"Doing the month": an exploration of postpartum practices in Chinese women

Experiences of expressed human milk feeding: A qualitative study

OBJECTIVE

The objective of this study was to understand and describe the breastfeeding experiences of Chinese women with a high proportion of expressed human milk feeding.

METHODS

A qualitative descriptive design was used to describe the usual practices of expressed human milk feeding among breastfeeding women. We conducted semi-structured, in-depth, one-to-one interviews with participants (N = 25) who had a high proportion of expressed human milk feeding. Thematic analysis was used to analyze the data.

RESULTS

We identified three main themes: a sense of control, a sense of security, and milk expression challenges. Participants described that expressed human milk feeding provided a greater sense of control over their time and provided more freedom as they were no longer restricted by their infant's feeding schedule. Furthermore, knowing the amount of milk and having a stored milk supply provided a sense of security. However, providing expressed human milk can be time-consuming and has a lower intimacy level when compared with direct breastfeeding.

CONCLUSION

Expressed human milk feeding can provide a greater sense of control and was used as an immediate solution to direct breastfeeding problems. However, some participants experienced challenges in expressed human milk feeding, and some preferred breastfeed directly. Therefore, it is crucial to strengthen the breastfeeding support provided in the early postpartum period to ensure that all breastfeeding persons can breastfeed directly.

Maternal postnatal confinement practices and postpartum depression in Chinese populations: A systematic review

BACKGROUND

The postpartum period is critical for maternal health status after childbirth. The traditional Chinese postpartum confinement practice, "doing-the-month", is considered especially effective in helping mothers recover during the postpartum period. However, research has not provided evidence to confirm its benefits. Postpartum depression is a common postpartum disease that seriously threatens maternal health. The systematic review aims to explore the association between "doing-the-month" and postpartum depression in the Chinese female population and to provide a scientific foundation for evidence-based postpartum maternal care.

METHODS

Five databases (PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, and Web of Science) were searched according to the protocol (INPALSY202320102). The JBI assessment tool was used to assess the quality of the included studies.

RESULTS

Sixteen quantitative studies from China and Chinese female immigrants in other countries, including 15 cross-sectional studies and 1 randomized controlled study, were identified. Four studies indicated that "doing-the-month" rituals reduced postpartum depression risk while 2 studies showed opposite results; 10 studies did not show a significant association between "doing-the-month" practices and postpartum depression.

CONCLUSION

There is conflicting evidence regarding the association between "doing-the-month" and the likelihood of developing postpartum depression. Some studies have explored the impact of family ties, particular rituals, and specific stressors during the postpartum period on the occurrence of postpartum depression in Chinese women. According to current research, "doing-the-month" practice failed to show a significant protective effect on postpartum depression in the Chinese maternal population. Evidence-based medical health education for the Chinese postpartum female community is urgently needed.

Be the mother, not the daughter: Immigrant Chinese women, postpartum care knowledge, and mothering autonomy

Scholars have documented the transformation of modern motherhood, as mothering practices have been a target of medical knowledge that comes to define correct modes of conduct for women caring for their pregnant bodies, undergoing childbirth and childrearing. Such accounts usually set scientific knowledge and medical authority in opposition to women's autonomy. Drawing on the interviews with immigrant Chinese mothers in Canada, we offer a different account of knowledge and agency in new motherhood. These women's often-intense experiences of intergenerational care-giving associated with the practice of zuo yuezi reveal a more fluid relationship between medical authority and mothering agency. We find that the central tension during the postpartum experience lies in intergenerational and family relationships. In this context, new mothers draw on alternative sources of knowledge-and medical professionals are one such key source-to demonstrate within the family their competence to make care decisions for themselves and their babies. These women's use of medical knowledge to counter a familial and intergenerational authority complicates dominant accounts about medicalisation, demonstrating that women's relationship to medical knowledge and authority maybe be far more fluid and complex than a standard account of medicalisation and loss of women's agency would predict.

A Participatory, Needs-Based Approach to Breastfeeding Training for Confinement Centres

With a focus on traditional practices rather than evidence-based practices, breastfeeding support is sub-optimal in confinement centres (CCs). We used a participatory, needs-based approach to develop a training module for CC staff adopting Kern's six-step approach as our conceptual framework. Of 46 identified CCs, 25 accepted our invitation to a dialogue aimed at establishing relationships and understanding their needs. An interactive training workshop was developed from the dialogue's findings. The workshop, attended by 32 CCs (101 participants), was conducted four times over a four-month period. Questions raised by the participants reflected deficits in understanding breastfeeding concepts and erroneous cultural beliefs. Correct answers rose from 20% pre-test to 51% post-test. Post-workshop feedback showed that participants appreciated the safe environment to ask questions, raise concerns and correct misconceptions. An interview conducted 14 months later showed that while some CCs improved breastfeeding support, others made no change due to conflict between breastfeeding and traditional postnatal practices, which was aggravated by a lack of support due to the COVID-19 pandemic. A participatory approach established a trustful learning environment, helping CCs appreciate the value of learning and adopting new concepts. However, cultural perceptions take time to change, hence continuous training and support are vital for sustained changes.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

The Association between Postpartum Practice and Chinese Postpartum Depression: Identification of a Postpartum Depression-Related Dietary Pattern

