Learning needs of postpartum women: does socioeconomic status matter?

[Medical recommendations from primary care on physical exercise in the postpartum]

There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.

Obstetric Provider Perspectives on Postpartum Patient Navigation for Low-Income Patients

BACKGROUND

Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients.

METHOD

Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method.

RESULTS

Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks.

CONCLUSIONS

Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.

Primary Care Clinician Perspectives on Patient Navigation to Improve Postpartum Care for Patients with Low Income

Background

Birthing individuals experience significant physical and psychosocial transitions during the postpartum period. Despite amplified health needs, many individuals do not successfully transition from obstetric to primary care. Patient navigation provides a patient-centered solution that has been applied to other health care specialties resulting in improved care coordination and patient engagement for populations in greatest need. Our objective was to understand primary care clinician perspectives regarding the role of navigators in improving postpartum care for individuals with low income.

Methods

In this qualitative investigation, we conducted focus groups with primary care clinicians from family and internal medicine specialties. Semistructured interview guides addressed clinician perceptions of navigator roles during the postpartum period and recommendations for navigator training. Focus group discussions were digitally recorded, transcribed, and analyzed via a constant comparative method.

Results

Twenty-eight primary care clinicians, including 26 physicians and 2 advanced practice registered nurses, participated in 8 focus groups. Participants reported favorable attitudes toward implementation of a postpartum patient navigation program. Themes regarding useful navigation services included streamlining obstetric to primary care transition, enhancing visit effectiveness, creating personalized postpartum care, and providing patient- and clinician-focused education. Recommendations for navigator training included education on basic medical concerns that are common in the postpartum period, health information privacy and electronic health record use, health care systems, and community resources.

Clinical Trial Registration number: NCT03922334.

Conclusions

Primary care clinicians were highly receptive to the concept of patient navigation as a process to improve health in the postpartum period through enhanced care coordination and improved patient knowledge, engagement, and self-efficacy.

Postpartum care promotion based on maternal education needs: A mixed study

BACKGROUND:

The postpartum period can be considered as one of the most sensitive stages of life in different countries; however, it is inadequate in many developed and developing countries. We aimed to determine the educational needs of mothers in the postpartum period in Bojnourd.

MATERIALS AND METHODS:

This study was conducted in Bojnourd 2019 with two parts: a qualitative part using the content analysis method and a quantitative part using the descriptive cross-sectional method. Data were collected 45 interviews with women, spouses, and key informants. All content was recorded and fully transcribed on paper. MaxQda10software was used for the data management. A simultaneous descriptive cross-sectional study was done including 250 pregnant in the third trimester (25.6%), in the first 48 h after delivery (24.4%), in the first 6 months after delivery (24.4%), and in the second 6 months after childbirth (25.6%) who referred to five health centers in Bojnourd to receive midwifery care. Quota sampling was performed for each center according to the population covered, and convenient sampling was done in each center.

RESULTS:

In the qualitative study, educational needs were classified into four main categories, including “maintaining and restoring physical health,” “sexual health needs,” “mental health needs,” and “educational barriers.” In the quantitative study, according to the findings, the most educational needs among mothers were self-care and breastfeeding and the best time for teaching was during the pregnancy, and the best method was face-to-face training and the best source of information was midwives and gynecologists.

CONCLUSION:

Attention to the educational needs of each region can be done through various training courses and continuous retraining to promote health provider and should be considered in the planning officials.

Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals

Background: Recent paradigm shifts in postpartum care have conceptualized the “fourth trimester” as a critical transitional period requiring tailored, ongoing health care. However, this concept presents challenges for providers, especially in low-resource settings. Our objective was to understand providers' perspectives on challenges in postpartum care to highlight strategies for optimizing care.

Methods: Focus groups were conducted using a semistructured interview guide to elicit perspectives on barriers and facilitators to postpartum care. Participants included physicians, nurses, and social workers who care for low-income postpartum individuals. Interviews explored the provider experience of postpartum care, with a focus on barriers experienced by patients and providers, and tools for maintaining engagement. Analysis was performed using the constant comparative method and framed by the Social Ecological Model.

Results: Participants (N = 26) all acknowledged the importance of the “fourth trimester” but identified multiple barriers to providing optimal postpartum care. Challenges providers perceived for patients and those they perceived for themselves often overlapped, including difficulty with appointment scheduling, insurance limitations, lack of provider continuity, and knowledge gaps. Providers identified ease of referrals to specialists, access to tangible services (e.g., contraception), and enhanced care coordination (e.g., patient navigation) as potential facilitators of improved postpartum care.

Conclusions: Obstetric providers recognize the importance of postpartum care yet highlighted significant systems- and patient-based barriers to achieving optimal care. The development and implementation of postpartum care delivery system redesign, such as the use of patient navigators to improve health care utilization and resource attainment, may enhance care during this critical time. Clinical Trial No.: NCT03922334.

Identifying maternal needs following childbirth: comparison between pregnant women and recent mothers

Background

The postnatal period is associated with new needs for mothers. Four categories of needs were highlighted in a previous study: for information, for psychological support, for the sharing of experiences and for practical and material support. To ensure that these four needs are inherent to the postpartum period, the aims of this study is to examine these needs by comparing recent mothers’ needs with the needs of pregnant women.

Methods

The 4 needs previously identified were cross-sectionally investigated by online self-reported questionnaires completed by women in their last trimester of pregnancy and by mothers who had a child between 0 and 6 months of age.

Results

The 4 needs were largely present during the postpartum period. The need for information seemed to be more present during pregnancy (92.4 %) than during the postpartum period (84.6 %, p = 0.03), but women used the Internet significantly more often to search for information after childbirth (54.8 %) than during pregnancy (41.2 %, p < 0.0001). The needs for psychological support and to share experiences seemed to be closely linked. Even if the global satisfaction with psychological support was fairly high, it weakened after childbirth (p < 0.05). Feelings of loneliness (p < 0.0001) and depression scores (p = 0.01) were also higher during the postpartum period than during pregnancy. Finally, the need for practical support was also more pronounced during the postpartum period than during pregnancy (p = 0.01).

Conclusions

All mothers seem to meet the 4 identified needs during the postpartum period but at different levels of intensity. Trying to meet these needs could offer an opportunity to improve mothers’ quality of life.

Relationship between stressors, stress reactions and hardiness in Japanese mothers of early neonatal babies: A cross-sectional study

AIM

Mothers of early neonatal babies are often in stressful situations. The stress of child rearing has been reported to influence the mental health of mothers. Hardiness, one of the individual factors affecting the cognitive evaluation of stress, may relate to stress for mothers of early neonatal babies. The aim of the present study is to clarify the relationship between stressors, stress reactions and hardiness of mothers with early neonatal babies.

