Socio-economic status and pregnancy outcome. An Australian study

A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers' Hospital in Brisbane was examined to consider the impact of socio-economic status on pregnancy outcome. The indicators of socio-economic status selected were family income, maternal education and paternal occupational status. Pregnancy outcomes considered were preterm delivery, low birthweight, low birthweight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational status of the father and three measures of perinatal morbidity. Initial adjustment for the mother's socio-demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variations between the three status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed class differences in pregnancy outcome are attributable to the mother's personal characteristics (height/weight, parity) and her lifestyle.     

Maternal health after childbirth: results of an Australian population based survey

Objective To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.
Design Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.
Participants All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.
Results The response rate was 62.5% (   n = 1336  ). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (435%), sexual problems (26.%), haemorrhoids (24.%) and perineal pain (21%); 16.% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.9 [95% CI 3.–6.]), sexual problems (OR 2.6 [95% CI 1.–3.]), and urinary incontinence (OR 1.81 [95% CI 1.–2.1). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.
Conclusion Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.     

Psychological growth after childbirth: an exploratory prospective study

Introduction: It is important to elucidate the psychologically positive aspects of childbirth for mothers, and not only the negative aspects such as perinatal depression. This study aimed to examine psychological growth after childbirth and its related variables by focussing on five factors of posttraumatic growth: relating to others, new possibilities, personal strength, spiritual change and appreciation of life.

Methods: Pregnant women during mid-pregnancy were consecutively recruited at a women’s hospital in Japan and followed up 1 month after childbirth. Psychological growth was assessed by the Posttraumatic Growth Inventory.

Results: Among 177 participants, 117 (66.1%) completed follow-up assessments 1 month after childbirth. Multivariable regression analysis revealed that primipara, higher resilience and less fear at childbirth were associated with posttraumatic growth factors of relating to others and new possibilities. High resilience and less fear at childbirth were also associated with personal strength. On the other hand, being primiparous and high depressive symptoms were associated with greater appreciation of life. No variables were associated with spiritual change.

Discussion: These findings suggest that giving birth for the first time could be a highly challenging life event as well as an opportunity which leads to PTG, and that giving birth with low fear might lead to mothers’ psychological growth. On the other hand, appreciation of life might need attention as it might signify some sorts of coping response. These findings contribute to our understanding of the psychological changes experienced by mothers.     

An exploration of negative thoughts as a normal phenomenon after childbirth

The period following the birth of a child brings many transitions into a woman's life, which can effect major psychological and social changes, including feelings of loss. If new mothers experience negative thoughts at this time, when societal expectations are of happiness, this may lead to feelings of unacceptability and guilt. This study aimed to investigate the prevalence of negative thoughts after childbirth in nondepressed mothers. Following the identification of negative thoughts experienced by women who had suffered postnatal depression, a quantitative survey was conducted, which asked nondepressed mothers to indicate how often they experienced the negative thoughts or images identified by depressed mothers. One hundred and fifty-eight returned questionnaire packs were included in the analyses. The 158 nondepressed mothers acknowledged experiencing all but one of the 54 negative cognitions. Negative cognitions usually associated with postnatal depression are also experienced by mothers who are not considered depressed. This information provides evidence for reassuring new mothers that negative thoughts after childbirth are common. This, in turn, may help to reduce feelings of guilt associated with experiencing negative thoughts in the postpartum period.     

Faecal incontinence after childbirth

Objective To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors.
Design A cohort study with information on symptoms collected in home-based interviews and obstetric data from hospital casenotes.
Setting Deliveries from a maternity hospital in Birmingham.
Participants Nine hundred and six women interviewed a mean of 10 months after delivery.
Main outcome measures New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.
Results Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.
Conclusions Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.     

Health problems after childbirth

Of the entire maternity care cycle, the postpartum period occupies the lowest priority in practice, teaching, and research. Despite this, data from research outside the United States show that health problems after birth are very common, may persist over time, and are often under-recognized by care providers. Women's health would be favorably impacted by updating patterns of postpartum care, and by obtaining baseline population data in midwifery practices on the extent of postnatal morbidity.     

Fear of childbirth before, during, and after childbirth

BACKGROUND: Only scanty research exists about the relationship between women's expectations during pregnancy and their experiences as reported during the actual process of labor and afterwards. The aims of the present study were: (1) to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during early active labor (phase 1: cervix dilatation 3-5 cm), and (2) to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia during labor. Methods. Fear of childbirth was measured in 47 nulliparous women during gestation weeks 37-39 by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ version A). During early active labor we measured women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale). Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery. RESULTS: A positive correlation appeared between fear of childbirth during pregnancy, postpartum, and early active labor. There were no differences in fear of childbirth during late pregnancy between women who received epidural analgesia and those who did not. Postpartum fear was higher in the women who had received epidural analgesia. CONCLUSIONS: Pregnant women who fear childbirth are prone to report fear during the actual labor and postpartum. The administration of epidural analgesia is not a sufficient response to women's fear during the process of labor.     

An Australian study of midwives' breast-feeding knowledge

OBJECTIVE: To investigate midwives' breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context. DESIGN: Postal questionnaire. SETTING: National Australia. PARTICIPANTS: Midwives (n=3500) who are members of the Australian College of Midwives Inc (ACMI). FINDINGS: A response rate of 31% (n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives' role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants' breast-feeding knowledge. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.     

Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study

Objectiveto investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth.Designprospective pregnancy cohort study.SettingMelbourne, Victoria, Australia.Population1507 nulliparous women.Methodswomen were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum.Outcome measuresEdinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems.Resultsoverall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0–2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0–15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6–12 months post partum (Adjusted OR=3.43, 95% CI 2.1–5.5).Conclusionspoor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems.