Predictors of women's physical health problems after childbirth

The objectives of this study were to document the extent and the correlates of common physical health symptoms in women two months after childbirth. Of special interest was determining whether violence and depression histories increase the risk for experiencing these symptoms. Participants were recruited in six Toronto-area hospitals and were interviewed by telephone 8–10 weeks later. Two hundred of the 332 (60.2%) women who were approached completed the study. Most women (96%) reported at least one physical health symptom 2 months postnatally (Mean?=?3.4, SD?=?2.0). Stepwise logistic regression was conducted for each outcome. Antenatal depression was a significant predictor of excessive fatigue and bad headaches. Sick leave during pregnancy predicted postpartum backaches. Adult emotional abuse and household income were associated with bowel problems. Episiotomy, maternal complications, and planned pregnancy predicted perineal pain. Finally, being Canadian born and having an assisted vaginal delivery increased the risk for hemorrhoids while cesarean section decreased the risk. A high prevalence of physical symptoms was found in women after childbirth. History of depression and violence were implicated in the occurrence of some of these symptoms. Other important predictors included demographic, maternal, and delivery-related factors.     

The longitudinal course of post-traumatic stress after childbirth

Post-traumatic stress was assessed in early and late pregnancy, and 1, 4, 7, and 11 months postpartum by means of questionnaires among 1224 women. Thirty-seven women (3%) had post-traumatic stress (meeting criteria B, C, and D for PTSD) at least once within 1–11 months postpartum. In pregnancy, depression, severe fear of childbirth, ‘pre’-traumatic stress, previous counseling related to pregnancy/childbirth, and self-reported previous psychological problems were associated with an increased risk of having post-traumatic stress within 1–11 months postpartum. Sum-scores of post-traumatic stress did not decrease over time among women who at least once had post-traumatic stress (criteria B, C, and D) within 1–11 months postpartum. Women with post-traumatic stress also showed a decrease in perceived social support over time postpartum.     

Self-criticism,negative automatic thoughts and postpartum depressive symptoms: the buffering effect of self-compassion

ABSTRACT

Objective: This study aimed to explore the direct and indirect effects of self-criticism on postpartum depressive symptoms, through postpartum cognitions, and analyse the moderating role of self-compassion in this relationship.

Background: Self-criticism and self-compassion are associated with postpartum depression. However, further research is needed to understand how these mechanisms operate in the development/maintenance of depressive symptoms.

Methods: 686 women in the postpartum period (up to 12 months after birth) recruited in-person and online answered a cross-sectional survey.

Results: The effect of self-criticism on postpartum depressive symptoms occurred sequentially, increasing the frequency of negative automatic thoughts and subsequently the metacognitive appraisal of these thoughts. Self-compassion had a moderating effect only on the relation between self-criticism and postpartum cognitions. The effect of self-criticism on postpartum cognitions decreased in the presence of higher self-compassion.

Conclusion: This study emphasises the negative effect of a self-critical thinking style and of a negative appraisal of thought’s content on depression symptoms. Moreover, this work underscores the buffering role of self-compassion in the relationship between self-criticism and postpartum cognitions. These results highlight the need to address the reduction of self-criticism and the promotion of self-compassion strategies to deal with postpartum cognitions, in order to prevent and treat postpartum depressive symptoms.     

Haptotherapy as a new intervention for treating fear of childbirth: a randomized controlled trial

Objective: To evaluate the effect of haptotherapy on severe fear of childbirth in pregnant women.

Design: Randomized controlled trial.

Setting: Community midwifery practices and a teaching hospital in the Netherlands.

Population or Sample: Primi- and multigravida, suffering from severe fear of childbirth (N?=?134).

Methods: Haptotherapy, psycho-education via Internet and care as usual were randomly assigned at 20–24?weeks of gestation and the effects were compared at 36?weeks of gestation and 6?weeks and 6?months postpartum. Repeated measurements ANOVA were carried out on the basis of intention to treat. Since there were crossovers from psycho-education via Internet and care as usual to haptotherapy, the analysis was repeated according to the as treated principle.

Main outcome measures: Fear of childbirth score at the Wijma Delivery Expectancy/Experience Questionnaire.

Results: In the intention to treat analysis, only the haptotherapy group showed a significant decrease of fear of childbirth, F(2,99)?=?3.321, p?=?.040. In the as treated analysis, the haptotherapy group showed a greater reduction in fear of childbirth than the other two groups, F(3,83)?=?6.717, p?<?.001.

Conclusion: Haptotherapy appears to be more effective in reducing fear of childbirth than psycho-education via Internet and care as usual.     

Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors

OBJECTIVE: To estimate the prevalence of post-traumatic stress disorder (PTSD) after childbirth in a group of postpartum Nigerian women and to examine any associated factors. DESIGN: A cross-sectional survey. SETTING: Postnatal clinics and infant immunisation clinics of the five health centres in Ilesa Township, Nigeria. POPULATION: A total of 876 women at 6 weeks postpartum. METHODS: The postpartum women were assessed for PTSD at 6 weeks. Other data collected were demographic characteristics, details of pregnancy and delivery and neonatal outcome. Additionally, the following measures were used: the MINI International Neuropsychiatric Interview to assess PTSD, the Index of Marital Satisfaction to measure the degree of problem a spouse encounters in the marital relationship, the Medical Outcome Study Social Support Survey to measure social support, the Life Events Scale to measure the life stress covering the preceding 12 months and the Labour Agentry Scale that measures the maternal experiences of control during childbirth. MAIN OUTCOME MEASURES: Prevalence of PTSD in this population of postpartum Nigerian women, and how this prevalence related to other maternal and neonatal characteristics. RESULTS: The prevalence of PTSD was 5.9%. The factors independently associated with PTSD after childbirth include hospital admission due to pregnancy complications (OR 11.86, 95% CI 6.36-22.10), instrumental delivery (OR 7.94, 95% CI 3.91-16.15), emergency caesarean section (OR 7.31, 95% CI 3.53-15.10), manual removal of placenta (OR 4.96, 95% CI 2.43-10.14) and poor maternal experience of control during childbirth (OR 5.05, 95% CI 2.69-9.48). CONCLUSIONS: The prevalence of PTSD after childbirth in Nigerian women is slightly higher than those found in western culture. An effective model for the prediction of the development of PTSD after childbirth needs to be developed and evaluated, and interventions aimed at reducing the incidence of PTSD after childbirth need further research.     

分娩阵痛对产妇心理因素及分娩的影响

目的：探讨分娩阵痛对产妇心理因素及分娩的影响。方法：收集在我院分娩的225例产妇,用自行设计的基于患者对产科优质护理指征问卷进行调查,对自然分娩与剖宫产产妇满意度比较。结果：提供支持减轻疼痛方面,剖宫产产妇的满意程度显著低于自然分娩产妇（Z=2．110,P=0．0035）,对于助产服务的其他方面的满意度评价无显著差异（P〉0．05）。结论：给产妇提供更多的支持、减轻分娩疼痛,促进自然分娩。     

Measuring posttraumatic stress following childbirth: a critical evaluation of instruments

Objectives.?To evaluate instruments used to assess posttraumatic stress disorder (PTSD) following childbirth with both quantitative (reliability analysis and factor analysis) and qualitative (comparison of operationalization) techniques.

Methods.?An unselected population of 428 women completed the Traumatic Event Scale-B (TES-B) and the PTSD Symptom Scale-Self Report (PSS-SR) 2–6 months after delivery.

Results.?Assessment of internal consistency yielded similar results for the TES-B and PSS-SR (Cronbach's α?=?0.87 and 0.82, respectively). Factor analysis revealed two rather than three DSM-IV symptom categories for both instruments: childbirth-related factors (re-experiencing/ avoidance) and symptoms of depression and anxiety (numbing/ hyperarousal). Although the TES-B and the PSS-SR sum-scores show a strong relationship (Spearmans ρ?=?0.78), agreement between the instruments on the identification of PTSD cases is low (κ?=?0.24); discrepancy between TES-B and PSS-SR is largely due to differences in instruction to respondents, formulation of items, answer categories, and cut-off values.

Conclusions.?Large operationalization differences between TES-B and PSS-SR have been identified, i.e., in the formulation of questions, answer categories, cut-off values and instructions to respondents. Comparison between studies using different instruments for measuring PTSD following childbirth should be done with utmost caution.     

State and trait anxiety as a psychopathological phenomenon correlated with postpartum depression in a Romanian sample: a pilot study

Abstract

The current study aimed to investigate the rate of postpartum depression and its correlation with both state and trait anxiety. A cross-sectional study was performed on 80 mothers monitored in the Ambulatory of “Bega” Obstetrics Clinic from Timisoara. The presence of depression was assessed with the Edinburgh Postnatal Depression Scale, using a cut-off ≥10. State anxiety was assessed using the Beck Anxiety Inventory and anchored visual analogue scales. Trait anxiety was dimensionally assessed using the Karolinska Scale of Personality (KSP). More than half of recruited mothers presented a global score significant for postpartum depression (N?=?43, 53.8%). Both perspectives of anxiety, as a state (p?<?0.001) and as personality traits (e.g. p?=?0.003 for psychic anxiety), were significantly correlated with postpartum depression. Furthermore, the levels of worry related to self-perceived health status of both mother and infant were significant in mothers with postpartum depression. We can conclude that postpartum depression was a highly-frequent psychopathological phenomenon among mothers from this sample set. In addition, both state and trait anxiety were common co-occurring clinical features.     

