Obstetric complications and psychological well-being: experiences of Bangladeshi women during pregnancy and childbirth

Women in developing countries experience postnatal depression at rates that are comparable with or higher than those in developed countries. However, their personal experiences during pregnancy and childbirth have received little attention in relation to postnatal depression. In particular, the contribution of obstetric complications to their emotional well-being during the postpartum period is still not clearly understood. This study aimed to (a) describe the pregnancy and childbirth experiences among women in Bangladesh during normal childbirth or obstetric complications and (b) examine the relationship between these experiences and their psychological well-being during the postpartum period. Two groups of women--one group with obstetric complications (n=173) and the other with no obstetric complications (n=373)--were selected from a sample of women enrolled in a community-based study in Matlab, Bangladesh. The experiences during pregnancy and childbirth were assessed in terms of a five-point rating scale from 'severely uncomfortable=1' to 'not uncomfortable at all=5'. The psychological status of the women was assessed using a validated local version of the Edinburgh Postnatal Depression Scale (EPDS) at six weeks postpartum. Categorical data were analyzed using the chi-square test and continuous data by analysis of variance. Women with obstetric complications reported significantly more negative experiences during their recent childbirth [95% confidence interval (CI) 1.36-1.61, p<0.001] compared to those with normal childbirth. There was a significant main effect on emotional well-being due to experiences of pregnancy [F (4,536)=4.96, p=0.001] and experiences of childbirth [F (4,536)=3.29, p=0.01]. The EPDS mean scores for women reporting severe uncomfortable pregnancy and childbirth experiences were significantly higher than those reporting no such problems. After controlling for the background characteristics, postpartum depression was significantly associated with women reporting a negative childbirth experience. Childbirth experiences of women can provide important information on possible cases of postnatal depression.     

Correction to: Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health

Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

     

Recovery from childbirth: Looking back 6 months after delivery

Women's perceptions of their recovery from childbirth were investigated by open‐ended interviews of 96 mothers of healthy, full‐term infants 6 months after delivery. Data included factors affecting physical, mental, and emotional recovery; sources of help and hindrance; ideas of what each woman would do differently after the delivery of another child; and overall evaluation of how the months after delivery compared with expectations. Content analysis of the data revealed that 25% of the women did not feel physically recovered from childbirth at 6 months postpartum. Husbands and other family members were major sources of help. Prolonged labor and cesarean delivery were the major hindrances to recovery. More household and child‐care help was desired after delivery of another child. Almost half of the women found the first 6 months after delivery more difficult than anticipated. The findings suggest that pregnant women need more information about lifestyle adjustments after childbirth.     

The obstetrical and postpartum benefits of continuous support during childbirth

The purpose of this article is to review the evidence regarding the effectiveness of continuous support provided by a trained laywoman (doula) during childbirth on obstetrical and postpartum outcomes. Twelve individual randomized trials have compared obstetrical and postpartum outcomes between doula-supported women and women who did not receive doula support during childbirth. Three meta-analyses, which used different approaches, have been performed on the results of the clinical trials. Emotional and physical support significantly shortens labor and decreases the need for cesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rate childbirth as less difficult and painful than do women not supported by a doula. Labor support by fathers does not appear to produce similar obstetrical benefits. Eight of the 12 trials report early or late psychosocial benefits of doula support. Early benefits include reductions in state anxiety scores, positive feelings about the birth experience, and increased rates of breastfeeding initiation. Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breastfeeding, and increased sensitivity of the mother to her child's needs. The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor.     

Japanese women's experience of childbirth in the United States

While Japanese people represent a significant and growing cultural group within the United States, little is known about the culture-specific needs of Japanese women who experience pregnancy and childbirth in this country. Five women participated in a study of Japanese women's experience of pregnancy and childbirth in the United States. The following thematic clusters emerged from the interview data: issues related to the maintenance of Japanese birth-related practices and traditions; comparison of the Japanese and U.S. health systems; language difficulties; and the need for support systems. This group of well-educated, medically sophisticated women regarded their experiences overall to be positive. Still, they identified areas of uncertainty and unfamiliarity of which health professionals should be aware in order to facilitate the negotiation of culturally congruent care.     