METHODS

We conducted a cross-sectional study using self-administered questionnaires. Survey items included demographic characteristics, hardiness, stressors, and stress reactions. A total of 226 mothers returned the completed questionnaire. Data analyzed correlation, t tests and multiple regression using SPSS 24.0.

RESULTS

The mothers' hardiness was not related to their demographic characteristics. Hardiness had a negative correlation with stressors and stress reactions. Hardiness mitigated especially anxiety/uncertainty and depression/feeling of insufficiency. Compared with those with high levels of hardiness, mothers with low hardiness exhibited higher levels of newborn baby stressors, breast-feeding stressors, anxiety/uncertainty and depression/feeling of insufficiency.

CONCLUSION

Hardiness showed a buffering relationship with stressors and stress reactions, especially anxiety. Understanding hardiness levels may be useful for choosing which nursing care methods are implemented as each mother begins child rearing.

Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes

Introduction:

The postpartum period represents the time of risk for the emergence of maternal postpartum depression. There are no systematic reviews of the overall maternal outcomes of maternal postpartum depression. The aim of this study was to evaluate both the infant and the maternal consequences of untreated maternal postpartum depression.

Methods:

We searched for studies published between 1 January 2005 and 17 August 2016, using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane Pregnancy and Childbirth Group trials registry.

Results:

A total of 122 studies (out of 3712 references retrieved from bibliographic databases) were included in this systematic review. The results of the studies were synthetized into three categories: (a) the maternal consequences of postpartum depression, including physical health, psychological health, relationship, and risky behaviors; (b) the infant consequences of postpartum depression, including anthropometry, physical health, sleep, and motor, cognitive, language, emotional, social, and behavioral development; and (c) mother–child interactions, including bonding, breastfeeding, and the maternal role.

Discussion:

The results suggest that postpartum depression creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. It therefore seems important to detect and treat depression during the postnatal period as early as possible to avoid harmful consequences.

Informed choice or guessing game? Understanding caregivers’ perceptions and use of infant formula labelling

Objective

Although breast-feeding is the recommended way to feed an infant, a safe and nutritious substitute for breast milk is needed for infants who are not breast-fed. Labelling information on infant formula (IF) products aims to enable caregivers (who have already made the decision to use IF) to make informed product choices. Yet, there is limited data on how caregivers understand and use the information provided on IF packaging. The present study aimed to increase understanding of caregivers’ interpretation and use of the following label elements on IF products: the nutrition information statement; the ingredients list; and statements around nutrition content and health claims.

Design

Qualitative data were obtained from twenty-one focus group discussions. To enable comparison of findings by education level and ethnicity, focus group participants were homogeneous with respect to educational attainment (Australian groups) or ethnic background (New Zealand groups).

Setting

Focus groups were conducted in metropolitan and regional areas of Australia and New Zealand.

Participants

Caregivers (n 136) of formula-fed infants.

Results

Framework analysis revealed that caregivers commonly experience difficulties when using labelling information, particularly when trying to identify and understand key differences between products. Moreover, comparing products can be a complex task regardless of education level and ethnicity.

Conclusions

Further research is required to determine the most effective strategies for meeting information needs of caregivers and allowing easier identification and understanding of product differences. This is especially important given that the vast range of IF products across large price ranges in the market adds to the complexity of purchase decisions.

Mothers' Facebook posts about infant health: findings from the Grow2Gether study

BACKGROUND

Social media is a common way for mothers to seek advice about their infants. However, little is known about how low-income urban mothers use social media to obtain infant health information and whether this information is consistent with expert pediatric recommendations.

OBJECTIVES

(1) identify the types of health questions asked by low-income mothers of infants in a social media parenting group; (2) describe whether peer answers are consistent with or contradict AAP guidelines; (3) identify the practices that mothers post about that are inconsistent with AAP guidelines.

METHODS

Forty-three low-income mothers were enrolled in Grow2Gether, a private Facebook group intervention focused on infant care and moderated by a psychologist. All health questions posted by mothers were coded thematically; answers to questions from the group were assessed for consistency with American Academy of Pediatrics (AAP) guidelines related to infant feeding, sleep, screen time, and safety. Additionally, all unique posts that contained practices inconsistent with these AAP guidelines were thematically coded.

RESULTS

In total, 215 posts were coded. Participants posted 61 questions related to infant health, most commonly solid food introduction (8/61), teething (8/61), and breastfeeding (7/61). Of the 77 answers given by peers, 6 contradicted guidelines. Separately, mothers had 73 posts demonstrating practices inconsistent with AAP guidelines [safe sleep (43/73) and screen time (21/73)].

CONCLUSIONS

Mothers' Facebook group interactions in the context of an infant care intervention revealed that when mothers posed direct questions regarding infant health, their peers generally gave answers that did not contradict AAP guidelines. In contrast, mothers' posts simply describing sleep and screen time practices commonly contradicted guidelines.

The "Happy-Mums" website dedicated to the perinatal period: Evaluation of its acceptability by parents and professionals

OBJECTIVE

Pregnancy and childbirth are associated with new needs for mothers, especially an eagerness for information. The aim of this study was to evaluate whether the Happy-Mums.be website meets the expectations and needs of its future users.

DESIGN

After the development of the Happy-Mums.be website, it was submitted to parents and professionals and evaluated by an online survey, which consisted of the third round of an ongoing Delphi survey.

SETTING AND PARTICIPANTS

The panel involved in the survey included parents (both mothers and fathers) and professionals (health professionals and early childhood professionals, orbiting mothers of children aged 0-2 years).

FINDINGS

Twenty-eight parents and professionals participated in the third round of the Delphi survey. The participants indicated that Happy-Mums.be was useful and easy to use. They attributed a mean score of 8 out of 10 for the content, design and quality of the information on the Happy-Mums.be website. The majority of participants said that they would recommend the website both during pregnancy and the postnatal period.

CONCLUSIONS

Happy-Mums.be meets the needs and expectations of parents and professionals in terms of both content and design. More specifically, the quality of the information found on Happy-Mums.be was judged to be significantly better than the information found on other websites.