Conflicting results of Chinese traditional postpartum practices have aroused concerns over their health effects. The role of postpartum practices in postpartum depression (PPD) is still a matter of discussion, especially from a dietary practice point of view. The current study was designed to (1) explore the association between postpartum practices and PPD, (2) to identify the dietary pattern related to PPD, and (3) to identify the possible pathways among postpartum practices and PPD. This study is part of the YI Study, which was a cross-sectional study conducted in 10 cities in China. Data for 955 postpartum women were used in the current analysis. The Edinburgh Postnatal Depression Scale (EPDS-10) was used to evaluate PPD with a cutoff value of 9. Postpartum practice was based on the participants’ self-reported practices. Individual practices were recorded and categorized as dietary and non-dietary practices. The dietary pattern was identified based on the food intake frequencies of 25 food groups using the method of reduced rank regression. Structural equation modeling was used to explore the potential pathways between postpartum practices and PPD. The current study observed significant associations between postpartum practices and PPD (Adjusted OR = 1.41, 95% CI: 1.04–1.90). A similar trend was also found between dietary postpartum practices and PPD (Adjusted OR = 1.39, 95%CI: 1.03–1.88) but not for non-dietary practices and PPD (Adjusted OR = 1.26, 95%CI: 0.92–1.75). A PPD-related dietary pattern was identified with the characteristics of a high intake of meat and eggs and a lower intake of vegetables, mushrooms, and nuts. This dietary pattern was significantly associated with a higher chance of adhering to postpartum practice (Adjusted OR = 1.26, 95% CI: 1.10–1.44). Based on the pathway analysis, this study also observed the association between postpartum practices and PPD, and the association between dietary practices and PPD were both mediated by sleep quality. In conclusion, this study demonstrated that a substantial proportion of women in modern China experience traditional postpartum Chinese practices and that either overall or dietary-related postpartum practices are associated with a higher risk of PPD. The current dietary practices in postpartum rituals may play an important role in developing PPD. A culturally embedded, science-based dietary guideline is required to help women to achieve both physical and psychological health in the postpartum period.

Adherence to Traditional Chinese Postpartum Practices and Postpartum Depression: A Cross-Sectional Study in Hunan, China

Background: The relationship between adherence to traditional Chinese postpartum practices (known as "doing-the-month") and postpartum depression (PPD) remains unknown. Practices including restrictions on diet, housework and social activity, personal hygiene, and cold contact, could introduce biological, psychological, and socio-environmental changes during postpartum. Methods: The cross-sectional study included 955 postpartum women in obstetric clinics in Hunan Province of China between September 2018 to June 2019. Thirty postpartum practices were collected by a self-report online structured questionnaire. Postpartum depression symptoms were assessed by the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear regression was used to estimate the differences in EPDS scores according to adherence to postpartum practices. Firth's bias-reduced logistic regression was employed to analyze the binary classification of having PPD symptoms (EPDS ≥ 10). Results: Overall, both moderate and low adherence to postpartum practices appeared to be associated with higher EPDS scores (adjusted difference 1.07, 95% CI 0.20, 1.94 for overall moderate adherence; and adjusted difference 1.72, 95% CI 0.84, 2.60 for overall low adherence). In analyses by practice domain, low adherence to housework-related and social activity restrictions was associated with having PPD symptoms compared with high adherence (OR 1.61, 95% CI 1.07, 2.43). Conclusions: Low adherence to traditional Chinese postpartum practices was associated with higher EPDS scores indicating PPD symptoms, especially in the domain of housework-related and social activity restrictions. Psychosocial stress and unsatisfactory practical support related to low adherence to postpartum practices might contribute to PPD. Longitudinal study and clinical assessment would be needed to confirm these findings.

Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study

BACKGROUND

Immigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization.

METHODS

We recruited 13 women ages 18-35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants' age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis.

RESULTS

Four themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while "doing the month", the perceived gap between the ideal of "perfect moms" and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages.

CONCLUSION

The recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.

Intimate partner violence during pregnancy in Vietnam: role of husbands

Intimate partner violence (IPV) perpetrators are often husbands. Understanding factors pertaining to women's male partners is essential for programming interventions against IPV. The objective of the study was to describe husband-related social and behavioural risk factors and assess how they are associated with IPV during pregnancy. Cross-sectional data were collected among 1309 pregnant women with husbands in Dong Anh district, Vietnam. Information on sociodemographic characteristics of husbands, the husband's behaviour and the husband's involvement in pregnancy care was indirectly collected via women's report at first antenatal care visit. Data on exposure to intimate partner violence during pregnancy were collected when the women returned for antenatal care in 30-34 gestational weeks. Logistic regression analyses were used to measure the relationships between IPV during pregnancy and risk factors from the husband. Pregnant women who had husbands who were younger or blue-collar worker/farmer/unemployed had more likelihood to be exposed to IPV. Women with husbands who drank alcohol before sexual intercourse and gambled were more likely to be exposed to IPV repeated times. Those with husbands who had intentions of having a child had over three times increased OR to be exposed to IPV once (AOR = 3.2, 95% CI 1.1-9.7). If the husband had a preference for sons, the woman had 1.5 times increased OR (AOR = 1.5; 95% CI 1.1-1.9) to be exposed to IPV repeated times during pregnancy. This study highlights significant associations between IPV and maternal perceptions of husbands' behaviours and involvement in pregnancy. Findings may help to identify at-risk pregnant women to IPV and guide the development of targeted interventions to prevent IPV from husbands.

Chinese Women's Acceptance and Uptake of Referral after Screening for Perinatal Depression

China recently issued a national plan on perinatal depression (PND) screening. Previous studies elsewhere suggested that uptake of referral after screening for PND is suboptimal, but little is known in China. In this cohort study including 1126 women in Hunan, we identified women at a high risk of PND using the Edinburgh Postpartum Depression Scale (EPDS) over multiple time points. We texted them and offered free consultations with a psychiatrist/psychologist. Among 248 screen-positive women, only three expressed interest and one attended the appointment. We surveyed the women about their reasons for declining referrals and preferred means of care. Of the 161 respondents, 128 (79.5%) indicated that they could cope with the condition without professional assistance and 142 (88.2%) chose their families as the preferred source of help. Only 15 (9.3%) chose professionals as their first option. Implementing a referral policy for screen-positive women would mean approximately one-third of women who gave birth in China would be eligible. Our result argues against referring all screen-positive women for professional services at this time. Interventions should instead build upon the tradition of family support in a more engaged response. These considerations are relevant for the implementation of national screening for PND in China.

The Impact of the Postpartum "Doing-the-Month" Practice on Human Milk Microbiota: A Pilot Study in Taiwan

Human milk microorganisms could benefit the healthy development of the immune system in infants. In Asia, the practice of “doing-the-month” indicates a month-long period of postpartum recuperation for new mothers. This is composed of cultural practices, traditional beliefs, behavioral, dietary, and herbal therapies. In this pilot study, we evaluated the effect of “doing-the-month” on the human milk microbiota using a molecular approach. We collected two “doing-the-month” milk groups from randomly recruited mothers who had completed their “doing-the-month” program in either postpartum care center A (milk-PCA, n = 14) or postpartum care center B (milk-PCB, n = 27) for 20 to 30 days. As for the control group, milk samples were selected from postpartum mothers (milk-H, n = 46), who did not conduct the “doing-the-month” program. We found that the “doing-the-month” milk samples were associated with more diverse and unique milk microbiota and that these samples were also linked with more abundant Lactobacillus (milk-PCB) and prevalent Bifidobacteria (milk-PCA and milk-PCB). In addition, the milk samples from “doing-the-month” mothers could be enriched with more Archaea bacterial members, but the “non-doing-the-month” milk samples were enriched with more common skin-, oral-, and environmental-related bacterial members. This study highlights the impact maternal practices may have on the milk microbiome. More research is needed to investigate the effects this may have on infant immune health.

An exploration of the breastfeeding behaviors of women after cesarean section: A qualitative study

Objectives

To explore the factors affecting breastfeeding behaviors in women after cesarean section.

Methods

This is a qualitative study that used a phenomenological approach. This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019. Information saturation was used to determine sample size. Data were analyzed using a thematic content analysis method. Themes were developed based on the theory of planned behavior.

Results

Thirteen (68.42%) had a planned cesarean section, and six (31.58%) cesarean sections were unplanned or emergent. Three major themes emerged: ambivalent attitude about breastfeeding, motivation to comply with the traditional cultural norms, and barriers and challenges. The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk, support from healthcare professionals, and responsibility for breastfeeding. The challenges for breastfeeding after cesarean sections included physical discomfort, knowledge and skills deficit of breastfeeding, lactation deficiency, and lack of knowledge and coping skills in managing their depressive mood after cesarean sections. There were a couple of neutral factors, such as the influences of family and peers. These factors could influence women either positively as facilitators or negatively as barriers.

Conclusions

The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections. To promote women’s breastfeeding behaviors after cesarean sections, it is necessary to change women’s attitudes, belief systems, and the external environments and help them become more confident.

Effects of a health education program targeted to Chinese women adhering to their cultural practice of doing the month: A randomized controlled trial

BACKGROUND

"Doing the month" is a prevalent Chinese postpartum custom which is believed to restore health after delivery. However, some traditional practices are potentially harmful for women's health.

OBJECTIVES

To examine the effect of an evidence-based health education program on Chinese postpartum women's adherence to traditional practices of doing the month and the effect of adherence to doing the month on maternal physiological and psychological health.

METHODS

A randomized controlled trial was conducted. During December 2016-July 2017, we recruited postpartum women at a tertiary hospital. Women randomized to the intervention group received evidence-based health education within 1 week after returning home and received a second visit 1 month later. The control group received routine postpartum home visits. Adherence to doing the month was measured by the Adherence to Doing-the-Month Practices questionnaire (ADP). Maternal physical health was measured by the Chair Stand Test and Postpartum Symptom Checklist. Maternal psychological health was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, t-test, and chi-squared test were used to analyze the differences in scores and symptoms of the two groups.

RESULTS

We recruited 124 eligible postpartum women and 108 of them (54 intervention group, 54 control group) completed this study. The ADP score of the intervention group was significantly lower than that of the control group (p < 0.001). The number of participants in the experimental group with poor appetite and indigestion was significantly lower than that of control group. No significant differences were found in numbers of symptoms and average EPDS scores between the 2 study groups (p > 0.05).

CONCLUSIONS

Evidence-based health education can reduce postpartum women's adherence to some traditional practices of doing the month and improve women's physical health.

Patterns and predictors of exclusive breastfeeding in Chinese Australian mothers: a cross sectional study

BACKGROUND

While exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers.

METHODS

Chinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression.

RESULTS

Almost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months.

CONCLUSIONS

While Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

The impact of intimate partner violence on the trajectory of perinatal depression: a cohort study in a Chinese sample

Abstract.

AIMS

Intimate partner violence (IPV) is an important risk factor for perinatal depression (PND). But IPV's impact on the natural prognosis of PND symptoms is not well understood. We tested two hypotheses: (1) pregnant women with IPV experiences will exhibit more severe PND symptoms than women without IPV experience; (2) IPV experience will impede the recovery prognosis of PND. We also explored the contribution of IPV to PND comparing with other risk factors.

METHOD

The sample is comprised of 813 pregnant women followed through perinatal period in Hunan, China. We assessed IPV experience using items from the Short Form of the Revised Conflict Tactics Scale (CTS2S), and PND symptoms via the Edinburgh Postnatal Depression Scale (EPSD). We conducted Linear Mixed-effects Model to compare the trajectories of PND symptoms between victims and non-victims and a multistage Generalised Estimating Equations Model to explore salient factors on the trajectory of PND symptoms.

RESULTS

There were 90 participants (11.07%) who reported IPV experience in the past 12 months. With respect to physical, psychological and sexual violence, the prevalence was 4.55% (37/813), 9.23% (75/813) and 2.34% (19/813). Victims reported more severe PND symptoms (t = 5.30, p < 0.01) and slower decreasing slope of trajectories (t = 28.89, p < 0.01). The PND trajectory was associated with IPV experience (OR = 3.78; 95% CI 1.39-10.26), social support (OR = 0.93; 95% CI 0.88-0.97), positive coping strategies (OR = 0.85; 95% CI 0.80-0.91), negative coping strategies (OR = 1.25; 95% CI 1.14-1.37) and monthly income of $0.15-$298.36 (compared to no income, OR = 0.0075; 95% CI 0.00052-0.11).

