First-time fathers' health status during the perinatal period

BackgroundFor first-time fathers, the perinatal period is a critical period of stress and imbalance. Marital intimacy and social support may affect their stress and health status while they change their roles.AimThis study was to explore the changes of and correlations among marital intimacy, social support, and health status and predictors of first-time fathers' health status during the perinatal period.MethodsWith a repeated measures study design, a total of 217 first-time fathers whose spouses were in the third trimester of pregnancy were recruited for the study. The Chinese Health Questionnaire, Marital Intimacy Scale, and Social Support Scale were employed to collect data at a medical center in the 36th week of pregnancy and the 1st and 4th weeks after childbirth.ResultsThe levels of marital intimacy and social support of first-time fathers during the perinatal period increased significantly with time. Meanwhile, the period of the first week after childbirth was a predictor of first-time father's health status.ConclusionsThis study only tracked the first-time fathers' health status in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. Future studies could track them until one year after childbirth in order to explore the impact of the perinatal period on the couples and their babies. During the perinatal period, health care providers shall assess and provide needed interventions to first-time fathers as soon as possible to facilitate the first-time fathers to get ready for the role transition and to promote their health status.     

The relationship between support systems and anxiety in couples admitted to the emergency department with vaginal bleeding

IntroductionFirst-trimester vaginal bleeding largely occurs due to miscarriage, ectopic pregnancy, gestational trophoblastic diseases. Pregnant women diagnosed with threatened abortion experience and their spouses severe anxiety and stress due to the probability of the pregnancy ending. Couples having difficulty coping with the see motions need support systems. The aim of this study was to examine the relationship between the anxiety levels experienced by couples who present at the emergency department with a complaint of vaginal bleeding and are diagnosed with threatened abortion, as well as their support systems.MethodsThe study was conducted with 276 participants (138 pregnant women and their spouses) admitted to the obstetrics emergency department of an obstetrics and paediatrics hospital in Turkey between December 2014 and March 2015. Data were collected through a demographic information form developed by the researcher, the State-Trait Anxiety Inventory (STAI), and the Multidimensional Scale of Perceived Social Support (MSPSS).ResultsThere were significant negative associations between mean the State-Trait Anxiety Inventory scores and Multidimensional Scale of Perceived Social Support scores of the pregnant women and their spouses (p < 0.05). The couples’ anxiety levels did not significantly differ according to whether they received support from each other and from emergency nurses (p > 0.05).ConclusionIt was found that both state and trait anxiety levels of the couples decreased as perceived social support increased. However, it was determined that the support couples received from each other and from emergency nurses was not sufficient in terms of reducing anxiety.     

Effects of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women at 3-month follow up: randomised controlled trial

BackgroundDeveloping a sense of well-being and achieving maternal role competence are considered critical components of maternal adaptation. Given the growing evidence of postpartum depression and its devastating effects, effective childbirth psychoeducation programme to promote maternal role competence, psychological well-being and prevent postpartum depression is essential and of an urgent priority.ObjectiveTo examine the effects of an interpersonal psychotherapy oriented childbirth education programme on social support, maternal role competence, postpartum depression and psychological well-being in Chinese first-time childbearing women at three-month postpartum.Design, setting and participantsRandomised controlled trial in a regional teaching hospital, Guangzhou, China with 194 first-time pregnant women, of whom 96 received interpersonal-psychotherapy-oriented childbirth education programme and 98 standard care. The intervention was developed from principles of interpersonal psychotherapy which consisted of two 90-min antenatal classes and a telephone follow-up within two weeks after delivery. Outcomes measurements included Perceived Social Support Scale, Parenting Sense of Competence Scale-Efficacy subscale, Edinburgh Postnatal Depression Scale and General Health Questionnaire, were compared over three-month follow up.ResultsThe study group had significantly better improvement on perceived social support (p < 0.01), maternal role competence (p < 0.01), postpartum depressive symptoms (p < 0.01) and psychological well-being (p < 0.01) when compared with the control group. The study group also had significantly higher level of social support (t = 2.33, p = 0.021), maternal role competence (t = 2.43, p = 0.016) and less depressive symptoms (t = ?2.39, p = 0.018) at three-month postpartum when compared with the control group.DiscussionThe childbirth psychoeducation programme can substantially benefit first time Chinese mothers. It could be implemented as a routine care with ongoing evaluation. Future studies could focus on women in lower social classes, with multiple pregnancy and complicated pregnancy.     