Postpartum Health Information Seeking Using Mobile Phones: Experiences of Low-Income Mothers

Objectives To assess low-income mothers' perceptions of their postpartum information needs; describe their information seeking behavior; explore their use of mobile technology to address those needs; and to contribute to the sparse literature on postpartum health and wellness. Methods Exploratory community-based qualitative approach. Interviewees were recruited among clients of community partners and had children aged 48 months and under. A survey assessing demographics was used to identify low-income mothers. 10 low-income mothers were recruited from survey participants to complete in-depth interviews regarding postpartum information needs, information seeking, and technology use. Interviews were transcribed verbatim and coded by three researchers independently. Narratives were analyzed along predetermined (etic) and emergent (emic) categories. Results Establishing breastfeeding and solving breastfeeding problems were central postpartum concerns leading to information seeking. Interviewees reported almost exclusive use of mobile phones to access the Internet. Mobile applications were widely used during pregnancy, but were not valuable postpartum. Face-to-face information from medical professionals was found to be repetitive. Online information seeking was mediated by default mobile phone search engines, and occurred over short, fragmented time periods. College graduates reported searching for authoritative knowledge sources; non-graduates preferred forums. Conclusions for Practice Low-income postpartum women rely on their smartphones to find online infant care and self-care health information. Websites replace pregnancy-related mobile applications and complement face-to-face information. Changes in searching behavior and multitasking mean information must be easily accessible and readily understood. Knowledge of page-rank systems and use of current and emergent social media will allow health-related organizations to better engage with low-income mothers online and promote evidence-based information.

Effect of educational package on lifestyle of primiparous mothers during postpartum period: a randomized controlled clinical trial

A healthy lifestyle is important for mothers during the postpartum period. This study was conducted to determine the effects of a lifestyle educational package in primiparous women. This randomized clinical trial was conducted on 220 mothers assigned to two groups using block randomization. In the intervention group, the mothers received face-to-face, phone and SMS counseling and a booklet in addition to routine postpartum training; in the control group, the mothers received only routine training. The Health Behaviors Questionnaire, a Food Frequency Questionnaire and the International Physical Activity Questionnaire were used for data collection. There were no significant differences between the two groups 6 weeks after delivery in terms of physical activity level and nutritional status (P > 0.05) except for the mean consumption of milk and dairy, which was higher in the intervention group (P = 0.041). Training significantly improved certain health behaviors in the intervention group compared to the controls, such as the first time brushing the teeth after delivery, the frequency of sun exposure, the frequency of ventilating the home, keeping warm and iron supplementation. The training provided positively affected certain health behaviors in the mothers; however, it failed to improve their physical activity level and nutritional status.

Support for new mothers and fertility in the United Kingdom: Not all support is equal in the decision to have a second child

Low fertility across Europe highlights the need to understand reproductive decisions in high-income countries better. Availability of support may be one factor influencing reproductive decisions, though within high-income countries availability varies between environments, including socio-economic environments. We test whether receiving higher levels of support, from different sources (informal and formal) and of different types (practical and emotional), is positively correlated with second births in the United Kingdom (UK) Millennium Cohort Study, and whether these relationships differ by socio-economic position (SEP). Our hypothesis is only partially supported: receiving emotional support correlates with higher likelihood of second birth, but the opposite is true for practical support. Availability of different types of support varies across SEP, but relationships between support and fertility are similar, with one exception: kin-provided childcare increases the likelihood of birth only among lower-SEP women. Our results highlight that not all support is equal in the decision to have a second child.

e-Health and new moms: Contextual factors associated with sources of health information

OBJECTIVE

Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors.

DESIGN AND SAMPLE

Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample.

MEASURES

Use of online media about mother-baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education.

RESULTS

Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother-baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messaging (χ² statistics, p < .001). Stress and race/ethnicity were among factors associated with preferences.

CONCLUSIONS

Mothers widely used e-Health related media, but use was associated with contextual factors. In public health efforts to reach new mothers, partnering with mother-favored Web sites, focusing on audience-relevant media, and adopting attributes of successful sites are recommended strategies.

What should a website dedicated to the postnatal period contain? A Delphi survey among parents and professionals

OBJECTIVES

Mothers have a great need for information during the postnatal period. Trying to meet this need, mothers are increasingly turning to the Internet. Nevertheless, many women have stated that they often or always found that the information that they found on the Internet was incomplete or wrong. Many women therefore believe that health professionals should suggest reliable Internet websites for new mothers. The aim of this study was therefore to find a consensus on the content of a reliable and centralized website dedicated to mothers from the end of pregnancy to 1 year after childbirth.

DESIGN

Two rounds of an online Delphi survey were used in this study.

SETTING AND PARTICIPANTS

The panel of participants involved in the survey included parents (both mothers and fathers) and professionals (health professionals and professionals of early childhood for mothers of children aged 0 to 2 years).

FINDINGS

Ninety-six parents and professionals participated in the first round (37.7 ± 9.76 years; 84.4% of women) and 78 in the second round. The majority of participants (94.6%) thought that a centralized website could help mothers from pregnancy to one year after childbirth. The content that the experts would like to find on a website were themed into five categories: "infants' information", "parents' information", "administrative information", "professionals' information" and "type of resources". In each category, experts highlighted the key words that they found important and should be reported on the website. The most important items highlighted by participants were baby's feeding/breastfeeding (92.8%), babies' needs (84.1%), baby blues (77.9%), postpartum depression (72.1%), management of the couple's relationship (72.1%), women's right to postnatal care (83.6%), links to reliable documents (63.9%) and a list of useful contacts (52.5%).

CONCLUSIONS

This study helped to understand the questions that mothers ask themselves during the postpartum period and provided priorities to respond to their questions in the process of developing a website.

Identifying maternal needs following childbirth: A qualitative study among mothers, fathers and professionals

BACKGROUND

Pregnancy and childbirth are two critical stages in a woman's life. Various studies have suggested that psychological distress is common during the year after childbirth. The objectives of this exploratory study were (1) to explore the needs of mothers in the year following childbirth; (2) to compare these needs between mothers who did not have the feeling of living a psychological disorder or a depression and mothers who lived a psychological disorder or had the impression of living a depression; and (3) to compare the needs expressed by mothers with the perception of professionals and fathers about the mothers' needs.

METHODS

First, we proceeded to 22 individual qualitative interviews followed by one focus group, with mothers, with and without experience of psychological distress. Then, we conducted 2 focus groups: one with professionals and one with fathers.

RESULTS

Needs of mothers after childbirth have been indexed in four categories: need of information, need of psychological support, need to share experience, and need of practical and material support. Women do not feel sufficiently informed about this difficult period of life. They do not feel sufficiently supported, not only from a psychological point of view but also from a more practical point of view, for example with household chores. They need to share their experience of life, they need to be reassured and they need to feel understood. It seems that some differences exist between mothers' and professionals' experiences but also between mothers' and fathers' experiences.