CONCLUSIONS

The findings suggest the reported prevalence of IPV is lower in Hunan than most of the previous studies during perinatal period in other provinces of China, and IPV victimisation is associated with increased severity and slowed prognosis of PND symptoms. Future studies that screen for victimisation and establish its explicit mechanism to the poorer prognosis of PND symptoms would benefit the prevention and treatment of PND.

'No Austrian Mother Does This to Sleep Without a Baby!' Postnatal Acculturative Stress and 'Doing the Month' Among East Asian Women in Austria: Revisiting Acculturation Theories From a Qualitative Perspective

Acculturative stress is a phenomenon describing negative emotions experienced by immigrants in their socio-cultural and psychological adaptation process to the host society’s dominant culture and its population. Acculturative stress is assumed to be one the reasons for higher prevalence of postnatal depression among immigrant women compared to non-immigrant women. Theories and models of acculturation and coping strategies suggest that certain cultural orientations or behaviors could mitigate acculturative stress and postnatal depression. Nevertheless, quantitative studies applying these theories have so far revealed inconsistent results. Given this background, we ask: what can a qualitative study of immigrant women’s postnatal experiences tell us about the interrelationships between immigrant mothers’ acculturation behaviors or cultural orientations, and maternal psychological health? Particularly, we explore the postnatal experiences of Chinese and Japanese women who gave birth in Austria, focusing on their experiences and behaviors influenced by their heritage culture’s postnatal practices (zuò yuè zi and satogaeri). Theoretically, we apply Berry’s acculturation model through a focus on what we call ‘Postnatal Acculturative Stress’ (PAS). By doing so, we identify factors that prevent or mitigate PAS. Another aim of this article is to critically reassess Berry’s model in the context of postnatal care and maternal psychological health. Data were analyzed using a combination of deductive and inductive method through the application of directed content analysis and phenomenological approach. Women’s postnatal experiences were summarized as an ‘unexpected solitary struggle in the midst of dual identity change’ in four specific domains: postnatal rest and diet, social support, feelings toward significant others and identity. Preventive and mitigating factors against PAS included trust (in self and one’s health beliefs) and mutual respectful relationships with and between the significant others. The application of Berry’s acculturation model provided a useful framework of analysis. Nevertheless, the multifarious complexity involved in the process of acculturation as well as different power dynamics in the family and healthcare settings makes it difficult to draw causal relationships between certain acculturation behaviors or cultural orientations with specific health outcomes. Health professionals should be aware of the complex psychosocial processes, contexts as well as social environment that shape immigrants’ acculturative behaviors.

Crucial Contributions : A Biocultural Study of Grandmothering During the Perinatal Period

Maternal grandmothers play a key role in allomaternal care, directly caring for and provisioning their grandchildren as well as helping their daughters with household chores and productive labor. Previous studies have investigated these contributions across a broad time period, from infancy through toddlerhood. Here, we extend and refine the grandmothering literature to investigate the perinatal period as a critical window for grandmaternal contributions. We propose that mother-daughter co-residence during this period affords targeted grandmaternal effort during a period of heightened vulnerability and appreciable impact. We conducted two focus groups and 37 semi-structured interviews with Himba women. Interviews focused on experiences from their first and, if applicable, their most recent birth and included information on social support, domains of teaching and learning, and infant feeding practices. Our qualitative findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being. We show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants. These findings demonstrate that the role of grandmother can be crucial, even when alloparenting is common and breastfeeding is frequent and highly visible. Situated within the broader anthropological and clinical literature, these findings substantiate the claim that humans have evolved in an adaptive sociocultural perinatal complex in which grandmothers provide significant contributions to the health and well-being of their reproductive-age daughters and grandchildren.

Beyond black and white: heibaika, neuroparenting, and lay neuroscience

Heibaika (Mandarin for black-and-white cards) are tools that Taiwanese parents use for infants below 3 months old. These cards are claimed to stimulate vision and enhance the brain. Although the scientific efficacy of heibaika is questionable, the wide circulation of these cards illustrates the ways some try to urge laypeople to imagine and picture the infant brain. Thus, the use of heibaika constitutes a good example of neuroparenting and neuroculture, where flourishing neuroscience transforms the parenting culture. In the present study, multiple methodologies are applied, and the emergence of heibaika is identified as a twenty-first century phenomenon popularised by online forums and postpartum care centres, among many other channels. Heibaika are contextualised in the globalisation of neuroparenting through translation since the 1990s and the rising anxiety of contemporary Taiwanese parents. Through interview analysis, parents are classified into believers, sceptics, and cautious experimenters. Their anticipations and worries are further elaborated. The paper concludes by highlighting its three major contributions: the importance of studying lay neuroscience as a way to rethink and problematise the boundary between science and culture, the enrichment of the concept of neuroparenting, and the emphasis on the dimension of globalisation and knowledge transmission.

"Doing the month" and postpartum depression among Chinese women: A Shanghai prospective cohort study

BACKGROUND

The Chinese postpartum custom of "doing the month" characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium.

METHODS

This study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional "doing the month" practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression.

RESULTS

The estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1-2 times: OR = 1.9, 95% CI = 1.4-2.4; 3-5 times: OR = 2.3, 95% CI = 1.5-3.5; ≥6 times: OR = 2.5, 95% CI = 1.2-5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2-2.4; less than 6 h : OR = 3.3, 95% CI = 2.2-5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4-0.9; always: OR = 0.4, 95% CI = 0.3-0.7).

CONCLUSIONS

Our results suggested that not all the activities of "doing the month" provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health.

Intimate Partner Violence among Pregnant Women and Postpartum Depression in Vietnam: A Longitudinal Study

Background

Exposure to intimate partner violence during pregnancy is associated with a wide range of adverse reproductive health outcomes. However, detailed knowledge on the association between specific types of exposure to partner violence and postpartum depression is limited.

