Postpartum Depression Help‐Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review

ABSTRACT: Background: Despite the well‐documented risk factors and health consequences of postpartum depression, it often remains undetected and untreated. No study has comprehensively examined postpartum depression help‐seeking barriers, and very few studies have specifically examined the acceptability of postpartum depression treatment approaches. The objective of this study was to examine systematically the literature to identify postpartum depression help‐seeking barriers and maternal treatment preferences. Methods: Medline, CINAHL, and EMBASE databases were searched using specific key words, and published peer‐reviewed articles from 1966 to 2005 were scanned for inclusion criteria. Results: Of the 40 articles included in this qualitative systematic review, most studies focused on women’s experiences of postpartum depression where help seeking emerged as a theme. A common help‐seeking barrier was women’s inability to disclose their feelings, which was often reinforced by family members and health professionals’ reluctance to respond to the mothers’ emotional and practical needs. The lack of knowledge about postpartum depression or the acceptance of myths was a significant help‐seeking barrier and rendered mothers unable to recognize the symptoms of depression. Significant health service barriers were identified. Women preferred to have “talking therapies” with someone who was nonjudgmental rather than receive pharmacological interventions. Conclusions: These results suggest that women did not proactively seek help, and the barriers involved both maternal and health professional factors. Common themes related to specific treatment preferences emerged from women of diverse cultural backgrounds. The clinical implications outlined in this review will assist health professionals in addressing these barriers and in developing preventive and treatment interventions that are in accord with maternal preferences. (BIRTH 33:4 December 2006)     

Canadian Maternity Experiences Survey Pilot Study

Abstract: Background : The Maternity Experiences Survey is a project of the Canadian Perinatal Surveillance System. Its primary objective is to provide insight into Canadian women's maternity experiences. A pilot study was conducted in 2002/2003 to determine to what extent women's reports could be used to assess Canadian perinatal health policies and practices, and to test the procedures proposed for a national maternity experiences survey. Methods : A nonrepresentative sample of 291 mothers was drawn from Canadian birth registration records. Mothers whose children had died or were no longer in their care were excluded. Participants were interviewed 9 to 11 months postpartum about prenatal, labor, and birth and postpartum experiences. Results : The response rate was 86 percent. Respondents were generally comfortable answering all questions and identified areas of potential strength and weakness in the Canadian maternity care system. They had difficulty recalling information on some prenatal tests, and labor and birth procedures. The use of birth registrations to draw the pilot sample worked well. However, some regions may not be able to provide timely access to birth registrations for the purposes of a national survey. Conclusions : The high response rate and women's ability to provide information on a wide range of topics demonstrates that a national maternity survey would be an effective method of providing important maternal health information. The data collected would allow Health Canada to carry out more effective national perinatal health surveillance with a view to influencing perinatal health policy and practice.     

Women’s Mental Health Before,During, and After Pregnancy: A Population‐Based Controlled Cohort Study

ABSTRACT: Background: Common mental health disorders like depressive and anxiety disorders are frequent in antenatal and postpartum women. However, no agreement about the prevalence of these disorders and the course of women’s mental health during the transition to motherhood exists. This study compared women’s mental health before, during, and after pregnancy with a control group of nonpregnant women. Methods: Three hundred and twenty‐four women were assessed before, during, and after their pregnancy with the 12‐item version of the General Health Questionnaire (GHQ‐12). A control group of 324 women who did not deliver during 3 subsequent years was assessed with the GHQ‐12 at corresponding time‐points. Results: No differences in GHQ‐12 mean scores, prevalence, and incidence of common mental health disorders between the study and control groups were found. No differences in prevalence and incidence rates within each group were found. The presence of a common mental health disorder before pregnancy or in early pregnancy predicted common mental health disorders in the postpartum period. Conclusions: Common mental health disorders are frequent during pregnancy and the postpartum period, but pregnant or postpartum women are not more at risk than those who are not pregnant or who did not deliver. (BIRTH 33:4 December 2006)     

Childhood Abuse History,Posttraumatic Stress Disorder,Postpartum Mental Health,and Bonding: A Prospective Cohort Study

