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For the postpartum patient and her newborn, the hospitalization period continues to decrease while educational needs are unchanged. This leads to high stress and a limited ability for patients to absorb needed information for safe care after discharge. The program described below shows how one home care agency combined the skills of the in-hospital nursing staff and home care staff to develop an in-home educational program for this population.
Women from a health maintenance organization who chose early postpartum discharge from the hospital were compared with women who chose a traditional stay. Subjects were mailed a questionnaire; 84% (n = 183) were returned. The survey instrument was designed to measure demographic, family, and birth-related characteristics; postpartum values and beliefs; early discharge program awareness; and postpartum care satisfaction. Findings revealed that the early discharge group had fewer primiparas, more rooming-in mothers, more bottle-feeding mothers, more deliveries between midnight and 6:00 AM, more deliveries at one hospital, more mothers who relied on themselves rather than others for their discharge decision, and more mothers who learned about early discharge from printed information rather than from clinic staff. Mothers in the late discharge group placed more value on rest and sleep, a quiet atmosphere, attention from others, and having a knowledgeable person available. Implications for hospitals and staff education are discussed in light of complete study findings.
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PURPOSE: : To examine the breastfeeding experiences and related behaviors of adolescent mothers after discharge from the hospital. STUDY DESIGN AND METHODS: : Descriptive telephone survey with both open-and closed-ended questions. Outcome variables included breastfeeding experiences and infant feeding practices. A convenience sample of mothers (N = 53), ranging in age from 14 to 19 years, were interviewed by telephone 5 months to 2 years postdelivery. RESULTS: : Over one half (60.3%) of the adolescent mothers breastfed for 2 months or longer (average 3.15 months), only 22.6% breastfed for 6 months or more, and 39.6% breastfed for 1 month or less. Friends, families, and healthcare professionals were supportive of breastfeeding, but participants found prenatal and postpartum education about breastfeeding to be limited. Many indicated that they were not plainly informed about the superiority of breast milk and the health advantages of breastfeeding. One mother stated, "They just asked if I wanted to bottle or breastfeed and didn't tell me about the benefits of breastfeeding." CLINICAL IMPLICATIONS: : Nurses and physicians who provide care for childbearing women need to promote breastfeeding among adolescents in a better way. Prenatal anticipatory guidance related to the physical aspects of breastfeeding, support after adolescent mothers are discharged from the hospital, and advocacy for breastfeeding in the school and workplace setting are warranted. Nurses should consider establishing postpartum education programs for breastfeeding adolescents, for almost all of the participants in this study expressed the need for more postnatal breastfeeding support as indicated by this representative statement:"I think that it would help you to be able to breastfeed if nurses could phone call you more than just once; my baby latched on good in the hospital; I had trouble later after we went home."
The selection of a research instrument to collect data is crucial to the success of a study. This choice can be one of the most time-consuming and challenging tasks in the research process. If they have not been involved in conducting a research study themselves, nursing students are unaware of the intricacies involved in the decision-making process for selection of an instrument. The author describes a teaching strategy to help nursing students appreciate the many components involved in this critical and challenging step in the research process. The example used is from the author's research program on postpartum depression, which describes step by step the author's decision-making process for selection of an instrument.
In 1989, Professional Nurse Associates, Inc., and Kaiser Permanente of Ohio collaborated to provide a home-centered postpartum recovery program to meet the postdelivery health-care needs of mothers, neonates, and families after a shortened hospital stay. This article reviews the history, process, and outcomes of that joint effort. The authors describe outcomes in terms of type and frequency of nursing diagnoses found on home visits, readmission rates, cost savings, and consumer satisfaction.
OBJECTIVE: To synthesize the results of nine qualitative studies related to the transition to motherhood, using Noblit and Hare's method of meta-synthesis development. DATA SOURCES: CINAHL, MEDLINE, PsycINFO, Sociological Abstracts, and Dissertation Abstracts, using the keywords transition, adaptation, motherhood, and mother. STUDY SELECTION: Studies were evaluated for inclusion related to study focus and comparability of findings. Nine studies were included in the final sample, four using a grounded theory methodology and five using either a phenomenologic or phenomenologic/hermeneutic method. DATA EXTRACTION: A series of overlapping, repeating steps as outlined by Noblit and Hare were followed in conducting this meta-synthesis. Detailed tables of metaphors, themes, concepts, and phrases from each study were constructed and studies were compared by means of reciprocal translations. DATA SYNTHESIS: Two processes inherent in maternal transition emerged: engagement and growth and transformation. In addition, five thematic categories signifying areas of disruption present in the maternal transition and 13 underlying themes were revealed. CONCLUSIONS: To facilitate maternal transition, nurses must remain sensitive to the maternal insecurity of primiparae and encourage their maximum maternal engagement, particularly during periods of forced mother-infant separation such as the newborn's admission to the intensive-care unit. In addition, prenatal discussion of realistic expectations for the transitional period, ongoing support through the first 6 months postpartum, and the use of role models should be integrated into postpartum support programs to assist mothers in negotiating typical areas of disruption during maternal transition.
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OBJECTIVES: Postpartum education on contraceptive use is a routine component of discharge planning in many different countries with a wide variety of health care systems. This education is based on assumptions concerning women's receptivity to contraceptive education during the postpartum period and their presumed lack of access to such education after that time. The objective of this review is to assess the effects of education about contraceptive use to postpartum mothers. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, Psychlit, Popline, citations indexes and reference lists of relevant articles. We contacted subject experts to locate additional research, in addition to the Group's Specialised Register of Controlled Trials. Date of the most recent search: April 1999. SELECTION CRITERIA: Trials using random or quasi-random methods of allocation which evaluated the effectiveness of postpartum education about contraceptive use. DATA COLLECTION AND ANALYSIS: Two independent reviewers abstracted data on trial characteristics and results. MAIN RESULTS: Three trials were identified with 5438 women. These trials were conducted in Lebanon, Peru and Nepal. None of the trials examined all major prespecified endpoints. Postpartum education about contraceptive use influenced short-term use assessed between 40 days and three months post-partum. Women in the intervention groups were less likely to be non-users than women in the comparison groups (Odds Ratio (OR) = 0.47, 95% Confidence Interval (CI) 0.39 to 0.58). This benefit was not apparent following analysis of data from better quality studies (OR = 0.67, 95% CI 0.41 to 1.13). An apparent benefit on contraceptive use at six months post-partum (OR = 0.52, 95% CI 0.37 to 0.74) was not apparent following sensitivity analyses (OR = 0.59, 95% CI 0.33 to 1.06). Data are inadequate to assess the impact on cessation of breast feeding and non-attendance at family planning clinics. Unplanned pregnancies, knowledge about contraception and satisfaction with care were not assessed in any trial. REVIEWER'S CONCLUSIONS: The effectiveness of postpartum education about contraceptive use has not yet been established in randomised controlled trials. Such education may be effective in increasing the short-term use of contraception. However, there are only limited data examining a more-important longer-term effect on the prevention of unplanned pregnancies. Research needs to be undertaken to assess the effectiveness of the minimalist education provided in more developed countries and the variety of programs provided in less developed regions. Such research should examine the content, timing, range and organisation of postpartum education on contraceptive use, as well as its impact on breast feeding rates.
Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.
We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)
A nurse practitioner (NP) program to improve postpartum appointment keeping in an outpatient family planning clinic is described and evaluated. The subjects (N = 59) were non-high-risk obstetric patients prescheduled to be seen at 6 weeks postpartum by the NP. Two groups were identified by convenience sampling: Group A (n = 25), the nonintervention group, and Group B (n = 34), the intervention group. Two types of intervention were used: a postpartum telephone call after discharge (n = 11), or a predischarge postpartum visit (n = 23). Results suggest that those in the intervention group were more likely to keep their appointments (p less than .02); only the postpartum visit increased the probability of appointment keeping (p less than .05).
Examined postpartum effects of a school-based intervention program for pregnant adolescents. Interviews were conducted with 102 innercity black, low-income, school-aged mothers who had attended the program, and their academic and medical records were reviewed. For teenagers who had been poor students prior to becoming pregnant, a strong linear effect was found for duration of program attendance: with sufficient time in the program, poorer students became indistinguishable from better students in educational success. Most of the better students were educationally successful at 2 years postpartum, independent of their length of time in the program. For all students, longer durations of postnatal intervention were predictive of lower likelihood of subsequent childbearing. Numerous academic, medical, social, and demographic variables were ruled out as possible confounding factors that might have produced the positive educational outcomes for poorer students. The results suggest that adolescents who appear to have minimal academic promise prior to their pregnancy are nevertheless very responsive to school-based intervention.
We investigated the effectiveness of a program of intensive postpartum support for low-income, breast-feeding women and identified potential predictors of prolonged breast-feeding in this population. Ninety-seven low-income women were randomized to receive intensive postpartum education and support for breast-feeding or to receive only the routine assistance provided by the obstetrical nurses. Both groups were telephoned 6 weeks post partum to determine the method of infant feeding then, and those still breast-feeding were contacted monthly until complete weaning had occurred. No significant difference in breast-feeding duration between the two groups was noted. There was no association between duration of nursing and race, marital status, or the need to return to work or school. Earlier age at introduction of supplement, younger maternal age, and participation in prenatal classes predicted breast-feeding duration by logistic regression.
OBJECTIVES: To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. METHODS: Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. RESULTS: Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. CONCLUSION: The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.
Dr. Ramon Aznar, head of the medical subdivision of the Mexican health insurance program (IMSS), reports that postpartum insertion of IUDs has met great success in Mexico. In 1983, the number of postpartum IUD acceptors in the family planning program of the IMSS reached 83,763, making it the most popular method of postpartum contraception there. The program emphasizes the need for adequate training of delivery room staff and for alerting women to possible contraceptives postpartum. FHI has conducted studies of postpartum IUD use worldwide, including Mexico before the programmatic use of the method. Mexico now has the largest experience of any country in postpartum insertion. The Mexican experience serves to validate the contention that postpartum IUD insertion, accomplished during 1 of the few times in many women's lives that they have contact with the health care system, can make a significant contribution to family planning in the developing world.
This study compared three programs for reproductive management of the postpartum period for reproductive performance and net economic benefit within three dairy herds (n = 1624 cows). Cows on one program received PGF alpha injection at 25 to 32 d postpartum for reproductive therapy, and cows on a second program received additional PGF2 alpha at 39 to 46 d postpartum for synchronization of estrus. These programs were compared with a postpartum program of rectal palpation based on veterinary intervention. Survival analysis indicated that cows receiving PGF2 alpha for reproductive therapy and synchronization of estrus had an 11% higher rate of first AI and 10% higher rate of pregnancy than did cows receiving the rectal palpation. No differences existed between the cows receiving rectal palpation and those receiving the PGF2 alpha. Because overall conception rates and conception rates at first AI did not differ among programs, the improved reproductive performance of cows receiving PGF2 alpha for both therapy and synchronization may be attributed to greater synchronization of estrus, which resulted in improved estrus detection. A partial budget indicated that the PGF2 alpha programs were less expensive than the rectal palpation program. When PGF2 alpha was used for postpartum reproductive therapy and synchronization of estrus, reproductive performance and net economic benefit were increased compared with those of the other programs.