Purpose

The aim of the present study was to investigate the association between exposure to emotional violence, physical violence, and sexual violence during pregnancy and postpartum depression among women in northern Vietnam.

Methods

The study was designed as a longitudinal study, which included a total of 1,337 women. The study participants were recruited from 24 communes in Dong Anh District, Hanoi, Vietnam, and interviewed four times: (a) at enrolment (which took place no later than week 24 of the pregnancy); (b) at a gestational age of 30-34 weeks; (c) at delivery; and d) 4-12 weeks after delivery. Emotional, physical, and sexual violence exerted by the intimate partner were measured using a modified version of the questionnaire initially developed by the World Health Organization, and signs of depression were measured by the Edinburgh Postpartum Depression Scale.

Results

More than one-third of the women (35.3%) experienced at least one type of violence during their pregnancy and 8.2% of the women reported postpartum depression. The results of multivariate analyses showed that both physical and sexual violence were statistically significantly associated with postpartum depression (AOR=2.75, 95%CI: 1.19-6.35 and AOR=1.93, 95%CI: 1.01-3.73, respectively).

Conclusions

The results showed strong and statistically significant associations between partner violence and postpartum depression. These findings clearly demonstrate a crucial need for relevant health professionals to identify women who are exposed to partner violence and screen for postpartum depression in order to mitigate the negative mental health outcomes among Vietnamese women.

Emotional violence exerted by intimate partners and postnatal depressive symptoms among women in Vietnam: A prospective cohort study

BACKGROUND

Previous studies have shown a relation between intimate partner violence (IPV) and postpartum depression (PPD). However, these studies have primarily focused on physical and sexual violence as predictors for postpartum depression and little attention has been given to emotional violence (EV), despite emotional violence having been well reported as the most common type of violence experienced by women. This present study aimed to investigate the association between various types of emotional experience during life with present partner and postnatal depressive symptoms among women in Vietnam.

METHODS

A total of 1,274 pregnant women were recruited from 24 communities in the Dong Anh District, Hanoi, Vietnam. They were interviewed four times: (a) at enrolment (before week 24 of pregnancy); (b) at a gestational age of 30-34 weeks; (c) 24-48 hours after delivery; and (d) 4-12 weeks after delivery. Emotional violence and postnatal depressive symptoms were measured using a questionnaire developed by the World Health Organization (WHO) and the Edinburgh Postpartum Depression Scale (EPDS), respectively.

RESULTS

A total of 639 (50.4%) women experienced at least one type of emotional violence with their present partner, whereas 104 women (8.2%) experienced postnatal depressive symptoms. Women exposed to emotional violence were more likely to experience postnatal depressive symptoms (OR = 3.15; 95%CI: 1.17-8.51). Other statistically significant predictors of increased postnatal depressive symptoms included type of employment, lack of family support after delivery, lower level of education, husband's preference for a specific sex of child, presence of mental disorder, and depression during pregnancy.

CONCLUSIONS

Among Vietnamese women, there was a statistically significant association between exposure to emotional violence with their present partner and postpartum depression. The findings indicate an urgent need for screening for all acts of emotional violence as risk factors for postnatal depressive symptoms.

Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review

Many cultures around the world observe specific postpartum rituals to avoid ill health in later years. This qualitative systematic review examined the literature describing traditional postpartum practices from 51 studies in over 20 different countries. Commonalities were identified in practices across cultures. Specifically, the themes included organized support for the mother, periods of rest, prescribed food to be eaten or prohibited, hygiene practices and those related to infant care and breastfeeding, among others. These rituals allow the mother to be ‘mothered’ for a period of time after the birth. They may have beneficial health effects as well as facilitate the transition to motherhood. In today's society, with modernization, migration and globalization, individuals may be unable to carry out the rituals or, conversely, feel pressured to carry out activities in which they no longer believe. The understanding of traditional postpartum practices can inform the provision of culturally competent perinatal services.

Risk of Subsequent Hypertension and Diabetes in Women With Hypertension During Pregnancy and Gestational Diabetes

OBJECTIVE

To assess risks of postpartum hypertension and diabetes mellitus (DM) for women with hypertension during pregnancy (HDP) with and without gestational DM (GDM).

PATIENTS AND METHODS

From insurance data of 15- to 44-year-old women with pregnancy in 2000-2011, we established an HDP/GDM cohort (n=1270), an HDP/non-GDM cohort (n=5077), and a comparison cohort without either disorder (n=12,594), frequency matched by age and year of pregnancy. Postpartum hypertension and DM were assessed before 2012.

RESULTS

The postpartum hypertension incidence increased with age in all cohorts, with overall rates of 13.1, 8.82, and 0.79 per 1000 person-years in the HDP/GDM, HDP/non-GDM, and comparison cohorts, respectively. The adjusted hazard ratios (aHRs) of hypertension were 16.8 (95% CI, 11.8-24.1) for the HDP/GDM cohort and 11.2 (95% CI, 8.19-15.2) for the HDP/non-GDM cohort relative to the comparison cohort. The corresponding incident DM rates were 41.9 and 8.06 vs 2.55 per 1000 person-years in the 3 cohorts, respectively, with aHRs of 16.2 (95% CI, 13.2-19.9) for the HDP/GDM cohort and 3.15 (95% CI, 2.55-3.89) for the HDP/non-GDM cohort relative to the comparison cohort. Incident DM in the HDP/GDM cohort was 44% greater in 15- to 29-year-old women vs 40- to 44-year-old women (49.1 vs 34.2 per 1000 person-years), with aHRs of 39.2 (95% CI, 24.5-62.7) and 5.52 (95% CI, 2.92-10.4), respectively, relative to comparisons of respective age groups.

CONCLUSION

Subsequent hypertension and DM risks are greater in women with HDP/GDM than in women with HDP only compared with women without these complications. Younger women with HDP/GDM should be particularly cautious.