CONCLUSION

Young mothers apparently feel a lack of support at different levels in the year following childbirth. This study provides ways to meet women's needs and to try to prevent the risk of postpartum psychological distress during this period of time.

Understanding maternal postpartum needs: A descriptive survey of current maternal health services

AIM AND OBJECTIVE

To assess mothers' learning needs and concerns after giving birth and to examine whether these needs were met at 6-8 weeks postpartum.

BACKGROUND

Women experience many physiologic and psychological changes during postpartum period, which is considered a vital transitional time. Exploring and meeting women's needs help woman to pass this period with little complications and enhance healthcare provider's ability to provide appropriate care following childbirth.

DESIGN

A prospective cohort design was employed in this study.

METHODS

A prospective cohort design was employed. A convenience sample of 150 postpartum women have completed perceived leaning needs scale prior to hospital discharge, at southern region of Jordan, and have completed perceived met learning needs scale at 6-8 weeks after giving birth.

RESULTS

Women reported a high level of concern across all eight learning needs subscales. The most common concerns were related to new baby care, episiotomy care and breastfeeding. At 6-8 weeks postpartum, the primary unmet learning needs postpartum were danger signs post-Caesarean section, physical changes, breastfeeding and new baby care. Attending postpartum check-up clinic was found as a significant predictor for postpartum meeting women's needs, particularly emotional changes and family planning-related information.

CONCLUSIONS

The current maternal health services are not at the optimum level to meet women's individual needs and concerns, which could increase the risk for postpartum complications. Some women's characteristics, such as employment status and educational level, have increased women's concerns and unmet needs in some of the learning needs.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers and policymakers should consider women's concerns and needs at early postpartum period to establish patient-centred postpartum care that is based on women's needs and concerns during this transitional period, with a focus on newborn baby care, episiotomy care and breastfeeding.

Meeting the Needs of Mothers During the Postpartum Period: Using Co-Creation Workshops to Find Technological Solutions

BACKGROUND

The postnatal period is associated with many new needs for mothers.

OBJECTIVE

The aim of this study was to find technological solutions that meet the needs of mothers during the year following childbirth.

METHODS

Two co-creation workshops were undertaken with parents and professionals. The aim of the first workshop was to create a list of all the criteria the proposed solution would have to address to meet the needs of mothers after childbirth. The aim of the second workshop was to create solutions in response to the criteria selected during the first workshop.

RESULTS

Parents and health professionals want solutions that include empathy (ie, to help fight against the feelings of abnormality and loneliness), that help mothers in daily life, that are personalized and adapted to different situations, that are educational, and that assures some continuity in their contact with health professionals. In practice, we found that parents and professionals think the solution should be accessible to everyone and available at all times. To address these criteria, technology experts proposed different solutions, such as a forum dedicated to the postpartum period that is supervised by professionals, a centralized website, a system of videoconferencing, an online exchange group, a "gift voucher" system, a virtual reality app, or a companion robot.

CONCLUSIONS

The human component seems to be very important during the postnatal period. Nevertheless, technology could be a great ally in helping mothers during the postpartum period. Technology can help reliably inform parents and may also give them the right tools to find supportive people. However, these technologies should be tested in clinical trials.

Mind the Gap: Assessing the Disconnect Between Postpartum Health Information Desired and Health Information Received

INTRODUCTION

Seeking and receiving health information are critical aspects of prenatal and postpartum care; however, many informational sources lack postpartum content. This study explores the gaps between information desired and information received postpartum and identifies the sources women use for health information seeking, with an emphasis on emergent online and mobile phone-based resources.

METHODS

Participants were recruited from our community partners' client base for a cross-sectional study. Mothers (n = 77) of a child 48 months or younger completed a survey on health information seeking, health information needs, and technology use. Postpartum health information gaps were defined as topics about which a participant indicated that she wanted information, but did not receive information. Bivariate analyses assessed the association between demographic characteristics, sources of health information used during pregnancy, and postpartum information gaps.

RESULTS

Health care providers, Internet-based resources, and mobile applications were common sources of health information during pregnancy. Mental and sexual health were the most common types of postpartum health information gaps. In bivariate analyses, higher income and education were associated with postpartum information gaps in mental health and sexual health, respectively (p < .05).

CONCLUSIONS

Postpartum health information gaps were common in this sample, particularly for topics in mental and sexual health. Unexpected associations between higher levels of education and income and postpartum health information gaps were observed in bivariate analyses. Health educators have the opportunity to capitalize on high rates of Internet information seeking by providing health information online. Health care providers must incorporate mental and sexual health into routine postpartum care.

Identifying and Exploring the Informational and Emotional Support Needs of Primipara Women: A Focus on Supportive Communication

Primipara women may require greater informational and emotional support than multipara women. Supportive communication, including informational and emotional support, can help to build a strong caregiver-patient relationship and can alleviate the difficulties associated with first-time birth. The objective of this study was to explore first-time mothers' experiences of labor and birth. Three hundred primipara women completed self-report questionnaires. Qualitative analysis of one open-ended question about the women's experience was conducted. Nine themes emerged from the data. Eight themes reflected informational and emotional support needs, whereas the final theme reflected instrumental support needs. The study concluded that informational and emotional supports are important factors of supportive communication and influence the birthing experience of primipara women.

Pregnant women: What do they need to know during pregnancy? A descriptive study

BACKGROUND

Antenatal education programs provide women with essential knowledge and skills in various aspects of maternal and fetal health. Antenatal education is based on improving women's health, reducing the risks of complications and enhancing couples' positive experience during childbirth. There is a lack of formal antenatal educational programs based on women's needs in Jordan.

AIM

This study sought to identify and prioritize the learning needs for women during pregnancy.

METHODS

A descriptive cross-sectional design was employed. The study sample was recruited from three maternal and child health centers. Data were collected from a convenient sample of 150 pregnant women during their antenatal visits. One hundred and twenty three participants (response rate=82%) completed the self-reported antenatal learning needs questionnaire.

FINDINGS

Women identified their most important learning needs were related to managing major complications of pregnancy (mean=3.49, SD=0.78), investigations and physician follow-up visit during pregnancy (mean=3.42, SD=0.71), appropriate diet (mean=3.36, SD=0.84) and information about medication and supplements (mean=3.22, SD=0.97). Spearman correlation showed negative association between participants' age and physical (r=-0.536, p=0.015) and emotional concerns (r=-0.490, p=0.001). Women who had a diploma or higher degree reported greater concern regarding physical (median=4.00, IQR=3.00-4.00, p=0.047) and emotional changes (median=3.33, IQR=3.00-4.00, p=0.004). Finally, migrant participants showed greater significant concern regarding emotional changes and coping with minor complications.

