postpartum Women (RWC/PPW) Cross-Site Study and two other recent national studies. Treatment success was defined as posttreatment abstinence from further drug or alcohol use, measured through in-person follow-up interviews conducted 6-12 months after each client's discharge. Despite differences in treatment programs, client profiles, follow-up intervals, data collection methods, and other factors, all three studies found high treatment success rates--ranging narrowly from 68% to 71% abstinent--among women who spent six months or more in treatment. Success rates were lower, and between-study differences were larger, for clients with shorter stays in treatment. Controlling for salient client and treatment project characteristics, strong associations between length of stay in treatment and posttreatment abstinence rate were found in all three studies, suggesting that women's length of stay in residential treatment is a major determinant of treatment effectiveness. In further analysis of RWC/PPW data, treatment completion was also found to be an important outcome factor. Among clients who remained in treatment for at least three months, those who achieved their treatment goals in three to five months abstinence outcomes were as good as those for clients who took more than six months to complete their treatment (76%-78% abstinent) and substantially better than those for clients who did not complete treatment (51%-52% abstinent). Notably, however, most of the RWC/PPW clients who successfully completed treatment (71%) required six months or more to do so.

Adult↗
PubMed1991

A randomized, controlled trial to measure the frequency of use of a hospital telephone line for new parents.

New parents have fewer supports today than in previous decades due to factors such as short postpartum hospital stay, fragmentation of services, and long-distance families. This controlled trial evaluated the frequency of use of a 24-hour, in-hospital telephone line by 130 parents randomly invited to use the service and 130 who were not aware of this service. A special line with a separate extension was installed on the postpartum unit. Randomly arranged, sealed envelopes were given to 260 women at the time of discharge, containing a congratulations message or description of a new 24-hour telephone line for advice given by postpartum nurses. Of 53 calls requesting help, 36 were received on the special line and 17 on regular ward telephones; 28 percent of those invited to call back did so, and 13 percent of those without an invitation called on the regular extension, (P = 0.015). Recommendations for future program planning are based on the results of this study.

Breast Feeding↗
PubMed1992

Teaching family-centered perinatal care in family medicine, Part 2.

Pregnancy, childbirth, postpartum, and infant care are a continuum in the family life cycle for which the family physician is especially qualified to provide primary, comprehensive care. The purpose of this paper is to document and share the controversies, wisdom, and knowledge about caring for women and their families before, during, and after pregnancy. Family physicians can be leaders in developing an appropriate perinatal care system for the community. The level of care the family physician chooses to provide is discretionary. However, the family physician should be invested in ensuring that all families receive the greatest benefit from pregnancy, birth, and the newborn experience. Interest in perinatal care in family medicine is increasing, as reflected by the growing numbers participating in the Society of Teachers of Family Medicine Working Group on Family-Centered Perinatal Care. The authors of this article, who are active in this working group, hope that this information is useful in designing a balanced curriculum and delivery system for perinatal care in family medicine training programs.

Anesthesia, Obstetrical↗
PubMed2006

Conceptualization and development of a theory-based healthful eating and physical activity intervention for postpartum women who are low income.

Eating and physical activity behaviors that confer risk for chronic disease are prominent among women from varying ethnic and racial groups who are low income. Conceptualization and development of a theory-based behavioral intervention to address their unique needs during the first year following childbirth comprised four steps: (a) translating public health guidelines and emerging epidemiologic data into specific intervention messages; (b) developing practical strategies to operationalize theoretical constructs, in the context of a social ecological framework; (c) stating achievement-based objectives and writing scripts for five home visits; and (d) conducting formative research. Focus group participants expressed a desire for a "health mentor," not somebody who "nags" or "stresses you out." Paraprofessionals from the Expanded Food and Nutrition Education Program (EFNEP) were directly involved in pretesting the intervention and remain involved as health mentors. This intervention can serve as a basis for future organizational partnerships to benefit the health of populations who are low income.

Adult↗
PubMed1990

A review of synchronization of estrus in postpartum cattle.

Estrus has been synchronized in cattle with progestogens, prostaglandins (prostaglandin F2 alpha and its analogues), progestogen-estrogen combinations and progestogen-prostaglandin combinations. Progestogens administered for 14 to 20 d are effective in synchronizing estrus; however, fertility at the synchronized estrus is subnormal. Duration of progestogen treatment can be reduced by combining it with an estrogen. Syncro-Mate B is a progestogen-estrogen combination that results in a tightly synchronized estrous response. Prostaglandins can be used in double- or single-injection programs. Fertility of the estrus after prostaglandin treatment is similar to that of controls. Estrus also has been synchronized effectively by combining a 5- to 9-d progestogen treatment with prostaglandin at or near the end of treatment. When prostaglandin is used alone, cattle in the late stages of the luteal phase (d 11 to 15 of the estrous cycle) at the time of prostaglandin injection have a higher estrous response and may be more fertile than those injected with prostaglandin in the early part (d 6 to 9) of the luteal phase. More recently, a 14-d progestogen treatment has been combined with a prostaglandin injection given 16 to 18 d after progestogen withdrawal. This system places cattle in the late luteal phase of the estrous cycle at the time of prostaglandin injection and has resulted in an estrus with greater fertility than that immediately following progestogen treatment.

Animals↗
PubMedDate not supplied

Role-modeling healthy behavior: peer counseling for pregnant and postpartum women in recovery.

The utilization of paraprofessional peer counselors for pregnant and postpartum women in recovery represents a nonthreatening and innovative departure from conventional medical and social service models. However, it must be acknowledged that these are women in recovery confronting the same daily stresses as their clients. In essence, they require the same social support services as their clients. Therefore, program planners must be reminded to build in the necessary social support systems for them at the outset. The rewards in terms of the peer counselors' capacity to engage and retain women with whom they can identify and help is well worth the investment. As a consequence of extensive community outreach and supportive activities undertaken by peer counselors, barriers to client receptivity may be removed, greater compliance and service utilization will be achieved, and the potential for successful recovery will be enhanced.

Alcoholism↗
PubMed2007

Triple antiretroviral prophylaxis administered during pregnancy and after delivery significantly reduces breast milk viral load: a study within the Drug Resource Enhancement Against AIDS and Malnutrition Program.

BACKGROUND: The administration of antiretroviral therapy to lactating women could represent a possible strategy to reduce postnatal HIV transmission. In this study, we assessed the effect of antiretroviral treatment on breast milk viral load and determined plasma and breast milk drug concentrations in pregnant women receiving highly active antiretroviral therapy (HAART). METHODS: We studied 40 women receiving zidovudine, lamivudine, and nevirapine from 28 weeks of gestation to 1 month postpartum (group A) and 40 untreated pregnant women (group B). Blood and breast milk samples were collected at delivery and 7 days postpartum. RESULTS: Women in group A had received a median of 85 days of therapy before delivery. Median breast milk concentrations of nevirapine, lamivudine, and zidovudine were 0.6, 1.8, and 1.1 times, respectively, those in maternal plasma. HIV RNA levels in breast milk were significantly lower in group A than in group B (median of 2.3 vs. 3.4 log at delivery and 1.9 vs. 3.6 log at day 7; P < 0.001 for both comparisons). CONCLUSIONS: Antiretroviral drugs administered during the last trimester of pregnancy and after delivery reach levels similar to or higher than plasma concentrations in breast milk and can significantly reduce HIV RNA levels. Our data support the potential role of maternal HAART prophylaxis in reducing the risk of breast-feeding-associated transmission.

Adolescent↗
PubMed2005

The unmet need for contraception among Nigerian women in the first year post-partum.

OBJECTIVE: To determine the level of Unmet need for Contraception among women in the first year post-delivery in Ile-Ife, Nigeria. METHODS: A prospective study of 256 women attending antenatal clinic of the OAUTHC, Ile-Ife, Nigeria was carried out 9-10 months post-delivery. Using a semi-structured questionnaire, the respondents were interviewed for socio-demographic characteristics; obstetric, sexual, and contraception history were also taken. The data were analyzed using descriptive and inferential statistical methods. RESULTS: There was a high level of unmet need (59.4%) in the sample of Nigerian women despite a high level of awareness of common methods of contraception. Education and parity had no significant effect on usage of contraception (p > 0.05). No reason was given for non-usage in the largest proportion (30.3%) of the non-users. Only one-third of the respondents could correctly report the 'at-risk' period for getting pregnant in the post-partum period. CONCLUSION: There is a need to study in more detail the social and cultural factors that determine contraceptive utilization before success can be achieved in closing the gap of unmet need, as it has become evident that increasing the awareness and knowledge of contraception is not enough to achieve the objectives of family-planning programs.