Introduction: Research is needed that prospectively characterizes the intergenerational pattern of effects of childhood maltreatment and lifetime posttraumatic stress disorder (PTSD) on women's mental health in pregnancy and on postpartum mental health and bonding outcomes. This prospective study included 566 nulliparous women in 3 cohorts: PTSD‐positive, trauma‐exposed resilient, and not exposed to trauma. Methods: Trauma history, PTSD diagnosis, and depression diagnosis were ascertained using standardized telephone interviews with women who were pregnant at less than 28 gestational weeks. A 6‐week‐postpartum interview reassessed interim trauma, labor experience, PTSD, depression, and bonding outcomes. Results: Regression modeling indicates that posttraumatic stress in pregnancy, alone, or comorbid with depression is associated with postpartum depression (R²= .204; P < .001). Postpartum depression alone or comorbid with posttraumatic stress was associated with impaired bonding (R²= .195; P < .001). In both models, higher quality of life ratings in pregnancy were associated with better outcomes, while reported dissociation in labor was a risk for worse outcomes. The effect of a history of childhood maltreatment on both postpartum mental health and bonding outcomes was mediated by preexisting mental health status. Discussion: Pregnancy represents an opportune time to interrupt the pattern of intergenerational transmission of abuse and psychiatric vulnerability. Further dyadic research is warranted beyond 6 weeks postpartum. Trauma‐informed interventions for women who enter care with abuse‐related PTSD or depression should be developed and tested.     

Postpartum Physical Symptoms in New Mothers: Their Relationship to Functional Limitations and Emotional Well‐being

ABSTRACT: Background: Postpartum physical health problems are common and have been understudied. The purpose of this investigation was to explore the associations among reported physical symptoms, functional limitations, and emotional well‐being of postpartum women. Methods: The study included data from interviews conducted at 9 to 12 months postpartum from 1,323 women who had received prenatal care at nine community health centers located in Philadelphia, Pennsylvania, United States, between February 2000 and November 2002. Emotional well‐being was assessed with the Center for Epidemiological Studies Depression Scale and perceived emotional health. Functional limitations measures were related to child care, daily activities (housework and shopping), and employment. A summary measure of postpartum morbidity burden was constructed from a checklist of potential health problems typically associated with the postpartum period, such as backaches, abdominal pain, and dyspareunia. Results: More than two‐thirds (69%) of the women reported experiencing at least one physical health problem since childbirth. Forty‐five percent reported at least one problem of moderate or major (as opposed to minor) severity and 20 percent reported at least one problem of major severity. The presence, severity, and cumulative morbidity burden associated with postpartum health problems were consistently correlated with reports of one or more functional limitations and measures of emotional well‐being including depressive symptomatology. Conclusions: Although physical problems typically associated with the postpartum period are often regarded as transient or comparatively minor, they are strongly related both to women’s functional impairment and to poor emotional health. Careful assessment of the physical, functional, and emotional health status of women in the year after childbirth may improve the quality of postpartum care. (BIRTH 35:3 September 2008)     

Comparison of maternity experiences of Canadian-born and recent and non-recent immigrant women: findings from the Canadian Maternity Experiences Survey

ObjectiveTo compare the maternity experiences of immigrant women (recent, ≤ 5 years in Canada; non-recent > 5 years) with those of Canadian-born women.MethodsThis study was based on data from the Canadian Maternity Experiences Survey of the Public Health Agency of Canada. A stratified random sample of 6421 women was drawn from a sampling frame based on the 2006 Canadian Census of Population. Weighted proportions were calculated using survey sample weights Multivariable logistic regression was used to estimate odds ratios comparing recent immigrant women with Canadian-born women and non-recent immigrant women with Canadian-born women, adjusting for education, income, parity, and maternal age.ResultsThe sample comprised 7.5% recent immigrants, 16.3% non-recent immigrants, and 76.2% Canadian-born women. Immigrant women reported experiencing less physical abuse and stress, and they were less likely to smoke or consume alcohol during pregnancy, than Canadian women; however, they were more likely to report high levels of postpartum depression symptoms and were less likely to have access to social support, to take folic acid before and during pregnancy, to rate their own and their infant’s health as optimal, and to place their infants on their backs for sleeping Recent and non-recent immigrant women also had different experiences, suggesting that duration of residence in Canada plays a role in immigrant women’s maternity experiences.ConclusionThese findings can assist clinicians and policy-makers to understand the disparities that exist between immigrant and non-immigrant women in order to address the needs of immigrant women more effectively.     