Vulnerabilidad a los problemas de salud mental: Percepción de las mujeres embarazadas y de sus maridos en Surakarta,Indonesia

ObjectiveThis study aims to explore the perception of women and their husbands on the vulnerability of pregnant women to mental health disorders.MethodQualitative study using a phenomenological approach. The inclusion criteria were pregnant women of the second and third-trimester gestation (13–35 weeks). The exclusion criteria were pregnant women with complications and who had a family record of mental disorders. Data was collected using focus group discussion and in-depth interviews at four Primary Health Cares in Surakarta, Indonesia. Then, the data were analyzed through thematic analysis, which was supported by the OpenCode 4.02® software.ResultsThis study uncovered two main topics, firstly the factors that trigger the vulnerability of pregnant women to experience mental disorders and secondly perceived barriers to managing mental health during pregnancy and postpartum. Pregnant women and husbands recognize that they need to get mental health information.ConclusionUnstable emotions during pregnancy are considered normal and neglected by their surroundings. Lack of knowledge about mental health in pregnancy justifies the need to increase education in this area in order to prevent prenatal and postpartum depression.     

Childbirth overseas: the experience of Japanese women in Hawaii

The purpose of this study is to investigate which kinds of stress women experience during childbirth in a foreign country and to explore whether childbirth in a foreign country influences women's mental health. The study was a quantitative and qualitative mixed study. Forty-five Japanese women, born and raised in Japan and who gave birth in Hawaii, USA, were telephone-interviewed within 1 year after childbirth. The stress factors that emerged were: language barrier, distance from family and friends, different culture, and health-care attitude about childbirth. Half of the participants experienced emotional dysfunction during their pregnancy. All primiparas experienced postpartum depression. The participants who had the maternity blues tended to have postpartum depression. Help from the participants' mothers after childbirth decreased postpartum depression. The importance of mental health for foreign-born primiparas emerges during the perinatal period.     

Paternal depressive symptoms during the early postpartum period and the associated factors following the implementation of the two-child policy in China

AimTo evaluate the prevalence of paternal depressive symptoms during the first three days of childbirth, as well as the associated factors, following the implementation of the two-child policy in China in 2015, which allows couples to have two children in the Chinese mainland.MethodsA cross-sectional study was conducted among 318 fathers. Paternal depressive symptoms and self-efficacy of fathers were screened using the Edinburgh Postnatal Depression Scale and the General Self-Efficacy Scale, respectively. In addition, basic information of all parents and neonates was collected. Univariate analysis, binary logistic regression analysis, and principal component analysis (PCA) were used to identify the relationship between paternal depressive symptoms and its associated factors.ResultsTwenty-two percentage of fathers had depressive symptoms during the first three days of childbirth. Binary logistic regression analysis revealed that older fathers, those who slept for more than 8 h per night, or were dissatisfied with their living conditions were more susceptible to developing the symptoms. On the contrary, protective factors such as the educational level of fathers, planned pregnancy, prenatal guidance, having the second-born child, and higher self-efficacy were found to reduce the development of paternal depressive symptoms. PCA showed that the main components that influenced the paternal depressive symptoms were parental age and parity.ConclusionsThe prevalence of paternal depressive symptoms during the postpartum period did not increase significantly after the implementation of the two-child policy in China. However, focusing on the associated factors is necessary in order to manage postpartum depression during the early postpartum period.     