CONCLUSION

A large proportion of pregnant women in this study reported a high degree of importance of specific learning topics that were closely relevant to their current period of pregnancy. The lack of focusing on issues related to maternal emotional status and possible complications suggests a need for a national strategy to provide antenatal education based on women's perceptions of their needs.

Psychometric properties of the Postpartum Women Health Quotient Scale among Chinese post partum women

OBJECTIVE

to examine the psychometric properties of a newly developed Postpartum Women's Health Quotient Scale (PWHQS) for Chinese post partum women.

DESIGN

a cross-sectional survey of post partum women was conducted.Categorical confirmatory factor analysis (CCFA) models were applied to examine the factorial structure of the PWHQS; test information function (TIF) was used to examine reliability of PWHQS subscales; and measurement invariance was examined by testing differential item functioning (DIF) using a multiple indicators multiple causes (MIMIC) model.

SETTING

two large hospitals with a level 3A designation in Suzhou, Jiangsu Province, China.

PARTICIPANTS

a convenience sample of 395 post partum women was recruited from April to September 2014.

MEASUREMENT

the PWHQS consists of 31 items with 5 subscales: health consciousness (HC, 6 items), maternal health knowledge (MHK, 8 items), infant health knowledge (IHK, 6 items), maternal health care ability (MHCA, 5 items), and infant health care ability (IHCA, 6 items).

FINDINGS

PWHQS has a valid factorial structure with five dimensions as theoretically designed. Each of its subscales has adequate reliability that is particularly high over the lower-moderate range of the factor score scale. Measurement non-invariance in PWHQS is very limited as only two of the 31 items displayed DIF related to one grouping variable (Age).

KEY CONCLUSION

PWHQS is a valid and reliable instrument that can be readily used as a screening tool to assess health quotient (HQ) among Chinese post partum women. PWHQS will also be useful for the development of interventions to help post partum women maintain and improve maternal and infant health. Further research to confirm the findings of the present study is desirable.

The Broken Thread of Health Promotion and Disease Prevention for Women During the Postpartum Period

Postpartum maternal health affects maternal functional status, future pregnancy outcomes, maternal chronic disease development, and infant health. After pregnancy, however, many mothers may find that they face gaps in care related to their health and caregiving roles. Research shows that they were unprepared, uninformed, and unsupported during the postpartum period as they struggle with physical and emotional symptoms, infant caregiving, breastfeeding concerns, and lifestyle adjustments. Limited follow-up after a diagnosis of gestational hypertension or gestational diabetes and screening for postpartum depression are additional gaps in preventive and supportive care. Integrative reviews revealed modest efficacy and limitations of recent postpartum health promotion and disease prevention interventions. System, clinical, and community strategies are identified to address these gaps in women's postpartum health services.

Successful early postpartum support linked to management, informational, and relational continuity

OBJECTIVE

to explore ways in which parents experience support from health professionals in the early postpartum period and understand how parenting support is related to management, informational, and relational continuity.

DESIGN

a qualitative study consisting of focus group interviews followed by deductive content analysis.

SETTING AND PARTICIPANTS

a large city in Sweden; 18 women and 16 men.

FINDINGS

study participants reported that parenting support occurs by providing consistent advice; indicating who to ask when care questions arise; enabling access to the care system when needs surface; providing sufficient information about self-management for mother or baby; involving parents in discharge planning; distributing information that empowers parents; enabling team/clinical care consistency; and appointing persons in the care system who can foster parents׳ feelings of trust--in short: by enabling management, informational, and relational continuity.

KEY CONCLUSIONS

care continuity experiences lead to perceived parenting support in the early postpartum period. Effective health care organisations within the postpartum care system must embody these types of continuity: management, informational, and relational. There is a need for researchers to design tools for measuring continuity and for policymakers to enable coherence and co-ordination among professionals.

IMPLICATIONS FOR PRACTICE

identify parents׳ needs so that health professionals can plan for parents׳ first few weeks at home and ensure that parents get access to appropriate care.

Low-income, urban minority women's perceptions of self- and infant care during the postpartum period

OBJECTIVE

To describe low-income, urban, first-time mothers' perceptions about self-care and infant care during the first 6-months postpartum.

DESIGN

Naturalistic approach.

SETTING

Recruitment from community centers and churches.

PARTICIPANTS

Thirteen Hispanic and African American women who delivered their first infants within the past 6 months.

METHODS

Demographic and health information data were collected and analyzed using descriptive statistics. Semistructured interviews were conducted; data were coded and then clustered conceptually into categories.

RESULTS

Postpartum maternal self- and infant care issues included four categories: preparedness for discharge, confidence and satisfaction with mothering, concerns about infant care, and indifference to maternal self-care. Women were confident in caring for themselves and their infants and reported few unmet learning needs or health concerns. External sources of stress included finances, uncertain living arrangements, and relationship issues.

CONCLUSION

Health care providers who care for low-income postpartum women need to acknowledge the influence of external stressors that contribute to health outcomes in this population. It is vital that nurses collaborate with other health care providers to make certain that community connections are made for women who might need additional services beyond the postpartum check-up visit.

Summary of international guidelines for physical activity after pregnancy

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety. This review summarizes current guidelines for postpartum physical activity worldwide. PubMed (MEDLINE) was searched for country-specific government and clinical guidelines on physical activity after pregnancy through the year 2013. Only the most recent guideline was included in the review. An abstraction form facilitated extraction of key details and helped to summarize results. Six guidelines were identified from 5 countries (Australia, Canada, Norway, United Kingdom, and United States). All guidelines were embedded within pregnancy-related physical activity recommendations. All provided physical activity advice related to breastfeeding and 3 remarked about physical activity after cesarean delivery. Recommended physical activities mentioned in the guidelines included aerobic (3/6), pelvic floor exercise (3/6), strengthening (2/6), stretching (2/6), and walking (2/6). None of the guidelines discussed sedentary behavior. The guidelines that were identified lacked specificity for physical activity. Greater clarity in guidelines would be more useful to both practitioners and the women they serve. Postpartum physical activity guidelines have the potential to assist women to initiate or resume physical activity after childbirth so that they can transition to meeting recommended levels of physical activity. Health care providers have a critical role in encouraging women to be active at this time, and the availability of more explicit guidelines may assist them to routinely include physical activity advice in their postpartum care.

Knowledge, attitudes, and behaviors of low-income women considered high priority for receiving the novel influenza A (H1N1) vaccine

The primary purpose of this qualitative study was to explore the knowledge, attitudes, and behaviors of low-income women considered high priority for receiving the novel influenza A (H1N1) vaccine to improve communication in emergency preparedness and response. Researchers sought to identify the factors that affect this high priority population's ability to successfully comply with vaccination recommendations. By utilizing an existing communication framework through the special supplemental nutrition program for women, infants, and children (WIC) they were able to document the systems and infrastructure needed to foster constructive responses in a sustainable manner in the future. Six focus group discussions with WIC clients (n = 56) and 10 individual interviews with staff members were conducted at two WIC clinics in Georgia (1 urban and 1 rural). Data were collected after the 2009-2010 influenza season and analyzed using thematic analysis. Knowledge and attitudes regarding H1N1 differed among participants with regard to perceived severity and perceived risk of influenza illness. Participants identified several barriers and motivators to receiving the vaccination, as well as information needs, sources, and information-seeking behaviors. Similarities emerged among both WIC clients and staff members regarding impressions of H1N1 and the vaccine's use, suggesting that while the information may be provided, it is not effectively understood or accepted. Comprehensive education, policy and planning development regarding pandemic influenza and vaccine acceptance among low-income women is necessary, including improvements in risk communication messages and identifying effective methods to disseminate trusted information to these high priority groups.

Improving quality and efficiency of postpartum hospital education

The purpose of this study was to investigate the implementation of an evidence-based, streamlined, education process (comprehensive education booklet, individualized education plan, and integration of education into the clinical pathway) and nurse education to improve the quality and efficiency of postpartum education during hospitalization. A one-group pretest-posttest design was used to measure the quality of discharge teaching for new mothers and efficiency of the education process for registered nurses before and after implementation of an intervention. Results indicated that a comprehensive educational booklet and enhanced documentation can improve efficiency in the patient education process for nurses.

Primiparous and multiparous mothers' perceptions of social support from nursing professionals in postnatal wards

OBJECTIVE

the study aimed at evaluating primiparous or multiparous mothers' perceptions of social support from nursing professionals (SSNP) in postnatal wards and factors associated with SSNP.

DESIGN

a cross-sectional and correlational design was used.

METHODS

data was collected in 2007-2008 in two maternity hospitals with a convenience sample of Finnish-comprehending primiparous and multiparous mothers (N=1300). Multiple-birth and early discharge mothers were excluded. The amount of SSNP including affection, affirmation and concrete aid was measured. Questionnaires were returned from 754 mothers (58%). Fisher's exact test, t-test, Pearson's correlation coefficients, ordinal regression and multiple regression were used in the analyses.

FINDINGS

mothers perceived the amount of SSNP as moderate. The amount of affirmational support was perceived as the highest compared with concrete and affectional support. Multiparas received statistically significantly less concrete aid compared with primiparas. The number of mother- and infant-related factors was substantial and their association was stronger among primiparas. Depressive symptoms were a significant factor among multiparas. Advice from nursing professionals, parenting self-efficacy, mother's age and infant age explained 54.0% of the variation in SSNP for primiparas. Correspondingly, advice from nursing professionals, state of mind on hospital discharge and family functioning explained 49.3% of the variation in SSNP for multiparas.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

primiparas that are vulnerable for a scarce amount of SSNP were easier to recognise on the basis of their background information, infant characteristics, childbirth-related factors, and sense of efficacy. Challenges lie in taking into account the whole family, especially among multiparas, and in developing professionals' guidance skills. Among primiparas the model of postpartum care may matter. Our results give professionals a better understanding of the resources and challenges faced by mothers in order to develop postnatal SSNP.

Examining the pathways of pre- and postnatal health information

OBJECTIVES

The objectives of our study were to 1) assess Canadian women's health information levels regarding pre- and postnatal topics in both primiparous and multiparous samples, and 2) identify factors associated with levels of health information in both groups and the pathways of such associations.

METHODS

Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N=6,421) were used. The study population included mothers ≥15 years of age at the time of the birth, who had a singleton live birth in Canada during a three-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Structural equation modeling was used to identify and examine pre- and postnatal acquired health information components in both samples and to assess factors that may influence this level of information.

RESULTS

Primiparous and multiparous women perceived insufficient levels of information on similar topics: pain medication/anesthesia, warning signs/complications, formula feeding and changes in sexual responses. This common finding underscored that these informational needs had a large impact on the entire population of pregnant women, rather than being parity-specific. Level of perceived social support was positively associated with information acquisition on all health topics studied in both samples (p&lt;0.0001 for both). Income was also positively associated with information levels to a similar extent on a range of topics in both samples (p&lt;0.0001 - p&lt;0.05).

CONCLUSIONS

Canadian primiparous and multiparous women perceived an inadequate level of information on the same topics, identifying knowledge gaps that should be addressed. Perceived level of social support and income significantly influenced information levels on pre- and postnatal health topics. Therefore women with low income and those with perceived lack of social support may be identified by health care providers as requiring additional health information.

Social support and online postpartum depression discussion groups: a content analysis

OBJECTIVE

Social support has a positive influence on women's childbearing experience and is shown to be a preventive factor in postpartum depression. This study examined the perceived value and types of social supports that characterize the discussions of women who participate in postpartum depression online discussion groups.

METHODS

A directed content analysis was used to examine 512 messages posted on a postpartum depression online support group over six months.

RESULTS

The majority of the women's postings illustrated emotional support followed by informational and instrumental support.

CONCLUSIONS

Online support groups provide women experiencing postpartum depression a safe place to connect with others and receive information, encouragement and hope.

PRACTICE IMPLICATIONS

Education strategies are needed to address the many questions regarding PPD medical treatment. Recommending vetted links to PPD online support groups will create opportunities for women to share their experiences and obtain support.

The effect of early postpartum home visits by health visitors: a natural experiment

OBJECTIVE

The purpose of this study was to assess if the absence of early home visits influenced the mothers' breastfeeding duration and use of medical services.

DESIGN

Data from mothers who had given birth during a strike period were compared with data from a reference period with usual work practice.

SAMPLE

The study included 3,834 newborn and 375 health visitors, 75 of whom worked during the strike period.

INTERVENTION

All families were offered nonstandardized home visits after discharge in the reference period. During the strike, the service was based on individual risk assessment.

RESULTS

Overall, no difference in breastfeeding duration between the two periods was seen, but unvisited mothers in the strike period had shorter durations of full breastfeeding than a comparable group of mothers in the reference period (p < .005). Moreover, mothers in the strike period reported a significantly higher use of medical services. The mothers' needs for postnatal visits differed depending on parity: primiparae underlined uncertainty, multiparae underlined previous breastfeeding experience. Mothers had missed out on guidance on all areas of the health visitors' service.