Systematic Review of the Literature on Postpartum Care: Effectiveness of Postpartum Support to Improve Maternal Parenting,Mental Health,Quality of Life,and Physical Health

Abstract: Background: Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. Methods: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. Results: In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal‐infant parenting skills in low‐income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference ‐ 2.23, 95% CI –3.72 to –0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was higher with home visitation programs. Conclusions: No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high‐risk populations may benefit from postpartum support. (BIRTH 33:3 September 2006)     

Transtheoretical model-based postpartum sexual health education program improves women's sexual behaviors and sexual health

IntroductionPostpartum sexual health education was once routinely administered to postpartum women, but few interventions were specifically described or clearly based on theory, and few sexual interventions affected women's sexual behaviors.AimTo evaluate the effectiveness of a refined theory‐based interactive postpartum sexual health education program (IPSHEP) in enhancing postpartum women's sexual behavior and health.MethodsFor this prospective, randomized controlled trial, 250 participants were randomized to three groups. Experimental group A received our refined theory‐based IPSHEP. Experimental group B received only an interactive, self‐help pamphlet. The control group received routine education (a 10‐ to 15‐minute educational talk and a sexual health pamphlet without an interactive design). Data were collected at baseline, 3 days, 2 months, and 3 months postpartum.Main Outcome MeasurePostpartum women's sexual self‐efficacy (SSE), diversity of sexual activity (DSA), return to sexual activity, and sexual satisfaction (SS).ResultsWomen who received our theory‐based postpartum sexual health education program had significantly greater SSE (P < 0.05) and greater DSA (P < 0.05), and tended to resume their sexual life earlier than women in the routine teaching and interactive pamphlet‐only groups (P < 0.05). However, the SS levels of postpartum women who received our program did not differ significantly from those of women who received routine teaching or the interactive pamphlet only.ConclusionsOur findings suggest that a theory‐based postpartum sexual health education program improved women's sexual health and sexual behavior and that the transtheoretical model can be translated into practice, supporting its use to enhance the sexual health of postpartum women. Despite the lack of a significant effect on SS, women who received our theory‐based postpartum sexual health education program tended to maintain their prepregnancy level of SS in early postpartum. Lee J‐T and Tsai J‐L. Transtheoretical model‐based postpartum sexual health education program improves women's sexual behaviors and sexual health. J Sex Med 12;9:986–996.     

Measuring Social Support in Pregnancy: Can It Be Simple and Meaningful?

Background: It is important to determine the level of a woman's social support at the booking‐in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes. Methods: Women (n= 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking‐in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow‐up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi‐square tests. Results: Women with low social support in pregnancy were more likely than well‐supported women to report poorer health during pregnancy (p= 0.006) and postnatally (p < 0.001), to book later for prenatal care (p= 0.000), to seek medical help more frequently (p= 0.004), and to be more depressed postnatally(p= 0.0001). Conclusion: Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking‐in visit.     

A pilot study evaluating a telephone-based exercise intervention for pregnant and postpartum women

Introduction: Exercise during pregnancy is associated with reduced rates of preeclampsia, gestational diabetes, anxiety, insomnia, and excessive weight gain. Continued exercise during the postpartum period is important for healthy weight loss and reduced anxiety. Unfortunately, pregnant and postpartum women are significantly less active than nonpregnant women. The purpose of this pilot study was to evaluate a telephone‐based exercise intervention designed for pregnant and postpartum women. Methods: Healthy women (N = 37) who were pregnant (16 weeks’ gestation or less) or postpartum (6 months or less) participated in a 3‐month, telephone‐based exercise intervention based on the transtheoretical model and social cognitive theory. Exercise was assessed by using the 7‐Day Physical Activity Recall Interview. Results: Pregnant participants significantly increased their exercise from a mean (standard deviation [SD]) of 60.47 (63.1) minutes per week at baseline to 132.9 (82.3) minutes at 3 months, F(1,13) = 9.96, P < .01. Postpartum participants significantly increased their exercise from a mean (SD) of 68.9 (63.5) minutes per week at baseline to 123.8 (48.8) minutes at 3 months, F(1,15) = 6.56, P < .05. Discussion: Participants responded positively to the intervention by significantly increasing their exercise levels. There is a need for a large, randomized controlled trial examining the efficacy of telephone‐based exercise interventions for pregnant and postpartum women.     

Poor Health‐related Quality of Life After Severe Preeclampsia

Abstract: Background: Preeclampsia is a major complication of pregnancy associated with increased maternal morbidity and mortality, and adverse birth outcomes. The objective of this study was to describe changes in all domains of health‐related quality of life between 6 and 12 weeks postpartum after mild and severe preeclampsia; to assess the extent to which it differs after mild and severe preeclampsia; and to assess which factors contribute to such differences. Methods: We conducted a prospective multicenter cohort study of 174 postpartum women who experienced preeclampsia, and who gave birth between February 2007 and June 2009. Health‐related quality of life was measured at 6 and 12 weeks postpartum by the RAND 36‐item Short‐Form Health Survey (SF‐36). The population for analysis comprised women (74%) who obtained scores on the questionnaire at both time points. Results: Women who experienced severe preeclampsia had a lower postpartum health‐related quality of life than those who had mild preeclampsia (all p < 0.05 at 6 wk postpartum). Quality of life improved on almost all SF‐36 scales from 6 to 12 weeks postpartum (p < 0.05). Compared with women who had mild preeclampsia, those who experienced severe preeclampsia had a poorer mental quality of life at 12 weeks postpartum (p < 0.05). Neonatal intensive care unit admission and perinatal death were contributing factors to this poorer mental quality of life. Conclusions: Obstetric caregivers should be aware of poor health‐related quality of life, particularly mental health quality of life in women who have experienced severe preeclampsia (especially those confronted with perinatal death or their child’s admission to a neonatal intensive care unit), and should consider referral for postpartum psychological care. (BIRTH 38:3 September 2011)     

Voices of Postpartum Women: Exploring Canadian Women's Experiences of Inpatient Postpartum Care

Objective

To explore and understand postpartum inpatient experiences in a Canadian context.

Effectiveness of a Counseling Intervention after a Traumatic Childbirth: A Randomized Controlled Trial

Abstract: Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife‐led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms. Method : Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face‐to‐face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self‐blame, and confidence about a future pregnancy. Results : At 3‐month follow‐up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self‐blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant. Discussion : A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants’ trajectory toward recovery compared with women who did not receive counseling. Conclusions : A brief, midwife‐led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self‐blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.     

Systematic Review of the Literature on Postpartum Care: Effectiveness of Interventions for Smoking Relapse Prevention,Cessation, and Reduction in Postpartum Women

ABSTRACT: Background: Many women stop smoking during pregnancy and relapse again either later in the pregnancy or in the postpartum period. Smoking is harmful to mothers, and environmental tobacco smoke is harmful for children. This systematic review examined the published evidence for the effectiveness of postpartum interventions that prevent relapse (current persons who have stopped but start smoking again), improve cessation rates (current smokers who stop smoking), and reduce smoking (number of cigarettes smoked per day) in postpartum women. Methods: MEDLINE, CINAHL, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postpartum women. The initial literature search was done in 1999 and enhanced in 2003 and 2005. Randomized controlled trials that examined relapse prevention, smoking cessation, or smoking reduction interventions in the postpartum period were reviewed in this report. Data were extracted in a systematic manner, and the quality of each study was reviewed. Results: Five papers were published based on three trials for which data were extracted and summarized. Our review of these trials showed no statistically significant benefits of advice materials and counseling interventions in hospital (Vancouver), pediatricians’ offices (Portland), or child health centers (Stockholm) on relapse prevention, cessation rates, or smoking reduction in the postpartum period. Although the interventions had little effect on the major smoking outcomes, some positive attitudinal and knowledge changes were reported. Conclusion: This review found no evidence from the randomized controlled trial literature to date to support implementing postpartum smoking cessation interventions, such as providing advice materials and counseling, insofar as they were delivered in the trials reviewed. (BIRTH 34:4 December 2007)     

Religion,Spirituality, Social Support,and Perceived Stress in Pregnant and Postpartum Hispanic Women