Adolescent↗
PubMedDate not supplied

Combined mother-infant nursing care.

A survey of five Canadian agencies where mother-infant nursing has been implemented found that there is a significant trend toward this concept of care. Agency characteristics, program operational details, the change process, and benefits are examined. Recommendations are made regarding program planning, and the need for more rigorous program evaluation is emphasized.

Attitude of Health Personnel↗
PubMed2006

[Postnatal depression in a Colombian city. Risk factors].

OBJECTIVE: Depression is a major public health problem, which women present, as well as at other periods of their lives, at the puerperium. Postnatal depression is the most frequent complication at this period, with worldwide prevalence as high as 15%. In Colombia, its frequency and associated factors were not clearly defined. DESIGN: To establish the incidence and associated factors for postnatal depression in the Bucaramanga, Colombia, metropolitan area. METHODS: Between May 2003 and April 2004, a cohort was assembled of 286 puerperal women from 11 health centres at different levels, within the Bucaramanga metropolitan area. Women were monitored for 6 weeks. Information was obtained on social, demographic and obstetric variables, psychiatric history, variables concerning the newborn, satisfaction with delivery, and breast-feeding. Postnatal depression was established by a psychiatrist, in a semi-structured clinical interview, using DSM-IV criteria. Incidence rate and associated factors were calculated through a regression model. RESULTS: Incidence rate of postnatal depression was: 1 case per 1000 days/person monitored (95% CI, 0.5-1.7). After the data were then fitted, only these factors were associated with postnatal depression: depression background, HR 3.87 (95% CI, 1.02-14.7), absence of prenatal monitoring, HR 3.87 (95% CI, 1.1-13.2), and background of dysphoria, HR 15.13 (95% CI, 1.9-118.2). CONCLUSIONS: Postnatal depression is little recognized during the puerperium. It is a major public health problem in Bucaramanga, where an appropriate prenatal monitoring program could reduce it. A follow-up program for mother and child would help its early diagnosis and management.

Adolescent↗
PubMed2002

Fertility in postpartum dairy cows in winter or summer following estrus synchronization and fixed time AI after the induction of an LH surge with GnRH or hCG.

In this study, the fertility of postpartum dairy cows after a sequence of treatments with GnRH (Day 0), PGF2alpha (Day 7) and GnRH (Day 9) (GnRH group; n = 164) or hCG (Day 0), PGF2alpha (Day 7) and hCG (Day 9) (group hCG; n = 166) was investigated in summer and winter seasons. All cows were artificially inseminated without estrus detection, 16-18 h after the end of treatment. Control cows (CONT; n = 226) were not treated and were inseminated at natural estrus. The pregnancy rates at Day 90 (46% versus 33%; P < 0.05) and at Day 135 (76% versus 62%; P < 0.05) postpartum were significantly lower in CONT cows in summer compared to winter months but this effect was not observed in the two treated groups. The number of days from calving to conception was significantly lower in GnRH and hCG treatment groups compared to CONT cows in cold months (102 +/- 3.2, 106 +/- 4.2, 126 +/- 3.1, respectively; P < 0.001) and in hot months (112 +/- 3.2, 114 +/- 4.2, 139 +/- 3.1, respectively; P < 0.001). The concentration of insulin was significantly higher in winter (P < 0.001). There were no differences in average plasma concentration of glucose (P = 0.474), GH (P = 0.441) or IGF-I (P = 0.190). In conclusion, we have shown that veterinary supervision combined with a program of estrous synchronization and fixed time insemination can improve fertility of cows suffering heat stress.

Animals↗
PubMed1987

Interval out-patient female sterilization in Lagos.

Out-patient sterilization services were introduced by the Family Planning Clinic of the Department of Obstetrics and Gynaecology, College of Medicine, Lagos, in September, 1981. This paper reviews the results of the first five years of its availability. There were 96 out-patient interval sterilizations, 47 were by the laparoscopic and 49 by the minilaparotomy procedures, representing 0.7% of maternities. Both local and general anaesthesia was used for the procedures. The patients' ages ranged from 28-52 years, all but three being above 31 years. Their parity ranged from 2-15 with between 2-10 living children. Only five patients had less than four children. 37.5% had used no contraception before. Termination of pregnancy was performed at the same time as tubal ligation in 12.5%, and 75% of these were secondary to contraceptive failure. Three patients had emergency laparotomy although in only one was it related to the sterilization procedure. Three patients were observed for 24 hours with no complications. Two patients were re-admitted after one week with pelvic peritonitis. The major complication rate was 3.1%. The failure rate was one per cent. There have been no requests for reversal. The results are compared with those of patients having puerperal sterilization during the same period, who totalled 2% of the maternities.

Adult↗
PubMedDate not supplied

Improving women's health during internatal periods: developing an evidenced-based approach to addressing maternal depression in pediatric settings.

The internatal period, the time between births of successive children, has become a focal point for risk assessment and health promotion in women's healthcare. This period represents a time when women are at high risk for a depressive disorder. The pediatric venue offers a unique opportunity for the identification and management of depression in the internatal period, as mothers who do not attend their own medical appointments are likely to accompany their child to pediatric visits. This paper discusses the role pediatric providers can undertake to improve women's health in the internatal period through the detection and management of maternal depression at well-child visits. Successful models of the management of depression in other primary care settings are explored for their potential for implementation in the pediatric venue. A specific model developed and implemented as part of a 3-year project is presented to highlight the feasibility of an evidenced-based approach to the management of maternal depression in the pediatric setting. We present evidence demonstrating that pediatric providers can successfully identify postpartum women with depression, monitor symptoms and treatment adherence, and communicate results to a woman's healthcare provider. Yet more investigation is needed to create preventive interventions for maternal depression that integrate evidenced-based practice standards for the treatment of depression in primary care venues into pediatric settings. Future programs and policies targeting maternal depression in the pediatric environment should address patient mental health literacy and stigma, the training and education of pediatric providers, and issues of privacy and reimbursement.

Adult↗
PubMed1997

Prenatal breastfeeding education: its effect on breastfeeding among WIC participants.

The effect of prenatal breastfeeding education on breastfeeding incidence and duration was determined among 31 prenatal WIC participants. The subjects, assigned to a control group (n = 17) or experimental group (n = 14), received prenatal nutrition education through the WIC program. The experimental group received at least one breastfeeding education class. There was no significant difference in breastfeeding incidence between the groups, however, there was a significant difference in breastfeeding incidence by parity (p < 0.05). There was a significantly higher percentage of women still breastfeeding at 3 and 4 months postpartum in the experimental versus the control group (p < 0.05). The control group breastfed for 29.5 +/- 43.6 days, while the experimental group breastfed for 76 days +/- 104.3 (p = .05). Multiparous women who had bottle-fed previous children breastfed for a shorter duration (18 +/- 22 days) than primiparous women (60 +/- 87 days) (p < .07).

Adolescent↗
PubMed1988

Factors influencing duration of breast feeding among low-income women.

Forty low-income breast feeding primiparous women were interviewed to determine whether family member and peer attitudes toward breast feeding and available postpartum support were associated with continued or early termination of breast feeding. Mean breast feeding duration equalled 20.5 weeks (range, 1 to 52 weeks). When an outside source of assistance (a doula) was available during the first 2 weeks postpartum, mean duration was 23.4 weeks compared with 12.3 weeks when a doula was unavailable (p less than .05). Breast feeding duration was independent of the doula's attitude regarding breast feeding. Duration of breast feeding was significantly longer for breast feeding women who participated in the USDA Special Supplemental Program for Women, Infants, and Children (WIC) than for those who did not participate. All of the women claimed to like breast feeding; 93% of the husbands or boyfriends, 83% of the women's mothers, and 81% of the women's best friends had positive attitudes toward breast feeding. The more breast feeding friends the woman had, the longer she breast fed (r = .32, p less than .05). Termination of breast feeding was not due to perceived negative attitudes of family members and peers regarding breast feeding.

Adolescent↗