The effect of psychosocial risk factors on postpartum depression in antenatal period: A prospective study

PurposeThe aim of this study was to determine the psychosocial risk factors that may increase the risk of developing postpartum depression (PPD) symptoms in the antenatal period at postpartum 6–8 weeks.MethodsThis study was a prospective longitudinal design, in which women completed questionnaire measures both at the third trimester of pregnancy and 6–8 weeks after birth. The present study was conducted in the women's clinic of a Medical Faculty Hospital in the Central Anatolia region of Turkey between March 15 and August 15, 2019. A total of 245 pregnant women in the third trimester were included in the study. Data were collected using a sociodemographic and obstetric data collection form, Pregnancy Psychosocial Health Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Edinburgh Postnatal Depression Scale.ResultsForty-four (18%) of the 245 women had scores above the cut-off point (>13) in EPDS. Being subjected to violence from husband or another male member of the family during pregnancy, having problems in marriage, depression, anxiety, and high levels of perceived stress affect the risk of developing PPD by 55% (χ² = 101.034, P < 0.001). It was observed that those who scored low on the psychosocial health scale, those who experienced unplanned pregnancy, those with pregnancy that was not wanted by the husband, those who were emotionally abused, and those who experienced a sad event in their families were more sensitive to PPD symptoms.ConclusionsPsychosocial health, perceived stress, and psychosocial risk factors, such as depression and anxiety, during pregnancy are important determinants of postpartum depressive symptoms.     

A qualitative study of childbirth fear and preparation among primigravid women: The blind spot of antenatal care in Lilongwe,Malawi

ObjectivesThis study aimed to explore childbirth fear and childbirth preparation among primigravid women in the late pregnancy from 36 to 40 weeks gestation.MethodsWe purposively recruited 18 primigravid women into in-depth interviews, 21 birth companions, and 13 health workers into focus group discussions. Participants were recruited from two community hospitals’ maternity waiting homes in Lilongwe, Malawi. Semi-structured interview guides were used to collect data that were analyzed using content analysis. NVivo11 computer software was used to organize the data.ResultsThe four categories developed were: “ambivalent pregnancy feelings” , “dependence on traditional childbirth counseling” ,“inadequate prenatal childbirth instruction” and “inconsistent roles of a birth companion” . The findings suggest that primigravid women who were mainly exposed to traditional childbirth mentoring rather than professional care providers, experienced childbirth fear, and lacked proper psychosocial childbirth preparation.ConclusionsChildbirth fear among primigravid women emanate from personal; family; ineffective traditional counseling; and inadequate antenatal childbirth instruction. Birth companions may increase childbirth stress. However, our findings highlight birth companions as readily available psychosocial support resources among primigravid women. We recommend that professional childbirth instruction during antenatal care should be strengthened to surpass traditional childbirth counseling. Appropriateness and effectiveness of birth companions need to be carefully assessed.     

Predicting Changes in Depressive Symptoms from Pregnancy to Postpartum: The Role of Brooding Rumination and Negative Inferential Styles

The current study examined the role of cognitive factors in the development and maintenance of depressive symptoms from pregnancy into the postpartum period. One hundred and one women were assessed for levels of rumination (brooding and reflection), negative inferential styles, and depressive symptoms in their third trimester of pregnancy and depressive symptom levels again at 4 and 8 weeks postpartum. We found that, although none of the three cognitive variables predicted women’s initial depressive reactions following childbirth (from pregnancy to 1 month postpartum), brooding rumination and negative inferential styles predicted longer-term depressive symptom changes (from pregnancy to 2 months postpartum). However, the predictive validity of women’s negative inferential styles was limited to women already exhibiting relatively high depressive symptom levels during pregnancy, suggesting that it was more strongly related to the maintenance of depressive symptoms into the postpartum period rather than increases in depressive symptoms following childbirth. Modifying cognitive risk factors, therefore, may be an important focus of intervention for depression during pregnancy.     

程序化产前健康教育对初产妇分娩结局的影响

目的探讨产前制定程序化健康教育对初产妇分娩结局的影响。方法选取行产前检查并自愿接受分娩计划及相应的健康教育120例初产妇为观察组,同期随机选取常规产前检查及健康教育120例初产妇为对照组,对两组孕妇分娩方式、会阴侧切、阴道助产、产后2小时出血量进行对比。结果观察组剖宫产率明显低于对照组,差异有统计学意义(P0.05)。结论对初产妇程序化健康教育可提高自然分娩率,降低剖宫产率,提高产科质量。     

Design and Implementation of a Group Prenatal Care Model for Somali Women at a Low-Resource Health Clinic