Objective:To examine the association between religion/spirituality and perceived stress in prenatal and postpartum Hispanic women.Design:Cross‐sectional survey.Setting:An urban, publicly funded hospital in California.Participants:Two hundred and forty‐eight pregnant and postpartum Hispanic women between age 18 and 45 years.Method:Patients presenting for prenatal or postpartum care or for the first infant visit were recruited to participate in the current study. Participants completed surveys consisting of questions about demographic characteristics, religiosity, spirituality, social support, and stress.Results:Most participants were unmarried, low‐income women with low educational attainment. Ninety percent of women reported a religious affiliation, with more than one half (57.4%) listing their religious affiliation as “Catholic.” Overall religiousness/spirituality was significantly associated with increased negative experiences of stress in women who selected English language instruments (Spearman's r=.341, p=.007); there was no such relationship in women who selected Spanish language instruments. Social support and greater relationship quality with a significant other were significantly associated with reduced perceived stress in Spanish reading and English reading women.Conclusions:In this sample of pregnant and postpartum Latinas, religiousness/spirituality was not associated with reduced perceived stress and was in fact associated with increased perceived stress among women who selected English‐language surveys. Additional research is needed to investigate this association. On the other hand, the current study reinforces the importance of social support and relationship quality for pregnant and postpartum women.     

A Mirage of Change: Family‐Centered Maternity Care in Practice

Abstract: Background: Since the 1970s, the movement to “humanize” birth in North America has evolved into “family‐centered maternity care,” which has focused on providing evidence‐based maternity care that is responsive to the needs of women and their families. The objective of this research was to explore women’s birth experiences within the context of the numerous changes that have occurred in perinatal care and to determine how information and knowledge acquired about pregnancy and birth influenced women’s birth experiences. Methods: Semi‐structured interviews were conducted in prenatal health clinics in Montreal and Vancouver with 36 women before and after birth. Results: Most study participants were unaware of the range of available providers and birth settings. Of the women who were more aware of their options, those selecting a birth center or home birth and midwives had different notions of risk than those who planned a hospital birth. Study participants felt generally well informed, but thought that information sharing, collaborative decision making, or both were inadequate during labor and birth within the hospital setting. Conclusions: Despite positive changes in recent years, family‐centered maternity care in Canada still needs to be improved. Women’s ability to use their acquired prenatal knowledge to feel satisfied by their birth experience continues to be undermined by a system of care that does not prioritize women’s informed choice. Further systemic change is required to align maternity care with the needs of Canadian birthing women and their families. (BIRTH 37:2 June 2010)     

Latent class analysis of health,social, and behavioral profiles associated with psychological distress among pregnant and postpartum women during the COVID-19 pandemic in the United States

Background

There is a growing body of literature documenting negative mental health impacts from the COVID-19 pandemic. The purpose of this study was to identify risk and protective factors associated with mental health and well-being among pregnant and postpartum women during the pandemic.

Methods

This was a cross-sectional, anonymous online survey study distributed to pregnant and postpartum (within 6 months) women identified through electronic health records from two large healthcare systems in the Northeastern and Midwestern United States. Survey questions explored perinatal and postpartum experiences related to the pandemic, including social support, coping, and health care needs and access. Latent class analysis was performed to identify classes among 13 distinct health, social, and behavioral variables. Outcomes of depression, anxiety, and stress were examined using propensity-weighted regression modeling.

Results

Fit indices demonstrated a three-class solution as the best fitting model. Respondents (N = 616) from both regions comprised three classes, which significantly differed on sleep- and exercise-related health, social behaviors, and mental health: Higher Psychological Distress (31.8%), Moderate Psychological Distress (49.8%), and Lower Psychological Distress (18.4%). The largest discriminatory issue was support from one's social network. Significant differences in depression, anxiety, and stress severity scores were observed across these three classes. Reported need for mental health services was greater than reported access.

Conclusions

Mental health outcomes were largely predicted by the lack or presence of social support, which can inform public health decisions and measures to buffer the psychological impact of ongoing waves of the COVID-19 pandemic on pregnant and postpartum women. Targeted early intervention among those in higher distress categories may help improve maternal and child health.     