Nurses’ Knowledge of Traditional Chinese Postpartum Customs

This study was conducted to determine nurses’ and postpartum women’s knowledge of and attitudes toward the traditional Chinese custom of 1-month confinement following delivery, to discover factors influencing the attitudes, and to analyze the correlation between them. After a descriptive and inferential analysis of 173 questionnaires (121 recent mothers and 52 nurses), a significant difference was found in the women’s and nurses’ scores for knowledge of the postpartum confinement custom, with postpartum women scoring higher than the nursing staff on average. Both groups held positive attitudes toward the traditional custom. Attitudes and level of knowledge were positively correlated. Results of this study can serve as a reference for in-service nursing education, which should include information about traditional postpartum customs.

Socialization environments of Chinese and Euro-American middle-class babies: Parenting behaviors, verbal discourses and ethnotheories

Children's socialization environments reflect cultural models of parenting. In particular, Euro-American and Chinese families have been described as following different socialization scripts. The present study assesses parenting behaviors as well as parenting ethnotheories with respect to three-month-old babies in middle-class families in Los Angeles and Beijing. Euro-American parents' behaviors towards their children, as well as their parental ethnotheories are assumed to express the cultural model of autonomy; whereas Chinese parents' socialization strategies are assumed to be shaped by the cultural model of relatedness. The results reveal that Euro-American and Chinese mothers embody different cultural models in their verbal parenting behaviors and verbalized parenting strategies. However, the differences are not consistent and there are no differences with respect to non-verbal parenting behaviors. The results are discussed as illustrating the complexity of cultural models of parenting, where cultural messages are expressed differently in different domains.

Perceptions and experiences of perinatal mental disorders in rural, predominantly ethnic minority communities in northern Vietnam

Background

Preliminary research has suggested that perinatal mental disorders (PMDs), including post-partum depression, are prevalent in Vietnam. However the extent to which these disorders are recognized at the community level remains largely undocumented in the literature. PMDs have also never been investigated within Vietnam’s significant ethnic minority populations, who are known to bear a greater burden of maternal and infant health challenges than the ethnic majority.

Objective

To investigate knowledge and perceptions of PMDs and their treatments at the community level in a rural, predominantly ethnic minority region of northern Vietnam.

Methods

Qualitative semi-structured interviews were conducted on the topic of common PMDs. Participant groups were primary health workers (PHWs) working at local community health centers, and pregnant or postpartum women enrolled in a program for maternal and infant health that was not mental health related. Interviews included vignette scenarios that asked respondents to interpret cases of women experiencing PMDs, as well as open-ended questions about mental disorders and their treatments.

Results

Twelve PHWs and 14 perinatal women completed the study. Major themes that emerged from the interviews included (1) Family relationships impact psychological well-being, (2) Nutrition contributes to perinatal mental health, (3) Both traditional and western medicine play roles in perinatal health, (4) There was a lack of personal experience with women experiencing PMDs, (5) Descriptions of mental health symptoms focused on behaviours, and (6) Community care is the primary mental health support.

Conclusions

PHWs reported having almost never treated a woman with a PMD. However, anecdotal evidence from the women interviewed suggests that there are incidents of mental disorders during the perinatal period that go largely unaddressed. Willingness to present to primary care appears to be high, and presents an opportunity to address this need by training PHWs in effective screening, treatment, and referral. Such training should account for culturally specific presentations of mental disorders as well as the importance of the patient’s social context. To the best of the author’s knowledge, this research presents the first evidence of a PMD burden within Vietnam’s ethnic minority communities.

Taiwanese Women's Experiences of Lactation Suppression After Stillbirth

OBJECTIVE

To explore the experiences of lactation suppression (LS) among Taiwanese women who experienced stillbirth after 20-weeks gestation.

DESIGN

Qualitative research combining practitioner ethnography and the observ-view method (participant observation and unstructured interviews while caring for participants).

SETTING

Participants were recruited from a medical center in central Taiwan between June 2013 and November 2014.

PARTICIPANTS

Seven Taiwanese women who had stillbirths.

METHODS

Data were collected by the observ-view method. Recorded interviews were analyzed by content analysis.

RESULTS

Participants described three core experiences: deciding to use LS without careful deliberation; psychological pain is substantially stronger than physical pain; and not regretting their choice regarding method of LS.

CONCLUSION

Physical pain often remains unaddressed because of the greater psychological pain following fetal death. Therefore, LS should be an essential component of follow-up care as part of the discharge plan. Follow-up should be for at least 14 days. More research is needed on nonpharmacological LS to address cultural differences and personal beliefs about methods of LS.

Dietary changes during pregnancy and the postpartum period in Singaporean Chinese, Malay and Indian women: the GUSTO birth cohort study

OBJECTIVE

To examine changes in food consumption during pregnancy and the postpartum period in women of major Asian ethnic groups.

DESIGN

Using interviewer-administered questionnaires, we assessed changes in food consumption during pregnancy (26-28 weeks' gestation) and the postpartum period (3 weeks after delivery) as compared with the usual pre-pregnancy diet.

SETTING

Singapore.

SUBJECTS

Pregnant women (n 1027) of Chinese, Malay and Indian ethnicity (mean age 30·4 (SD 5·2) years) who participated in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study.

RESULTS

During pregnancy, participants tended to increase their consumption of milk, fruit and vegetables and decrease their consumption of tea, coffee, soft drinks and seafood (all P < 0·001). Most participants reported adherence to traditional restrictions ('confinement') during the early postpartum period (Chinese: 94·8 %, Malay: 91·6 %, Indian: 79·6 %). During the postpartum period, participants tended to increase their consumption of fish and milk-based drinks and decrease their consumption of noodles, seafood, and chocolates and sweets (all P < 0·001). Ethnic differences in food consumption were pronounced during the postpartum period. For example, most Chinese participants (87·2 %) increased their ginger consumption during the postpartum period as compared with smaller percentages of Malays (31·8 %) and Indians (40·8 %; P for ethnic difference <0·001). Similar ethnic differences were observed for cooking wine/alcohol, herbs and spices, and herbal tea consumption.