Childbirth Education Classes: Sociodemographic Disparities in Attendance and the Association of Attendance with Breastfeeding Initiation

Objectives: To examine sociodemographic disparities in attendance at childbirth classes, and to evaluate the association of attendance with breastfeeding initiation. Methods: Parents of a nationally representative, cross-sectional sample of 2068 children ages 4–35 months were surveyed by telephone. The responses of 1540 mothers were included in the analysis. They were asked whether they had attended a childbirth class before giving birth. Disparities in attendance at childbirth classes and the association between attendance and breastfeeding initiation were examined using bivariate and multivariate logistic regression analyses. Results: Two thirds (66%) of the children's mothers had ever attended a childbirth class. White mothers were twice as likely (OR 2.15, CI 1.39, 3.31) as African American mothers to have ever attended. Attendance also varied by education, household income, and marital status. Attendance at childbirth classes was associated with a 75% increase in the odds that a child will be breastfed (OR 1.75, CI 1.18, 2.60). Conclusions: Significant sociodemographic disparities exist in attendance at childbirth classes. Further research is needed to determine whether improving utilization of childbirth education classes reduces sociodemographic disparities in breastfeeding initiation.     

产时医疗干预措施对新生儿健康的影响

目的 分析在产妇分娩过程中加入医疗干预措施后对新生儿健康情况的影响.方法 取某院产科于2008年5月～2011年5月间接产的孕妇154例,随机分为观察组和对照组.对照组采取产科常规分娩措施,观察组在常规措施基础上,根据实际情况加用产时医疗干预措施,比较两组产妇所生婴儿的新生儿Apgar评分及患病率的差异.结果 观察组所生新生儿的Apgar评分明显高于对照组产妇所生新生儿,疾病发生率明显低于对照组产妇所生新生儿,两组比较差异有统计学意义(P＜0.05).结论 对产妇进行产时的医疗干预,可以改善新生儿的Apgar评分,同时减少娩出胎儿的新生儿疾病的发生率,值得在产科接产中广泛推广使用.     

The association between childbirth experience and mother’s parenting stress: The mediating role of anxiety and depressive symptoms

ABSTRACT

Childbirth is one of the most significant experiences in women’s lives. A bad experience could lead to psychological distress, including severe disease. This experience has a significant impact not only on the mother’s well-being, but also on her first interactions with the baby. The present study thus had two aims: 1) investigate the association between the childbirth experience and parenting stress; and 2) analyze if this relation can be mediated by the woman’s psychological well-being (anxiety and depressive symptoms). One hundred fifty-eight Italian primiparous women, with a single pregnancy, recruited between January 2016 and December 2016, completed three months after delivery the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale and Parenting Stress Index (Short Form). Data were analyzed through path analyses. Results revealed that the birth experience was not directly associated with parenting stress. The final model confirmed that the childbirth experience was related to parenting stress through the full mediation of anxiety and depressive symptoms. These findings highlight the importance of making mothers’ childbirth experience as positive as possible, considering the crucial impact of this experience not only on their global functioning but also on their first relationships with the baby.     

Beyond Lamaze: Socioeconomic Status and Women's Experiences with Childbirth Preparation

The purposes of this study were to investigate the relationship between income and various types and levels of childbirth preparation utilized by women, and to examine the relationship between preparation and childbirth outcomes. Forty-five primiparous women recruited from health care facilities and childbirth preparation classes participated in this study. After the birth of their infants, participants completed scales that measured childbirth preparation, perceived control, satisfaction with childbirth experience, pain perception, and pain medication. Lower income women were less likely than higher income women to attend childbirth preparation classes and more likely to acquire information about childbirth from their mothers. The women experienced similar childbirth outcomes except that lower income women reported higher levels of pain during childbirth. Findings from this study challenge the assumptions that lower and higher income women experience different childbirth outcomes and that women who do not attend classes are unprepared. Implications for research and practice include a re-evaluation of the way childbirth education is conceptualized.     

Women's satisfaction with the experience of childbirth: validation of the Mackey Childbirth Satisfaction Rating Scale

Objectives

To determine the reliability and the content and construct validity of the Mackey Childbirth Satisfaction Rating Scale to measure women's satisfaction with labor and delivery.

Methods

The translation-back translation method was used to obtain an adapted version of the scale. For the validation study, a sample of 325 women who had delivered a healthy neonate through the vaginal route was selected. Data collection was performed using a self-administered questionnaire that included the modified scale, childbirth expectations, obstetric variables and sociodemographic characteristics. Reliability was assessed in a subsample of 45 women who completed the scale for the second time 15-30 days later. The factorial structure and internal consistency of the scale were analyzed. Construct validity was evaluated by analyzing the relationship between satisfaction with the experience, fulfillment of expectations and preferences regarding pain management.

Results

In the test-retest study, an intraclass correlation coefficient of 0.93 was obtained for the total scale. Factor analysis identified six factors that explained 69.42% of the variance. Cronbach's alpha coefficient was 0.94 for the total scale, ranging from 0.72 to 0.96 for the subscales. Satisfaction with the experience of childbirth was higher among women whose expectations were met and among those who accessed the pain relief method chosen.

Conclusions

This scale is a useful instrument to measure women's satisfaction with the experience of childbirth, adapted to our context and with good psychometric properties.     

Perceptions About Lactation Consultant Support,Breastfeeding Experiences and Postpartum Psychosocial Outcomes

Introduction

Many women seek lactation consultant support in the postpartum period. Lactation consultant support in community or clinical settings is often assumed to extend breastfeeding duration, improve breastfeeding experiences, and be well-received. Few studies have assessed women’s perceptions of the support they received, nor have perceptions been examined in relationship to breastfeeding outcomes and maternal well-being. Our objective was to characterize the lactation consultant support women received and examine how women’s perceptions about the support related to their breastfeeding outcomes, anxiety and depressive symptoms, and parenting stress.

Methods

This observational, cross-sectional study examined receipt of postpartum lactation consultant support among 210 US women. Perceptions of lactation consultant support were examined in relation to breastfeeding outcomes, anxiety and depressive symptoms, and parenting stress to explore outcomes of negative versus positive lactation consultant support experiences, using linear and proportional hazards regression.

Results

While overall perceptions of lactation consultant support were positive for most recipients (71%, n?=?98), 29% (n?=?40) reported negative perceptions of lactation consultant support. Negative perceptions were associated with lower breastfeeding self-efficacy (β?=????11.7, 95% CI???17.3,???6.0), a less successful breastfeeding experience (β?=????19.5, CI???27.8,???11.3), greater general anxiety (β?=?6.5, CI 2.1, 10.9), and shorter total duration of milk production (HR?=?0.39, 95% CI 0.18, 0.84). Perceptions were not associated with depressive symptoms or parenting stress.

Discussion

Findings highlight the importance of ensuring that postpartum breastfeeding support provided by lactation consultants is perceived as positive by women.

     

Fathers' participation in childbirth at a public hospital: institutional difficulties and motivations of couples

Participation by fathers in the process of childbirth, an aspect of the humanization of obstetric care, helps foster the fathers' involvement in raising their children. This participation provides psychosocial support for pregnant women during labor and delivery, sharing of the experience by the couple, and father-child bonding. The focus of this ethnographic research was the impact of this process on fathers participating in childbirth at a State hospital in Rio de Janeiro, with two stages: participant observation of labor and delivery and eleven interviews with fathers who had been present at delivery. Fathers' participation was influenced by: the motivation of mothers and fathers; social representations of delivery and fatherhood; and exclusion of fathers from reproductive health and pediatrics services. The father's participation was not valued by the attending staff as either a source of emotional support for the mother or as part of fatherhood. The following are necessary: inclusion of fathers in prenatal care, delivery, and pediatrics services; the training of staff to work with the families; social discussion of fatherhood and health services policies to ensure the presence of fathers during labor and childbirth.     

分娩教育对初产妇心理及分娩方式的影响

目的　探讨分娩教育对初产妇孕晚期心理以及分娩方式的影响。方法　 1 2 0例初产妇 ,随机分为 2组。试验组在妊娠晚期接受分娩教育 ,对照组接受医院常规护理。观察 2组分娩教育前后焦虑和抑郁程度以及分娩方式。结果　试验组分娩教育后焦虑、抑郁程度减轻 ,自然分娩率提高 ,由社会原因引起的剖腹产率明显降低 ;与对照组相比差异有统计学意义 (P <0 0 1 )。结论　分娩教育能够减轻分娩对初产妇的不良心理应激 ,促进自然分娩 ,值得在国内推广     

Evaluation of the Effects of Skin-to-Skin Contact on Newborn Sucking,and Breastfeeding Abilities: A Quasi-Experimental Study Design

Mother and newborn skin-to-skin contact (SSC) after birth has numerous protective effects. Although positive associations between SSC and breastfeeding behavior have been reported, the evidence for such associations between early SSC and breastfeeding success was limited in high-income countries. This quasi-experimental intervention design study aimed to evaluate the impact of different SSC regimens on newborn breastfeeding outcomes in Taiwan. In total, 104 healthy mother–infant dyads (52 in the intervention group and 52 in the control group) with normal vaginal delivery were enrolled from 1 January to 30 July 2019. The intervention group received 60 min of immediate SSC, whereas the control group received routine care (early SSC with 20 min duration). Breastfeeding performance was evaluated by the IBFAT and BSES-Short Form. Generalized estimating equations (GEEs) were used to evaluate the effectiveness of the intervention. In the intervention group, the breastfeeding ability of newborns increased significantly after 5 min of SSC and after SSC. The intervention also improved the total score for breastfeeding self-efficacy (0.18 point; p = 0.003). GEE analysis revealed that the interaction between group and time was significant (0.65 point; p = 0.003). An initial immediate SSC regimen of 60 min can significantly improve neonatal breastfeeding ability and maternal breastfeeding self-efficacy in the short term after birth.     

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE

To assess the determinants of exclusive breastfeeding abandonment.

METHODS

Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period.

RESULTS

The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care.

CONCLUSIONS

Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.     

Breastfeeding Practices in the United Arab Emirates: Prenatal Intentions and Postnatal Outcomes

Breastfeeding provides the ideal nutrition in infancy, and its benefits extend to the health of mothers. Psychosocial factors such as the intention to breastfeed, self-efficacy, or maternal confidence to breastfeed have been shown to impact breastfeeding outcomes in other communities. The aim of this study was to assess the potential associations between mothers’ prenatal intention to breastfeed and post-delivery breastfeeding practices. A cross-sectional study was conducted from March to September 2017. Emirati and non-Emirati mothers with children below the age of 2 were recruited from maternal and child health centers in various geographical areas in Abu Dhabi Capital district, United Arab Emirates. The variables (mothers’ intention to breastfeed, breastfeeding knowledge, support from family and health care professionals, and initiation and duration of breastfeeding) were collected by research assistants during an in-person interview, using a structured questionnaire. A total of 1799 mothers participated in this study. Mothers’ prenatal intention to breastfeed was significantly associated with breastfeeding initiation (p < 0.001) and length of exclusive breastfeeding (p = 0.006). Furthermore, intention to breastfeed during early pregnancy showed a strong association (p < 0.001) with mothers who had exclusively breast fed for more than three months. In addition, knowledge on the benefits of breastfeeding and getting support from relatives and non-relatives demonstrated significant relationship with a longer period of exclusive breastfeeding (p < 0.01) In total, mothers in the study reported receiving almost four thousand advice about breastfeeding, of which 3869 (97%) were encouraging to our others in the study. Our findings on prenatal intentions, knowledge and network support on exclusive breastfeeding indicates the importance of including breastfeeding knowledge and support as critical topics during prenatal education, not only to the mothers but also to close network members who seek a healthy pregnancy outcome.     

Prevalence and risk factors for developing traumatic childbirth in Iran

Aim

Traumatic childbirth is among the important factors that make childbirth an unpleasant experience and has psychological negative effects on women. This study aimed to determine the prevalence and risk factors associated with traumatic childbirth.

Subject and methods

In this cross-sectional study, 400 women were interviewed in the first 48 h after childbirth in Torbate-heydariyeh (eastern Iran) in 2015. Traumatic childbirth was determined based on DSM-V-A criteria. Statistical analysis of the data was done through chi-square and logistic regression.

Results

The prevalence of traumatic childbirth was 48.3% (N?=?193). Logistic regression showed variables such as place of residence, type of delivery, pregnancy complications, bleeding during pregnancy, rupture of grade 3 or 4 during delivery, and emergency cesarean section were significantly correlated with traumatic childbirth (p <0.001).

Conclusion

Considering the high prevalence of traumatic childbirth, it is recommended that its associated risk factors be identified so that negative psychological consequences for the mother can be prevented.

     

Effectiveness of a Breastfeeding Self-efficacy Intervention: Do Hospital Practices Make a Difference?

Breastfeeding self-efficacy interventions are important for improving breastfeeding outcomes. However, the circumstances that may influence the effectiveness of the interventions are unclear, especially in the context of hospitals with suboptimal infant feeding practices. Thus, we aimed to evaluate the effect of a self-efficacy intervention on breastfeeding self-efficacy and exclusive breastfeeding, and further assessed the difference in its effect by hospital-routine type. In this intervention study with a control group, 781 pregnant women were recruited from 2 “Baby-Friendly”-certified hospitals (BFH) and 2 non-Baby-Friendly Hospitals (nBFH) in Japan, and were allocated to an intervention or control group. Participants in the intervention group were provided with a breastfeeding self-efficacy workbook in their third trimester. The primary outcome was breastfeeding self-efficacy and the secondary outcome was infant feeding status. All analyses were stratified by the type of hospital, BFH or nBFH. In BFHs, the intervention improved both breastfeeding self-efficacy through 4 weeks postpartum (p = 0.037) and the exclusive breastfeeding rate at 4 weeks postpartum (AOR 2.32, 95 % CI 1.01–5.33). In nBFHs, however, no positive effect was observed on breastfeeding self-efficacy (p =? 0.982) or on the exclusive breastfeeding rate at 4 weeks postpartum (AOR 0.97, 95 % CI 0.52–1.81); in nBFHs, supplementation was provided for breastfed infants and the mother and infant were separated in the vast majority of cases. Infant feeding status at 12 weeks was not improved in either hospital type. The intervention improved breastfeeding self-efficacy and exclusive breastfeeding at 4 weeks postpartum only in BFHs. When breastfeeding self-efficacy interventions are implemented, hospital infant feeding practices may need to be optimized beforehand.     

Paid parental leave supports breastfeeding and mother-infant relationship: a prospective investigation of maternal postpartum employment

Objective: To investigate the association between the mother‐infant relationship, defined as maternal‐infant emotional attachment, maternal separation anxiety and breastfeeding, and maternal employment status at 10 months following first childbirth. Method: Samples of employed, pregnant women, over 18 years of age and with sufficient English literacy were recruited systematically from one public and one private maternity hospital in Victoria. Data were collected by structured interview and self‐report questionnaire in the third trimester, and at 3 and 10 months postpartum. Socio‐demographic, employment, and breastfeeding information was collected. Participants completed standardised assessments of maternal separation anxiety and mother‐to‐infant emotional attachment. Results: Of 205 eligible women, 165 (81%) agreed to participate and 129 (78%) provided complete data. A reduced odds of employment participation was independently associated with continuing to breastfeed at 10 months (OR=0.22, p=0.004) and reporting higher maternal separation anxiety (OR=0.23, p=0.01) when maternal age, education, occupational status and use of paid maternity leave and occupational status were adjusted for in analyses. Conclusion: Employment participation in the first 10 months postpartum is associated with lower maternal separation anxiety, and shorter breastfeeding duration. Implications: Paid parental leave has public health implications for mothers and infants. These include permitting sufficient time to protect sustained breastfeeding, and the development of optimal maternal infant attachment, reflected in confidence about separation from her infant.