Rediscovering the "M" in "MCH": maternal health promotion after childbirth

Exploring the Feasibility, Acceptability, and Potential Benefits of the Mom Movement Intervention (MOMmi)

OBJECTIVE

To explore the feasibility, acceptability, and potential benefits associated with a mind-body intervention and varied delivery styles among women during the postpartum period.

DESIGN

Mixed-methods feasibility study.

SETTING

Fraser Valley, British Columbia, Canada.

PARTICIPANTS

Forty-three women (93% White), with an average age of 32.1 (SD = 2.9) years, who had given birth within the last 6 months.

METHODS

Participants were randomized to three physical activity groups. Validated questionnaires were administered before and after the 12-week intervention. Attendance and feasibility metrics and qualitative semistructured interviews were conducted to assess the intervention.

RESULTS

The intervention and trial were partially feasible, and retention to the intervention was high; however, adherence as assessed by attendance was lower than expected. There was high acceptability among those in the group-based, in-person intervention. There was moderate acceptability among those in the individual, home-based asynchronous program.

CONCLUSION

Findings highlight the necessity of better understanding what is desired by this population or simply providing more options to participants so that we can tailor physical activity to their needs and provide the necessary support.

Home Visits for Postpartum Depression Intervention among Low-Income Latinas: Results from the PST4PPD Project

Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.

"It's Hard Being a Mama": Validation of the Maternal Distress Concept in Becoming a Mother

New mothers actively adapt to new demands and challenges in the mothering role but some may find this adjustment difficult and distressing, depending on their perceptions and resources. Previous research on maternal distress is primarily concentrated on needs of mothers with depression but nonpathological approaches of viewing difficulties in early parenting should be explored. A secondary analysis of a descriptive, qualitative study was completed on new, low-income mothers in early parenthood to determine how maternal distress influences mothers' transition to becoming a mother and to validate the use of the Maternal Distress Concept in the clinical setting. Findings reveal new mothers experience maternal distress on various levels: stress, adaptation, functioning, and connecting. Implications for practice and education are discussed.

Comparison of an additional early visit to routine postpartum care on initiation of long-acting reversible contraception: A randomized trial

OBJECTIVE

To investigate whether an early 3-week postpartum visit in addition to the standard 6-week visit increases long-acting reversible contraception (LARC) initiation by 8 weeks postpartum compared to the routine 6-week visit alone.

STUDY DESIGN

We enrolled pregnant and immediate postpartum women into a prospective randomized, non-blinded trial comparing a single 6-week postpartum visit (routine care) to two visits at 3 and 6 weeks postpartum (intervention), with initiation of contraception at the 3-week visit, if desired. All participants received structured contraceptive counseling. Participants completed surveys in-person at baseline and at the time of each postpartum visit. A sample size of 200 total participants was needed to detect a 2-fold difference in LARC initiation (20% vs. 40%).

RESULTS

Between May 2016 and March 2017, 200 participants enrolled; outcome data are available for 188. The majority of LARC initiation occurred immediately postpartum (25% of the intervention arm and 27% of the routine care arm). By 8 weeks postpartum, 34% of participants in the intervention arm initiated LARC, compared to 41% in the routine care arm (p=.35). Overall contraceptive initiation by 8 weeks was 83% and 84% in the intervention and routine care arms, respectively (p=.79). There was no difference between the arms in the proportion of women who attended at least one postpartum visit (70% vs. 74%, p=.56).

CONCLUSION

The addition of a 3-week postpartum visit to routine care does not increase LARC initiation by 8 weeks postpartum. The majority of LARC users desired immediate rather than interval postpartum initiation.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.govNCT02769676 IMPLICATIONS: The addition of a 3-week postpartum visit to routine care does not increase LARC or overall contraceptive initiation by 8 weeks postpartum when the option of immediate postpartum placement is available. The majority of LARC users desired immediate rather than interval postpartum initiation.