CONCLUSION

Nonstandardized home visits by health visitors were associated with a longer breastfeeding duration. The postnatal visits depended on parity and unmet needs increased the use of medical services.

Measuring Patient Satisfaction With Postpartum Teaching Methods Used by Nurses Within the Interaction Model of Client Health Behavior

The purpose of this study was to determine the relationship between new mothers’ interaction with nurses using different teaching methods to provide postpartum discharge teaching and their satisfaction with nursing care. Cox’s Interaction Model of Client Health Behavior (IMCHB) provided the framework for this study. This study used a quasi-experimental posttest design with two groups to examine patient satisfaction with different teaching methods used by nurses to provide postpartum education. The Modified Client Satisfaction Tool measured satisfaction with discharge teaching. Data were analyzed with descriptive statistics, chi-square, Kendall’s tau, and Mann-Whitney U tests. The data showed high satisfaction scores for new mothers receiving both methods of discharge teaching, indicating that new mothers who received the traditional method of discharge instruction provided by nurses were just as satisfied as those who received the demonstration/return demonstration method of discharge instructions provided by nurses. Providing individualized care, based on the expressed needs of the patient, was demonstrated in this study to result in high satisfaction with nursing care using both methods of providing postpartum discharge teaching.

Immigrant and refugee women's post-partum depression help-seeking experiences and access to care: a review and analysis of the literature

ACCESSIBLE SUMMARY

• This literature review on post-partum depression (PPD) presents an analysis of the literature about PPD and the positive and negative factors, which may influence immigrant and refugee women's health seeking behaviour and decision making about post-partum care. • A critical review of English language peer-reviewed publications from 1988 to 2008 was done by the researchers as part of a qualitative research study conducted in a western province of Canada. The overall goal of the study is to raise awareness and understanding of what would be helpful in meeting the mental health needs of the immigrant and refugee women during the post-partum period. • Several online databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE (Ovid), EBM Reviews - Cochrane Database of Systematic Reviews. • Review of the literature suggests: 1 Needs, issues and specific risk factors for PPD among immigrant and refugee women have been limited. 2 Descriptive accounts regarding culture and PPD are found in the literature but impact of cultural factors upon PPD has not been well studied. 3 Few studies look at how social support, gender, and larger institutions or organizational structures may affect immigrant and refugee women's help-seeking and access to mental health care services. 4 More research is needed to hear the immigrant and refugee women's ideas about their social support needs, the difficulties they experience and their preferred ways of getting help with PPD.

ABSTRACT

This review and analysis of the literature is about the phenomenon of post-partum depression (PPD) and the barriers and facilitators, which may influence immigrant and refugee women's health seeking behaviour and decision making about post-partum care. As part of a qualitative research study conducted in a western province of Canada a critical review of English language peer-reviewed publications from 1988 to 2008 was undertaken by the researchers. The overall goal of the study is to raise awareness and understanding of what would be helpful in meeting the mental health needs of the immigrant and refugee women during the post-partum period. Several online databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE (Ovid), EBM Reviews - Cochrane Database of Systematic Reviews. Findings suggest: (1) needs, issues and specific risk factors for PPD among immigrant and refugee women have been limited; (2) descriptive accounts regarding culture and PPD are found in the literature but impact of cultural factors upon PPD has not been well investigated; (3) few studies examine how social support, gender, institutional and organizational structures present barriers to the women's health seeking behaviour; and (4) additional research is required to evaluate immigrant and refugee women's perspectives about their social support needs, the barriers they experience and their preferred support interventions.

Adaptation, postpartum concerns, and learning needs in the first two weeks after caesarean birth

AIMS

The purpose of this Roy Adaptation Model-based study was to describe women's physical, emotional, functional and social adaptation; postpartum concerns; and learning needs during the first two weeks following caesarean birth and identify relevant nursing interventions.

BACKGROUND

Studies of caesarean-delivered women indicated a trend toward normalisation of the caesarean birth experience. Escalating caesarean birth rates mandate continued study of contemporary caesarean-delivered women.

DESIGN

Mixed methods (qualitative and quantitative) descriptive research design.

METHODS

Nursing students collected data from 233 culturally diverse caesarean-delivered women in urban areas of the Midwestern and Northeastern USA between 2002-2004. The focal stimulus was the planned or unplanned caesarean birth; contextual stimuli were cultural identity and parity. Adaptation was measured by open-ended interview questions, fixed choice questionnaires about postpartum concerns and learning needs and nurse assessment of post-discharge problems. Potential interventions were identified using the Omaha System Intervention Scheme.

RESULTS

More positive than negative responses were reported for functional and social adaptation than for physical and emotional adaptation. Women with unplanned caesarean births and primiparous women reported less favourable adaptation than planned caesarean mothers and multiparas. Black women reported lower social adaptation, Hispanic women had more role function concerns and Black and Hispanic women had more learning needs than White women. Post-discharge nursing assessments revealed that actual problems accounted for 40% of identified actual or potential problems or needs. Health teaching was the most commonly recommended postpartum intervention strategy followed by case management, treatment and surveillance interventions.

CONCLUSIONS

Caesarean-delivered women continue to experience some problems with adapting to childbirth. Recommended intervention strategies reflect the importance of health teaching following hospital discharge.

RELEVANCE TO CLINICAL PRACTICE

Women who experience caesarean birth require comprehensive assessment during the early postpartum period. Nurses should devise strategies to continue care services for these women following hospital discharge.

Physical activity beliefs, barriers, and enablers among postpartum women

BACKGROUND AND METHODS

Physical activity during postpartum is both a recommended and an essential contributor to maternal health. Understanding the beliefs, barriers, and enablers regarding physical activity during the postpartum period can more effectively tailor physical activity interventions. The objective of this study was to document self-reported beliefs, barriers, and enablers to physical activity among a cohort of women queried at 3 and 12 months postpartum. Five questions about beliefs and two open-ended questions about their main barriers and enablers regarding physical activity and exercise were asked of 667 women at 3 months postpartum. Among the sample, 530 women answered the same questions about barriers and enablers to physical activity at 12 months postpartum.