CONCLUSIONS

Marked changes in food consumption that reflect both modern dietary recommendations and the persistence of traditional beliefs were observed in Singaporean women during pregnancy and the postpartum period. Traditional beliefs should be considered in interventions to improve dietary intakes during these periods.

Parity and the risk of diabetes mellitus among Chinese women: a cross-sectional evidence from the Tongji-Dongfeng cohort study

Objectives

Little is known about the long-term health impact of pregnancy on women. The objective of this study was to examine the association between parity and the risk of diabetes among a population of Chinese women.

Study design

A total of 14,196 women (aged ≥45 years) from the Dongfeng-Tongji Cohort study who had experienced at least one live birth completed baseline questionnaires, medical examinations, and provided baseline blood samples. Participants were categorized into four groups according to parity (one, two, three, or four or more live births). Logistic regression models were used to investigate the association between parity and the risk of diabetes after controlling potential confounders.

Results

The prevalence of diabetes in the study population was 18.0% (2,552/14,196). Fasting plasma glucose levels increased with the increasing number of live births (P<0.001) and parity had a positive graded association with diabetes without adjustment for any covariates (P for trend <0.001). After adjusting for potential confounders, women who had had two, three, and four or more live births had 1.35 times (95% CI, 1.20–1.52), 1.59 times (95% CI, 1.39–1.82) and 1.44 times (95% CI, 1.21–1.71), respectively, higher risk of diabetes compared with women who had had one live birth.

Conclusion

Multiparity was associated with increasing risk of diabetes in this population of Chinese women. These findings suggested that multiparity may be a risk factor for the development of diabetes among Chinese women. Future studies are needed to examine the physiological changes during pregnancy for risk of diabetes in later life.

Quality of life during the transition to parenthood in Hong Kong: a longitudinal study

OBJECTIVE

Quality of life has emerged as an important health outcome in the care of perinatal families. This study was designed to examine the changes in quality of life among Chinese couples during the transition to parenthood.

METHODS

A longitudinal design was used. Participants comprised a convenience sample of 203 Chinese-childbearing couples attending the antenatal clinics, who completed data collection during pregnancy and at six weeks and six months postpartum. At each point, couples completed the Medical Outcomes Study Short Form 12-Item Health Survey.

RESULTS

The results showed that women experienced substantial changes in their quality of life during pregnancy and postpartum, whereas the changes in their partners' quality of life were less noteworthy. Women had a poorer quality of life than their partners during the early postpartum period. The mental health component of women's quality of life was closely related to their partners' across the perinatal period.

CONCLUSIONS

The findings of the present study highlight the need for more attention to a couple's quality of life during the transition to parenthood. Couple-based and culturally relevant interventions should be developed to assist both parents to cope with the new challenges and demands of parenthood, and thus achieve a better quality of life.

The Lived Childbirth Experience of Korean First-Time Mothers in the United States

OBJECTIVE: To explore the lived experience of Korean first-time immigrant mothers giving birth in the United States from their own perspectives.

DESIGN: Hermeneutic phenomenological study using semistructured interviews with seven Korean first-time mothers who recently gave birth in the United States. The interview data were analyzed to identify emerging themes, which were centered on both positive and negative perceptions of the experience.

RESULTS: The emerged positive perceptions included friendly health care providers, husband’s active involvement, strengthened bonding with husband, freedom from traditional rituals and taboos, and giving the baby a U.S. citizenship. Difficulty in making medical decisions, health literacy, a different health system, different postpartum food culture, and lack of support system were identified as negative perceptions.

CONCLUSIONS: The findings of this study may help health care providers in obstetrical settings better understand the meaningful aspects of childbirth experienced by Korean immigrant first-time mothers while they gave birth and received perinatal care in the U.S. sociocultural context. Immigrants’ childbirth experience in a foreign country has multidimensional aspects that suggest further research on their perinatal health needs evolving from a different health culture, culturally embedded health practices, and lack of support system.

Effect of Postpartum Practices of Doing the Month on Chinese Women’s Physical and Psychological Health

The purpose of the study was to describe Chinese women’s postpartum physiological and psychological health and adherence to “doing-the-month” practices. A descriptive repeated measures design was used, with data collected at 3 days and 6 weeks postpartum. The convenience sample consisted of 198 healthy childbearing women with a term birth. Maternal physical health was measured by the Six-Minute Walk (endurance), Chair Stand test (muscle strength), severity of physical symptoms, and physical health subscales of SF36v2. Maternal psychological health was measured by the Edinburgh Postnatal Depression scale. Adherence was measured by the Adherence to Doing-the-Month Practices questionnaire. Aerobic endurance and lower-body muscle strength improved significantly across time ( p < .001) but remained suboptimal for maternal age. Women who delivered by Cesarean section had significantly poorer physical health than those who had a vaginal delivery. Physical functioning significantly increased, but general health and role limitations due to physical health significantly decreased over time. Postpartum physical symptoms decreased in number and severity. Depression increased over time ( p < .001). Adherence to doing the month was negatively correlated with aerobic endurance and positively correlated with depression at 6 weeks ( p < .05). These findings challenge the assumption that practices of doing the month are healthy for Chinese women’s recovery after childbirth. Research-based evidence needs to be integrated into doing-the-month practices. Education of Chinese women and families, whether living at home or abroad, is needed about the adverse health effects of doing the month. Routine screening for postpartum depression is also advised.