The impact of general health and social support on health promoting lifestyle in the first year postpartum: the structural equation modelling

Background and aim

Postpartum is a critical period for mothers which often leads to neglect of their own health. Mothers’ new responsibilities may affect their health promoting lifestyle (HPL). The aim of this study was to determine the impact of both general health and social support on health-promoting lifestyle.

Methods

A cross-sectional survey was conducted on 310 women who gave birth over a one-year period in Zanjan (Iran), 2016. A proportionate stratified random sampling technique was used to select respondents from each stratum. Health-promoting lifestyle was assessed using the health-promoting lifestyle profile II (HPLP II) scale. A structure equation model (SEM) was used to determine the relationship between observed and latent variables. Data were analysed using SPSS version 22 and LISREL 8.5 software.

Results

The age of 42.6% of the participants was more than 30 years and 40.3% of them had an academic education. The mean score of the health-promoting lifestyle was 131.28 (15.37). The structural equation model fitted well with RMSEA =0.07, CFI=0.92, and GFI=0.94. Among the latent factors, general health, with a factor load of −0.68, had greater impact on health-promoting lifestyle than social support. Moreover, there was a significant correlation (−0.63) between general health and perceived social support in the postpartum period.

Conclusion

health-promoting lifestyle was not at appropriate levels among women in the first year after delivery. These findings suggest that strengthening general health and social support would improve a health-promoting lifestyle in Iranian postpartum women.

Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: A pilot randomized controlled trial

BACKGROUND

Gymnastics is a preferable safe exercise for postnatal women performing regularly.

OBJECTIVE

The aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women.

DESIGN

Single-blinded, randomized controlled trial held from December 2014 until September 2015.

SETTING

Postnatal clinic of a medical center in southern Taiwan.

PARTICIPANTS

140 eligible postnatal women were systematically assigned, with a random start to experimental (n=70) or a control (n=70) group.

INTERVENTIONS

Engage in aerobic gymnastic exercise at least three times (15min per section) a week for three months using compact disc in the home.

OUTCOME MEASURES

Perceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale.

RESULTS

In a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.

Applications of and Barriers to Holistic Self-Care in a Low-Income, High-Risk Obstetric Population

OBJECTIVE

We examined 1) women's perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care.

METHODS

Four focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: women's valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied.

RESULTS

Although women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money.

CONCLUSIONS

Socioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget.

Results of a randomized controlled trial to promote physical activity behaviours in mothers with young children

OBJECTIVE

Increasing levels of physical activity in mothers have long-term health benefits for the mother and family. The study aimed to evaluate the effect of a six-month, physical activity RCT for mothers of young children.

METHODS

Women were recruited via playgroups and randomly assigned to intervention (n=394) or control group (n=322). The intervention group received a six-month multi-strategy programme delivered via playgroups in Perth, Australia. measures were mean minutes per week of moderate (M) and vigorous (V) intensity physical activity (PA), and number of days/week of muscle strength exercises.

RESULTS

The intervention had a significant effect on mean time for vigorous (p=0.008), moderate (p=0.023) and total physical activity (p=0.001) when compared to the control group. The intervention group increased their vigorous activity by a mean of 24min/week, moderate activity by 23min/week and total physical activity by 72min/week.

CONCLUSIONS

A relatively minimum home based intervention was able to demonstrate modest but statistically significant improvements in physical activity in a hard to reach group. These changes if maintained over a longer period are likely to improve the health of mothers and have a positive impact on their partners and children. Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.

Effects of a Brief, Prevention-Focused Parenting Education Program for New Mothers

We evaluated the effects of a parenting program, Baby and You, on parenting knowledge, parenting morale, and social support using a single-group, pre-test, and post-test design with 159 Canadian mothers of infants aged 2 to 9 months old. Baby and You is a prevention-focused parenting program (PFPP) to improve maternal and infant health through education and social support. The 4-week curriculum focuses on infant development and safety, parent–child relationships, maternal self-care, and community resources. We computed repeated-measures ANOVAs separately for scores on Parenting Knowledge Scale, Parenting Moral Index, and Family Support Scale. We found a significant increase between pre-test and post-test on parenting knowledge, but not parenting morale or social support. Parenting morale may be a stable construct that shows little change over time. It may take more than 4 weeks of programming for mothers to identify and integrate new sources of social support.