Parents' experiences of using videoconferencing as a support in early discharge after childbirth

Objective

to describe parents’ experiences of using videoconferencing (VC) when discharged early from a maternity unit.

Design

a combination of quantitative and qualitative methods was used to describe parents’ experiences. Data were collected via questionnaires and interviews.

Setting

a pilot study involving a maternity department and new parents in their homes was conducted. Through VC, parents discharged early were able to maintain follow-up contact with the midwife via sound and picture at the department.

Participants

nine couples/new parents participated.

Findings

the analysis revealed four categories of responses: ‘feeling confident with the technology’; ‘feeling confident of having control of their privacy’; ‘feeling confident being face-to-face on the VC’; and ‘feeling confident when worries and concerns were met and answers were received’.

Key conclusions

using VC as a support in cases of early discharge after childbirth can facilitate a meeting that makes it possible for new parents to be guided by the midwife in their transition into parenthood.

Implications for practice

the findings of this study indicate that VC equipment may be helpful for parents discharged from hospital early after childbirth. The findings can also be used as a foundation for further development of the application of VC within maternal health care and in health care in rural areas.     

Relationship between maternal self-efficacy and functional status four months after delivery in Iranian primiparous women

Introduction: Postpartum women experience changes in their physiological and psychological functions as they adapt to their parenting role. The objective of this study was to examine the association between maternal self-efficacy and functional status in postpartum period.

Methods: In this cross-sectional study, 305 Iranian women were selected randomly via a two-stage cluster sampling method at the end of the fourth month postpartum in 25 healthcare centers of Tabriz-Iran, 2016. Data were collected using the socio-demographic characteristics questionnaire, self-efficacy scale and inventory of functional status after childbirth. The statistical tests including Pearson correlation, Independent sample t-test, one-way ANOVA and General linear model were used for data analysis.

Results: A significant positive relationship was observed between functional status and self-efficacy (p?<?0.001, r?=?0.359). According to the adjusted general linear model, self-efficacy, mother’s age, income status and planned pregnancy have statistically significant relationships with functional status and explain 33.5% of the variance in the functional status score.

Conclusion: The findings of the present study showed that increased postpartum maternal self-efficacy is associated with improved functional status, which requires health providers to evaluate postpartum maternal self-efficacy and make the necessary interventions if it is low.     

Factors related to exclusive breastfeeding among postpartum Thai women with a history of gestational diabetes mellitus

Objective: This study aimed to investigate the factors related to exclusive breastfeeding among postpartum Thai women with a history of gestational diabetes mellitus. Background: Postpartum women with diabetes are more likely to have delayed lactogenesis. Strict glycaemic control may affect lactation. Methods: A cross-sectional analytic research was designed to carry out the study. One hundred and fifty participants were included in the study. Data were collected in two phases using the Exclusive Breastfeeding questionnaire. Data were analysed using Pearson correlation, independent t-test and binary logistic regression. Results: The significant factors related to the 6-month exclusive breastfeeding were maternal age, employment, parity, body mass index, duration of newborn’s admission in NICU and exclusive breastfeeding intention. Conclusion: These findings indicate that effective nursing interventions need to be implemented for promoting exclusive breastfeeding among postpartum women with diabetes.     

Developing a woman-centered,inclusive definition of positive childbirth experiences: A discussion paper

Introduction

A positive childbirth experience promotes women’s health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

Aim

To formulate an inclusive woman-centered definition of a positive childbirth experience.

Methods

A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women’s feedback (n = 42).

Results

The following definition was formulated: “A positive childbirth experience refers to a woman’s experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman’s psychosocial well-being.”

Conclusions

This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.     

Professional attitudes towards normal childbirth in a shared care unit

Objective

to identify and compare obstetricians', midwives' and, assistant personnel's attitudes towards Clinical Practice Guidelines (CPG) for normal birth of The National Health System.

Design

quantitative methodology using a self-completed questionnaire regarding the recommendations of the CPG for normal birth with two five-point Likert scales that measured the degree of agreement and the level of applicability.

Setting

a Labour Ward: Catalonia, Spain.

Participants

a total sample of 96 professionals (obstetricians=32, midwives=44 and assistant personnel=20) answered the questionnaire.

Findings

midwives and obstetricians often have significantly divergent levels of agreement on key recommendations. Assistant personnel have more similar opinions to midwives', even though they are a more diverse group. Midwives are more in line with the recommendations of CPG for normal birth than obstetricians and assistant personnel. Concerning the applicability, obstetricians showed greater degree of applicability, followed by the other two groups.

Conclusions

given that there is divergence in opinion on agreement and applicability between professional groups it is necessary to identify areas of accordance, disagreement or ambiguity of knowledge and practice among all care providers, so that midwives can facilitate normal childbirth in a shared-model unit.