ObjectiveTo design and implement group prenatal care (GPC) for Somali women and to evaluate participants’ satisfaction, knowledge, and care engagement.DesignQuality improvement project.Setting/Local ProblemA federally qualified health center in an urban Midwestern setting, which serves a largely East African immigrant and refugee population.ParticipantsPregnant Somali women at more than 20 weeks gestation receiving prenatal care at the project site. Many participants were non–English speaking.Intervention/MeasurementsWhile honoring the 13 essential elements of CenteringPregnancy, the model was adapted to the East African population at the project site and offered to all eligible women receiving individual prenatal care at the clinic. Women attended biweekly sessions, including individual assessment and education, exposure to integrative health therapies, and group discussion. Pre- and postintervention data were collected in surveys and in-depth interviews from March through August 2017.ResultsSeventeen Somali women attended a median of two sessions (range = 1–7). Self-reported results for knowledge of safe exercise in pregnancy (p = .02), exclusive breastfeeding (p = .04), what happens in the hospital (p = .02), and stress management (p = .03) increased after GPC participation. Ninety-three percent of women preferred GPC to individual care.ConclusionWhen adapted to meet the needs of Somali women, GPC has the potential to improve care satisfaction, increase knowledge, and reduce stress during pregnancy and the postpartum period. This model may interest women and care providers in similar community health care settings.     

综合干预措施对产妇抑郁的影响评价

目的探讨产妇抑郁的发生及其影响因素,观察综合干预措施对降低产后抑郁发生率的作用。方法将1210例孕妇随机分为干预组(实施干预措施)和对照组,每组各605例,采用医院焦虑-抑郁自评量表、艾迪产后抑郁量表进行产前产后跟踪调查至,并进行对比分析。结果两组产前医院焦虑-抑郁情绪自评量表评定焦虑抑郁发生率无显著性差异(P>0.05);有焦虑情绪者产后抑郁发生率为54.10%,有抑郁情绪者产后抑郁发生率为56.36%,有焦虑-抑郁情绪者产后抑郁发生率成倍增加;干预组产后抑郁发生率为5.12%,对照组产后抑郁发生率为14.22%,两组差异有极显著性(P<0.01)。结论孕期焦虑-抑郁情绪是发生产后抑郁的最主要因素,综合干预措施能够显著降低产后抑郁的发生率。提示,加强对孕产妇及其家属进行产前、产时、产后宣教,能有效预防产后抑郁的发生。     

Implementation of a Perinatal Depression Care Bundle in a Nurse-Managed Midwifery Practice

ObjectiveTo implement a perinatal depression care bundle at a midwifery practice to help certified nurse-midwives (CNMs) educate women about perinatal depression and direct those affected to mental health services.DesignQuality improvement project to implement a perinatal depression care bundle for care of pregnant women between 24 and 29 weeks gestation.Setting/Local ProblemCNMs practicing in a nurse-managed midwifery practice systematically screen all women for perinatal depression during pregnancy and the postpartum period but do not have a consistent method of providing anticipatory guidance about perinatal depression.ParticipantsAll CNMs in the midwifery practice providing prenatal care (n = 16) participated in implementation.Intervention/MeasurementsThe perinatal depression care bundle included three elements: (a) an educational handout; (b) a brief, provider-initiated discussion about perinatal depression; and (c) lists of local and online mental health resources. Four weeks after the care bundle was implemented, we conducted a retrospective chart review to assess CNMs’ adherence to the new bundle.ResultsOver 4 weeks, 51 prenatal visits met eligibility criteria for participation. CNMs implemented the perinatal depression care bundle for 22 (43.1%) eligible visits. CNM feedback indicated that the care bundle was brief, easy to incorporate into routine care, and well received by women.ConclusionThis project incorporated the use of a perinatal depression care bundle for women seen during routine prenatal care. Using a systematic approach to deliver perinatal depression education and resources reduces process variability and may destigmatize the illness, allowing women to feel empowered to seek help before depression symptoms become severe.     