Understanding and meeting the needs of women in the postpartum period: the Perinatal Maternal Health Promotion Model

A new model for the care of women in the postpartum focuses on the development of life skills that promote complete well-being. The year following childbirth is a time of significant transition for women. In addition to the physiologic changes associated with the postpartum period, a woman undergoes marked psychosocial changes as she transitions into a motherhood role, reestablishes relationships, and works to meet the physical and emotional needs of her infant and other family members. It is a time when women are vulnerable to health problems directly related to childbirth and to compromised self-care, which can manifest in the development or reestablishment of unhealthy behaviors such as smoking and a sedentary lifestyle. In addition to long-term implications for women, compromised maternal health in the postpartum period is associated with suboptimal health and developmental outcomes for infants. Maternal health experts have called for a change in how care is provided for women in the postpartum period. This article presents the rationale for a health promotion approach to meeting the needs of women in the postpartum period and introduces the Perinatal Maternal Health Promotion Model. This conceptual framework is built around a definition of maternal well-being that asserts that health goes beyond merely the absence of medical complications. In the model, the core elements of a healthy postpartum are identified and include not only physical recovery but also the ability to meet individual needs and successfully transition into motherhood. These goals can best be achieved by helping women develop or strengthen 4 key individual health-promoting skills: the ability to mobilize social support, self-efficacy, positive coping strategies, and realistic expectations. While the model focuses on the woman, the health promotion approach takes into account that maternal health in this critical period affects and is affected by her family, social network, and community. Clinical implications of the model are addressed, including specific health promotion strategies that clinicians can readily incorporate into antepartum and postpartum care.

Making friends at antenatal classes: a qualitative exploration of friendship across the transition to motherhood

This study explored how friendships made at antenatal classes preserve new mothers' well-being, postnatally. Eight women from the United Kingdom who had attended antenatal classes in the third trimester were interviewed following the birth of their first baby. Transcripts were analyzed using a constant comparative method. Findings suggest that friendships made at antenatal classes are not only unique but also support women's mental health and enhance self-efficacy because the women give and gain reassurance that their babies are developing normally. Such friendships may reduce demands on overstretched social and health-care services. Childbirth educators, midwives, and nurses can be encouraged to capitalize on the opportunity provided by antenatal classes to facilitate the formation of friendships that can help mothers to find "a new equilibrium."

Psychosocial factors associated with patterns of smoking surrounding pregnancy in fragile families

Although research has documented factors associated with maternal smoking, we need a more in-depth understanding of the risk factors associated with changes in smoking behaviors during the postpartum period. We investigate smoking patterns during pregnancy and 1 year postpartum as a function of relevant psychosocial factors. We use data on 3,522 postpartum mothers from the Fragile Families and Child Wellbeing Study to analyze the predictors of smoking among mothers who did not smoke during pregnancy but smoked at 1 year postpartum, mothers who smoked both during pregnancy and postpartum, and mothers who did not smoke during either period. Our covariates are grouped into four categories of risk factors for smoking: socioeconomic status, health care, life course and health, and partner and social support. Postpartum mothers in our sample were more likely to smoke throughout or after their pregnancies if they had only a high school education or less, had a household income three or more times below the poverty line, had public or no health insurance, breastfed for less than 5 months, were not married to the infant's father, if the infant's father currently smoked, and if they attended religious services less than once a week. Mental health problems were consistently associated with an increased risk of constant and postpartum smoking relative to non-smoking. Psychosocial factors play a role in postpartum smoking, but they have a stronger effect in predicting smoking that persists throughout pregnancy and the first year postpartum.

Uncertainty during perimenopause: perceptions of older first-time mothers

AIM

This article is a report of a study exploring older first-time mothers' perceptions of health during their transition to menopause.

BACKGROUND

Increasing numbers of women world-wide are delaying motherhood, yet little is known about the unique phenomenon created when midlife motherhood is closely followed by the transition to menopause. A literature search revealed that the effect of these overlapping life transitions on women's health was unknown.

DESIGN

A hermeneutic phenomenological approach utilizing Gadamer's philosophical underpinnings guided the study.

METHOD

A purposive sample of thirteen women aged 45-56 years who were mothering children aged 12 years or younger and experiencing symptoms of perimenopause was recruited. Two in-depth interviews were conducted with each woman and meaning was mutually negotiated through participative dialogue with the women, ongoing construction and thematic analysis of data collected between 2004 and 2007.

FINDINGS

The key theme 'Perimenopause as a State of Uncertainty' is an interpretation of older first-time mothers' perceptions of health during perimenopause and is the focus of this article. Hermeneutic interpretation culminated in the construct 'uncertainty' as theoretical embodiment of the women's lived experience. An uncertain temporality, projection of the lifespan and valuing health as precious enabled these women to transform uncertainty into opportunities for health promotion to 'be there' for their children.

CONCLUSION

Nurses, nurse practitioners and midwives will increasingly be caring for midlife mothers and need to understand the unique issues of older mothers to offer education and health promotion that support healthy transitions to menopause.

Maternal general health and children's cognitive development and behaviour in the early years: findings from the Millennium Cohort Study

BACKGROUND

Mothers often experience physical and psychological difficulties during the post-natal period and these may continue through the early years of raising children and have negative effects on engagement and caregiving. Pathways between maternal depression, parental engagement and caregiving and children's subsequent development have been described in longitudinal studies; yet, less is known about how other aspects of maternal health may influence children's development.

METHODS

A longitudinal analysis within the Millennium Cohort Study was conducted including 7906 families from England. Maternal general health and psychological well-being were assessed when their children were 9 months and 3 years old, socio-demographic characteristics were assessed at 9 months, and engagement and caregiving were assessed at 3 years. These were examined as predictors of children's learning and development and behaviour at age 5.

RESULTS

There are clear associations between maternal general health and children's development with regard to both learning and development and behaviour. These effects are reduced if psychological distress is taken into account; yet, maternal general health maintains importance as a predictor for children's subsequent development. There is evidence of an association via engagement and caregiving which links maternal health to children's development and evidence of the influence of underlying socio-demographic disadvantage.

CONCLUSION

General maternal health as well as psychological well-being during the early years of raising children may be influential for children's development. This study suggests the need for a broader recognition of maternal health as well as psychological well-being as a foundation for family well-being, and speaks to support for mothers in maintaining engagement and caregiving for their children during periods of ill health.

What has public health got to do with midwifery? Midwives' role in securing better health outcomes for mothers and babies

BACKGROUND

The maternity services hold a unique position in influencing current and future maternal and infant health and midwives play a pivotal role. However, midwifery's role in public health is rarely acknowledged by the "system" or by midwives themselves. In fact most midwives may find it difficult reconciling public health with the care they provide.

AIM AND METHODS

This paper aims to raise midwives' public health consciousness and explores the ways in which they can, regardless of the maternity service context in which they work, explicitly acknowledge their own public health practice and the role of midwifery more generally in securing maternal and infant health.

DISCUSSION

Salient examples in antenatal, intrapartum and postnatal care have highlighted how midwives can engage in public health issues relevant to their everyday clinical practice and in so doing re-define and extend their boundaries of care. Public health has much to do with midwifery and midwifery has much to do with public health.

IMPLICATIONS FOR PRACTICE

Midwifery practice can have a profound impact on maternal and infant health both short and long-term, so it is critical that all midwives take up the public health challenge for the benefit of the population they serve.

Maternal predictors of toddler health status

PURPOSE

The purposes of this study were to examine the relationships among maternal and environmental variables in the first 6 months postpartum and toddler health status, and to identify predictors of toddler health.

DESIGN AND METHODS

A secondary analysis was conducted on an existing dataset of a longitudinal parent-child survey.

RESULTS

Maternal stress predicted 8% of the variance in child health status at 18 months of age. Children in nonparental care more than 20 hr per week were perceived as less healthy.

PRACTICE IMPLICATIONS

Pediatric nurses should assess levels of maternal stress in the early months postpartum and anticipate poorer health status in toddlers who spend more than 20 hr per week in nonparental care.

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles

BACKGROUND

To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period.

AIM

To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan.

METHODS

This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale.

RESULTS

The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model.

CONCLUSIONS

This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.

Continuing education module: postpartum maternal health care in the United States: a critical review

Postpartum maternal health care is a neglected aspect of women's health care. This neglect is evident in the limited national health objectives and data related to maternal health. Missed opportunities for enhancing the health care of postpartum women occur in the scope of routine postpartum care. Differing perceptions of maternal needs between nurses and new mothers also contribute to inadequate health care. Therefore, collecting national data on postpartum maternal morbidity, reforming postpartum care policies, providing holistic and flexible maternal health care, encouraging family support and involvement in support groups, and initiating educational programs are recommended. Further research is needed on issues related to postpartum maternal health.

Psychotropic medication in pregnancy: ethical aspects and clinical management

This article explores the dilemma of whether women with mental illness should take potentially teratogenic psychotropic medications during pregnancy, from both the maternal and fetal perspectives. Ethical and social aspects of the dilemma are presented to assist perinatal and psychiatric practitioners to provide holistic and competent care to the mother/fetus dyad. Specific fetal risks involved with maternal psychotropic drug use are described and contrasted with fetal risks of an untreated, psychiatrically ill mother. Nursing and healthcare considerations for the care of this population are presented in general, and specific psychotropics are reviewed for their risk profile in pregnancy. The article concludes with a discussion of actions to reduce maternal and fetal risk for women who are mentally ill and are currently taking, or considering taking, a psychotropic medication.

Transition to motherhood

OBJECTIVE

To synthesize the results of nine qualitative studies related to the transition to motherhood, using Noblit and Hare's method of meta-synthesis development.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Sociological Abstracts, and Dissertation Abstracts, using the keywords transition, adaptation, motherhood, and mother.

STUDY SELECTION

Studies were evaluated for inclusion related to study focus and comparability of findings. Nine studies were included in the final sample, four using a grounded theory methodology and five using either a phenomenologic or phenomenologic/hermeneutic method.

DATA EXTRACTION

A series of overlapping, repeating steps as outlined by Noblit and Hare were followed in conducting this meta-synthesis. Detailed tables of metaphors, themes, concepts, and phrases from each study were constructed and studies were compared by means of reciprocal translations.

DATA SYNTHESIS

Two processes inherent in maternal transition emerged: engagement and growth and transformation. In addition, five thematic categories signifying areas of disruption present in the maternal transition and 13 underlying themes were revealed.

CONCLUSIONS

To facilitate maternal transition, nurses must remain sensitive to the maternal insecurity of primiparae and encourage their maximum maternal engagement, particularly during periods of forced mother-infant separation such as the newborn's admission to the intensive-care unit. In addition, prenatal discussion of realistic expectations for the transitional period, ongoing support through the first 6 months postpartum, and the use of role models should be integrated into postpartum support programs to assist mothers in negotiating typical areas of disruption during maternal transition.

The importance of first-time parent groups for new parents

First-time parent groups are offered to all new parents in Victoria, Australia through the Maternal and Child Health Service, which is funded by state and local governments. Parents who join a group attend a series of eight sessions that emphasize parenting skills, relationship development and social support in order to increase confidence and skills in parenting. The present paper highlights the importance of first-time parent groups, claiming that these groups serve an important social support and health function amid a climate of early discharge policies and changing family structures. Although there are a number of challenges to the successful running of groups, it is argued that first-time parents benefit from participating in these groups in a number of ways: by developing social networks, gaining self confidence, and through access to relevant information on child health and parenting. Research indicates that first-time parent groups provide lasting benefits not only for families, but also for society as a whole. Maternal and child health nurses play a key role in facilitating groups for first-time parents.