RESULTS

Agreement on all five beliefs statements was high (>or=89%), indicating that women thought that exercise and physical activity were appropriate at 3 months postpartum, even if they continued to breastfeed. For the cohort, the most common barriers to physical activity at both 3 and 12 months postpartum were lack of time (47% and 51%, respectively) and issues with child care (26% and 22%, respectively). No barrier changed by more than 5% from 3 to 12 months postpartum. For the cohort, the most common enablers at 3 months postpartum were partner support (16%) and desire to feel better (14%). From 3 to 12 months postpartum, only one enabler changed by >5%; women reported baby reasons (e.g., baby older, healthier, not breastfeeding, more active) more often at 12 months than at 3 months postpartum (32% vs. 10%). Environmental/policy and organizational barriers and enablers were reported less often than intrapersonal or interpersonal barriers at both time points.

CONCLUSIONS

A number of barriers and enablers were identified for physical activity, most of which were consistent at 3 and 12 months postpartum. This study provides information to create more successful interventions to help women be physically active postpartum.

Information-seeking and its predictors in low-income pregnant women

This study examined information-seeking and its predictors (information needs and barriers) in low-income pregnant women. Eighty-four pregnant women from a prenatal clinic were interviewed using three scales that measured the frequency of information-seeking from eight different sources, information needs for 20 pregnancy health topics, and 15 barriers to seeking information, respectively. Most women were black, unmarried, between 20 and 29 years of age, high school educated or less, multigravidas, and in their third trimester of pregnancy. Information needs and barriers were significant predictors of information-seeking. Together, they explained 26% of the variance in the seeking outcome. High information needs and low barriers predicted more frequent information-seeking. First pregnancy and asthma during pregnancy were significant covariates for information-seeking. Information needs and barriers are related to information-seeking among low-income pregnant women. To facilitate pregnant women's information-seeking, health care providers may assess a woman's need for information and barriers that the woman experiences when seeking information, and factors such as first pregnancy and asthma.

HIV-infected mothers' foci of concern during the viral testing of their infants

The objective of this study was to explore HIV-infected mothers' most worrisome concerns during their infants' HIV viral testing. A total of 20 HIV-infected women consented to one antepartum and five postpartum study visits clustered around infant HIV viral testing time points. Content analysis was used to categorize maternal responses about their concerns. The majority (80%) of mothers identified infant health as the most worrisome concern during the prenatal and early postpartum periods. This concern declined after the second infant viral test result but rebounded before obtaining the final viral test. Once the final viral test result was known, the majority (60%) of mothers identified psychosocial issues as most worrisome. Maternal health did not surpass infant health or psychosocial issues as a primary concern. The primary concern of the HIV-infected mothers in this study was infant health during the infant viral testing period. Maternal health issues remained secondary to infant health and psychosocial issues as major concerns several months after infant viral testing was completed.

Critical views on postpartum care expressed by new mothers

BACKGROUND

Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not.

METHODS

Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed.

RESULTS

Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother.

CONCLUSION

The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.

Evaluating multi-dimensional aspects of postnatal hospital care

OBJECTIVES

to investigate women's experiences of postnatal hospital care in relation to four different aspects: (1) interpersonal care; (2) time spent on physical check-ups; (3) time spent on information and support; and (4) time spent on assistance with breast feeding. More specifically, we aimed to establish whether typical clusters of women could be identified, and if so, whether these clusters could be related to specific outcomes of care, to the way in which care is organised, and to the individual's psychological health and socio-demographic background.

DESIGN

longitudinal population-based survey, including three questionnaires completed in early pregnancy, at 2 months and 1 year after birth.

SETTING

all postnatal wards in Sweden.

PARTICIPANTS

women (n=2338) recruited at their first booking visit at 593 antenatal clinics, who responded to questions relating to postnatal hospital care 2 months after birth.

FINDINGS

eight cluster profiles defined by the four aspects of postnatal care were identified. About half of the women were found in clusters that were satisfied with most aspects of care, and half in clusters that were dissatisfied with one aspect or more. Only 32% were very satisfied with all four dimensions. Specific groups of women, such as first-time mothers, migrants, young mothers and those with a short length of stay, were dissatisfied with different assessments of postnatal care. Psychological health in early pregnancy was associated with high ratings of all aspects of care, whereas emergency caesarean section and instrumental vaginal delivery was associated with dissatisfaction with breast feeding support and time spent on health check-ups.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

women's individual appraisal of specific aspects of hospital postnatal care could be grouped into response patterns that were shared by smaller or larger groups. These patterns were related to maternal characteristics, labour outcomes and the way in which care was organised. The multi-faceted approach used in this study provided details about who was dissatisfied with what, and showed that women are not necessarily either satisfied or dissatisfied with care in a general sense. In order to provide individualised care, the carer needs to be aware of these differences.

Jordanian women?s perceptions of post-partum health care

PURPOSE

This qualitative descriptive study aimed to explore Jordanian childbearing women's perceptions of their needs for health care and the post-partum healthcare services they received.

METHODS

Twenty-four Jordanian childbearing women participated in the focus groups. Discussions focused on infant and maternal health concerns, access to post-partum health care, including family-planning services, the characteristics and behaviour of healthcare providers, and suggestions for the provision of quality maternal post-partum health care.

FINDINGS

The majority of the women indicated that most of the services perceived and provided during the post-natal period were related to child care. They indicated that they attend post-natal visits mostly for treatment, family planning and/or child care and stated that they have not been told about the post-natal visits during pregnancy, or after giving birth.

CONCLUSIONS

Study findings provided insight and understanding of women's perspectives on post-partum health care and implied a need to translate qualitative findings into clinical practice guidelines. It is suggested that the Jordanian Ministry of Health develops a comprehensive plan to improve educational offerings for post-partum women, and ensure that all healthcare facilities offer affordable and high-quality post-partum health care.

Challenges faced by new mothers in the early postpartum period: an analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) survey

OBJECTIVE

To identify challenges that women face 2-9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS).

METHODS

PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states who answered the PRAMS survey in 2000. Preliminary analysis included a review of the comment data to identify major themes and a demographic comparison of women who commented (n = 3,417) versus women who did not (n = 12,497). Subsequent analysis included systematic coding of the data from 324 women that commented about postpartum concerns and evaluation to ensure acceptable levels of reliability among coders.

RESULTS

We identified the following major themes, listed in order of frequency: (1) need for social support, (2) breastfeeding issues, (3) lack of education about newborn care after discharge, (4) need for help with postpartum depression, (5) perceived need for extended postpartum hospital stay, and (6) need for maternal insurance coverage beyond delivery.

CONCLUSION

The themes identified indicate that new mothers want more social support and education and that some of their concerns relate to policies regarding breastfeeding and medical care. These results can be used to inform programs and policies designed to address education and continuity of postpartum care for new mothers.