妊娠晚期心理干预对乙型肝炎病毒携带者妊娠结局的影响

目的：探讨妊娠晚期心理干预对携带乙肝病毒孕妇妊娠结局以及产后抑郁症发生率的影响。方法：妊娠晚期出现产前抑郁的携带乙肝病毒（HBV）孕妇共97例,其中52例接受系统的咨询式心理干预以及支持性心理治疗（干预组）,另45例未进行干预（未干预组）,观察比较其妊娠结局以及产后抑郁症的发生率。结果：心理干预组与非干预组的妊娠结局（包括分娩难产率、产后出血发生率、早产率、新生儿窒息率等方面）差异有统计学意义（P〈0.01）。干预组产后42d抑郁症的发生率为32.69%（17/52）,而非干预组产后抑郁症的发生率为62.22%（28/45）,有显著差异（P〈0.01）。结论：妊娠晚期心理干预能有效改善出现产科抑郁的携带乙肝病毒孕妇的妊娠结局,并能有效地减轻其抑郁情绪,提高产后抑郁症的发生率。     

Effect of individualized medical nutrition guidance on pregnancy outcomes in older pregnant women

ObjectiveWe aimed to explore the effect of individualized medical nutrition guidance on pregnancy outcomes among older pregnant women.MethodsThis was a prospective study using a randomized controlled trial design. We selected 820 older pregnant women and randomly divided them into a study group and control group (410 women each). The control group was given routine health education and nutrition guidance; the study group was provided individualized medical nutrition guidance. Gestational diabetes mellitus, hypertensive disorders of pregnancy, vaginal delivery rate, postpartum hemorrhage rate, gestational body weight, neonatal birth weight, and neonate transfer to the neonatal intensive care unit (NICU) were compared between the groups.ResultsThe incidence of gestational diabetes in the study group was significantly lower and the rate of vaginal delivery was significantly higher than those in the control group. The incidence of macrosomia, rate of neonatal transfer to the NICU, and rate of neonatal hyperbilirubinemia were significantly lower in the study group than those in the control group.ConclusionsIndividualized nutritional intervention for older pregnant women can effectively reduce the incidence of complications during pregnancy and childbirth and improve maternal and child outcomes.     

妊娠期及围产期全程干预预防压力性尿失禁的效果观察

目的:研究妊娠期及围产期全程干预预防压力性尿失禁(SUI)的效果。方法:随机选取2005年1月~2008年1月在我院行规范产前检查及分娩且接受从孕期至产褥期全程指导的孕妇330例作为干预组,同期行规范产前检查及分娩但只给予常规指导的孕妇300例作为对照组,研究SUI的发病情况。结果:孕37周、产后6周、产后半年SUI发生率:干预组为4.5%、3.3%、0.3%,对照组为32.7%、33.7%、6.0%,两组比较差异具有统计学意义(P<0.01)。结论:妊娠期个性化营养指导、产前及产后盆底肌训练、分娩期避免对盆腔组织和尿道损伤,加强全程干预指导,可有效减少SUI的发病率。     

The effects of antenatal education on fear of childbirth,maternal self-efficacy and post-traumatic stress disorder (PTSD) symptoms following childbirth: an experimental study

BackgroundFear of birth and low childbirth self-efficacy is predictive of post-traumatic stress disorder symptoms following childbirth. The efficacy of antenatal education classes on fear of birth and childbirth self-efficacy has been supported; however, the effectiveness of antenatal classes on post-traumatic stress disorder symptoms after childbirth has received relatively little research attention.PurposeThis study examined the effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder symptoms following childbirth.DesignQuasi-experimental study.MethodsThe study was conducted in a city located in the Middle Anatolia region of Turkey and data were collected between December 2013 and May 2015. Two groups of women were compared—an antenatal education intervention group (n = 44), and a routine prenatal care control group (n = 46). The Wijma Delivery Expectancy/Experience Questionnaire, Version A and B, Childbirth Self-efficacy Inventory and Impact of Event Scale–Revised was used to assess fear of childbirth, maternal self-efficacy and PTSD symptoms following childbirth.ResultsCompared to the control group, women who attended antenatal education had greater childbirth self-efficacy, greater perceived support and control in birth, and less fear of birth and post-traumatic stress disorder symptoms following childbirth (all comparisons, p < 0.05).ConclusionsAntenatal education appears to alleviate post-traumatic stress disorder symptoms after childbirth.