Postpartum cultural practices are negatively associated with depressive symptoms among Chinese and Vietnamese immigrant mothers married to Taiwanese men

The objectives of researchers in this study were to examine acceptance and adherence to mainstream Taiwanese postpartum cultural practices and their association with postpartum depressive symptoms among Chinese and Vietnamese immigrant mothers married to Taiwanese men. While the postpartum cultural practices in China are similar to mainstream Taiwanese practices, those of Vietnam differ from Taiwanese practices. This cross-sectional survey was conducted in Taiwan from October 2007 through March 2008, and included190 immigrant mothers from China and Vietnam who had delivered a child within the past year. Immigrant mothers from China had higher levels of acceptance and adherence to mainstream Taiwanese postpartum cultural practices and a lower rate of postpartum depressive symptoms than immigrant mothers from Vietnam, but the association between adherence to "doing-the-month" practices and postpartum depressive symptoms did not vary significantly between Chinese and Vietnamese mothers. Adherence to these practices was negatively associated with postpartum depressive symptoms among immigrant mothers (OR = 0.93, 95% CI: 0.90-0.96) after adjustment for social support, duration between moving to Taiwan and delivery, and country of origin. Adherence to mainstream postpartum cultural practices was negatively associated with postpartum depressive symptoms for both Chinese and Vietnamese immigrant women married to Taiwanese men.

Chinese primiparous women's experiences of early motherhood: factors affecting maternal role competence

AIM

The aim of this study was to explore Chinese women's perceptions of maternal role competence and factors contributing to maternal role competence during early motherhood.

BACKGROUND

Developing a sense of competence and satisfaction in the maternal role are considered critical components in maternal adaptation, which have a significant impact on parenting behaviours and the psychosocial development of the child. However, qualitative studies that address maternal role competence are limited in the Chinese population.

DESIGN

This was an exploratory descriptive study.

METHOD

A purposive sample of 26 Chinese primiparous mothers participated in a childbirth psychoeducation programme and was interviewed at six weeks postpartum. Data were analysed using content analysis.

RESULTS

Women perceived a competent mother as being able to make a commitment to caring for the physical and emotional well-being of child, while cultivating appropriate values for childhood. Personal knowledge and experience of infant care, success in breastfeeding, infant's well-being, availability of social support and contradictory information from various sources were major factors affecting maternal role competency.

CONCLUSION

The findings highlight the importance of understanding Chinese cultural attitudes to childrearing and maternal role competence. New Chinese mothers need information on child care, positive experiences of infant care, social support and consistent information to enhance their maternal role competency. Recommendations are made for Chinese culturally specific guidelines and healthcare delivery interventions to enhance maternal role competence in early motherhood.

RELEVANCE TO CLINICAL PRACTICE

Nursing and midwifery care should always take into account the cultural beliefs and enable adaptation of traditional postpartum practices. Providing consistent information and positive experience on parenting skills and infant behaviour as well as enhancing effective coping strategies could strengthen Chinese women's maternal role competency.

New mothers' experiences of social disruption and isolation during the severe acute respiratory syndrome outbreak in Hong Kong

In Hong Kong during the severe acute respiratory syndrome outbreak of 2003, sustained uncertainty caused daily stress for residents for > 3 months. Expectant women experienced unexpected social disruption and isolation within their day-to-day life that have not been described in their own voice. The purpose of this study was to describe the experiences of women who became mothers during the outbreak and the ways in which these experiences impacted their early post-partum mothering. A phenomenological research design was chosen. The participants' responses then led the interview process. As the women's experiences had many similarities, saturation was reached after eight interviews. Four themes emerged: living with uncertainty, intense vigilance, isolation, and disrupted expectations. The participants spoke of disrupted daily routines as they tried to eliminate their risk of contracting this disease, including relationship difficulties with their spouse. None of the women had the birth experience they had hoped for because of changes in hospital practices.

Evaluating the effect of childbirth education class: a mixed-method study

AIM

To examine Chinese women's satisfaction with and the perceived effect of childbirth education class on their labour experience.

BACKGROUND

Attending childbirth education classes is a common activity for pregnant women. Nonetheless, evidence reveals that evaluation of the effects of childbirth education classes is inconsistent. Moreover, women's perceived effect of these classes has not been systematically examined.

METHODS

This two-phase study adopted a mixed-method design with Donadedian's model as the theoretical framework. In Phase One, a random sample of 40 Chinese women was invited to complete a questionnaire after attending a childbirth education class. The questionnaire was focused on their satisfaction with specific aspects of the class. Descriptive statistics were performed to summarize participants' response. In Phase Two, six of the original 40 women were purposely selected for a semi-structured interview pertaining to the perceived effect of the childbirth education class on their labour experience. Thematic analysis was conducted on the interview data.

FINDINGS

The participants expressed overall satisfaction with the class. The area that satisfied them the most was the performance of the midwife. The areas that satisfied them the least were the date, length, size and time of the class. Three themes emerged from the interview data, namely, 'learning about labour', 'contributing to a smooth labour process' and 'coping with uncertainty and handling anxiety.

CONCLUSION

This study supports using a mixed-method approach to evaluate client education activity, and highlights the importance of cultivating positive coping measures among the Chinese women after attending childbirth education class when facing childbirth-related anxiety.

The role of traditional confinement practices in determining postpartum depression in women in Chinese cultures: a systematic review of the English language evidence

BACKGROUND

The Chinese postpartum custom of "confinement" or "doing-the-month" involves formalised social support and recognition of the status of motherhood and has been presumed in anthropological literature to protect mothers of newborns from postpartum depression. The aim of this review was to examine systematically the evidence about the relationship between confinement practices and postpartum depression in Chinese cultures.

METHODS

A systematic search of the English-language literature.

RESULTS

Sixteen studies met inclusion criteria. It was found that the role of confinement in postpartum depression is complex: eight studies concluded that it had a protective role; four that it increased risk of postpartum mood disturbance and four studies had inconclusive findings. Aspects of the confinement practice that could contribute to or fail to protect against postpartum depression include the generally diminished social support in contemporary society, conflict with a mother-in-law and the tension experienced by modern women as they work to balance traditional with contemporary values.

LIMITATIONS

Methodological differences limit meaningful comparisons between the reviewed studies and generalizations from them.

CONCLUSIONS

There is little consistent evidence that confinement practices reduce postpartum depression in Chinese cultures. Specific components of confinement practices might reduce psychological distress in Chinese mothers of newborns, but these cannot be discerned from the existing evidence. Confinement cannot be presumed to be available to, welcomed by or effective for all Chinese women or to be a substitute for health service provision.