Women's Experiences After a Third‐Degree Obstetric Anal Sphincter Tear: A Qualitative Study

Abstract: Background: Little qualitative data are available that address the experiences of women who sustain a third‐degree obstetric anal sphincter tear during childbirth. The objective of this study was to explore the views and experiences of women in the postpartum period after sustaining a third‐degree obstetric anal sphincter tear. Methods: A qualitative study was conducted using focus groups in a large maternity hospital in the United Kingdom. Two focus groups used a purposive sample of women who had suffered a third‐degree tear. One group (n = 6) had a tear in the index pregnancy and the second group (n = 4) had a subsequent pregnancy after the tear. Results: The main themes identified included apprehension about consequences of the injury in terms of continence; body image and sexual functioning; anxiety about and lack of involvement in planning for future pregnancies; poor information exchange and communication (including both content and timing of discussions); poor emotional support from professionals and family members; physical and emotional impact; and unresolved anxieties in partners. Similarities occurred across both groups. Conclusions: A third‐degree tear causes a significant emotional and psychological impact on women's physical and emotional well‐being. We recommend that all staff receive adequate training to deal with the issues that may be raised. The provision of a dedicated, multidisciplinary team involved at an early stage to coordinate the repair and follow‐up is recommended to allow a sensitive, consistent, evidence‐based approach, particularly in terms of decision‐making for subsequent births. The experiences and needs of partners require further study. (BIRTH 32:2 June 2005)     

Examining Relationships Between Body Dissatisfaction,Maladaptive Perfectionism,and Postpartum Depression Symptoms

ObjectiveTo explore body dissatisfaction and maladaptive perfectionism as risk factors for postpartum depression symptomatology.DesignProspective, cohort design.SettingUrban and suburban hospital‐based obstetrician and midwifery offices.ParticipantsForty‐six (46) adult ethnically diverse pregnant women with gestational age greater than or equal to 28 weeks.MethodBody dissatisfaction and maladaptive perfectionism were assessed in the offices of health care providers during the third trimester of pregnancy. Postpartum depression symptomatology was assessed at least 2 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) via postal mail or e‐mail.ResultsBody dissatisfaction predicted postpartum depression symptoms, even after controlling for previously established risk factors. No main effect emerged between maladaptive perfectionism and postpartum depression symptoms.ConclusionsBody dissatisfaction in the third trimester of pregnancy serves as a risk factor for postpartum depression. Therefore, assessment of body image during the third trimester of pregnancy may help health care providers identify women at risk of postpartum depression. Body dissatisfaction also may be an important target for postpartum depression prevention and treatment programs.     

An analysis of the meanings of pre-eclampsia for pregnant and postpartum women and health professionals in Rio Grande do Norte, Brazil

Objective

to understand the meanings of pre-eclampsia for pregnant and postpartum women and health-care professionals.

Design

a word-association test and semi-structured interviews.

Setting

a maternity hospital located in Natal, Rio Grande do Norte, Brazil that serves pregnant and postpartum women considered to be at high risk.

Participants

51 pregnant women, 10 postpartum women and 87 health-care professionals completed a word-association test; 18 pregnant women, two postpartum women and 20 health-care professionals for the interviews.

Measurements and findings

thematic categories based on the word-association test and the interviews were created to help the data analysis. χ² test was used to compare the categories raised by both groups in the word-association test to determine the association between the frequencies of these categories. The meanings of pre-eclampsia to pregnant and postpartum women were fear, risk, care and lack of information. To the health-care professionals, the meanings were care, fear, risk, high blood pressure, oedema and proteinuria. The frequencies of the categories ‘fear’, ‘care’ and ‘risk’ were statistically different (χ²=31.84, 14.5, 38.19, respectively; df=2, p<0.001) between the group of pregnant and postpartum women and the group of health-care professionals. For the first group, the most significant meanings were fear and risk, compared with care for the second group. The analysis of the interviews confirmed and deepened the results of the word-association test, and also demonstrated that the pregnant and postpartum women had no information about pre-eclampsia.

Key conclusions and implications for practice

there is a gap between how women and health professionals view their experiences of pre-eclampsia. A warm welcome to the health-care facility, with clear explanations about the disease and the procedures to be performed during the visits and hospitalisation would be important aspects for the physical and mental well-being of pregnant and postpartum women.