An exploration of health concerns & health-promotion behaviors in pregnant women over age 35

PURPOSE

To explore the specific health concerns and health-promotion behaviors of childbearing women 35 years of age or older.

STUDY DESIGN AND METHODS

Semistructured interviews with women ( = 50) ages > or =35 in their third trimester of pregnancy. Interviews lasted approximately 1 hour, were conducted by two nursing faculty, and were scheduled to accommodate participant needs. Process recording was used to document participant responses. Verbatim statements were recorded, and subjects were redirected to clarify responses when necessary. Content analysis and coding were completed by an independent researcher, based upon techniques derived from Miles and Huberman (1994). Data reduction was accomplished by the identification of categories of responses that described the participants' meaning.

RESULTS

Study participants reported concerns reflecting both fetal well-being and maternal health-related issues. The majority of childbearing women (86%) reported engaging in multiple health-promotion behaviors focusing on daily nutritional intake, lifestyle activities, and rest patterns. Participants reported conscientious decisions to eliminate substances recognized as harmful, and to alter exercise, employment, or daily responsibilities to accommodate physical changes during pregnancy. Participants were "proactive healthcare seekers," accessing information from a variety of sources and seeking services to meet their individualized needs.

CLINICAL IMPLICATIONS

The multitude and frequency of health-promotion behaviors adopted by those > or =35 years of age during pregnancy is indicative of this group's ability to independently initiate change, and exceeds the percentages previously reported. The nurse can be influential in supporting lifestyle modifications adopted during the childbearing period as permanent health-promotion behaviors.

Paradigms for assessment: women's knowledge and skill attainment

This article describes two models of assessment that nurses can use with women throughout their life span: (1) knowledge attainment (Belenky, Clinchy, Goldberger, & Tarule, 1986) and (2) skill attainment (Dreyfus & Dreyfus, 1996). These models consider each woman's unique reality, acknowledging that how she experiences pregnancy and postpartum is based on how she has lived her life. Her integration of experiences, coping strategies, and life events may be the foundation upon which she will incorporate the new experiences of pregnancy and motherhood. Using these models can help provide the maternal-child nurse with a blueprint for the development of appropriate care plans and teaching plans.

Psychosocial thriving during late pregnancy: relationship to ethnicity, gestational weight gain, and birth weight

OBJECTIVE

To test the relationships between psychosocial thriving (depressive symptoms, health-related lifestyle) and gestational weight gain and birth weight. To test the influences of ethnicity on the relationships between psychosocial thriving and gestational weight gain and birth weight.

DESIGN

Baseline data taken from the Austin New Mothers Study.

SETTING

A community hospital in Texas.

PARTICIPANTS

305 low-risk African American, Hispanic, and White women with full-term pregnancies, singleton births, and Medicaid coverage.

MAIN MEASURES

Center for Epidemiologic Studies Depression Scale, Self Care Inventory, Food Habits Questionnaire, gestational weight gain, and birth weight.

RESULTS

Newborns of African American women had lower birth weights (3,240 g) than newborns of Hispanic (3,422 g) or White women (3,472 g), even though no ethnic differences were found among the mothers on psychosocial variables. Late in pregnancy, women had high levels and prevalence (> 70%) of depressive symptoms regardless of ethnicity, and 50% exceeded recommended gestational weight gains. In full regression models, psychosocial variables were not significant predictors of gestational weight gain or birth weight. Ethnicity also was not a significant moderator of weight outcomes.

CONCLUSIONS

Psychosocial thriving late in pregnancy was unrelated to gestational weight gain or birth weight. Ethnicity did not moderate psychosocial-weight relationships. Although ethnic differences were not found on psychosocial variables, high levels of depressive symptoms and greater than recommended gestational weight gains were prevalent. These findings have implications for maternal health during and beyond pregnancy.