An Early Intervention Program for Adolescent Mothers: A Nursing Demonstration Project

Objective: To improve health outcomes in a vulnerable population of adolescent mothers and their infants.
Design: Effects of an intensive early intervention program (EIP) are compared with those of traditional public health nursing (TPHN) care.
Setting: A large California county with urban and rural communities, an ethnically diverse population, and a high teen birth rate.
Participants: One hundred twenty-one young mothers and their children from impoverished and predominantly minority backgrounds.
Interventions: During pregnancy and through 1 year postpartum, participants ( n = 63) in the EIP were provided with 4 prenatal classes and approximately 17 home visits by specially trained public health nurses. Interventions addressed health issues, sexuality and family planning, life skills, the maternal role, and social support systems. Participants in TPHN ( n = 58) received three home visits (for intake, prenatal care, and postpartum/well-baby care information).
Main Outcome Measures: Antepartum, intrapartum, and newborn medical records; maternal responses to written questionnaires; and nurse interviews.
Results: Early program outcomes indicate reduced premature birth rates for both groups compared with national data on adolescent mothers, and fewer days of infant hospitalization during the first 6 weeks postpartum for the EIP participants.
Conclusion: Public health nurse care (both traditional and intensive) significantly improved perinatal outcomes; the intensive intervention significantly reduced the number of infant hospitalization days.     

Mandatory Reporting in the Context of Home Visitation Programs: Intimate Partner Violence and Children's Exposure to Intimate Partner Violence

The mandatory reporting of intimate partner violence (IPV) is a controversial issue that is receiving increased attention. A related concern is whether children's exposure to IPV constitutes child maltreatment, making it reportable to child protective services. These issues have been relatively unexplored within the context of home visitation programs. A secondary analysis of qualitative data collected from community stakeholders, clients, and home visiting nurses in the Nurse-Family Partnership program was carried out. Participants' perceptions about mandatory reporting of IPV and reporting of children's exposure to IPV are highlighted. Emergent themes and implications for research, practice, and policy are discussed.     

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)     

Reasons for intimate partner violence perpetration among arrested women

There are limited empirical data regarding the reasons or motives for the perpetration of intimate partner violence among women arrested for domestic violence and court referred to violence intervention programs. The present study examined arrested women's self-report reasons for partner violence perpetration and investigated whether women who were victims of severe intimate partner violence were more likely than were women who were victims of minor partner violence to report self-defense as a reason for their behavior. In all, 87 women in violence intervention programs completed a measure of violence perpetration and victimization and a questionnaire assessing 29 reasons for violence perpetration. Self-defense, poor emotion regulation, provocation by the partner, and retaliation for past abuse were the most common reasons for violence perpetration. Victims of severe partner violence were significantly more likely than were victims of minor partner violence to report self-defense as a reason for their violence perpetration. The clinical implications of these findings are discussed.     

Outreach and integration programs to promote family planning in the extended postpartum period

Background

WHO recommends birth spacing to improve the health of the mother and child. One strategy to facilitate birth spacing is to improve the use of family planning during the first year postpartum.

Objectives

To determine from the literature the effectiveness of postpartum family-planning programs and to identify research gaps.

Search strategy

PubMed and the Cochrane Central Register of Controlled Trials were systematically searched for articles published between database inception and March 2013. Abstracts of conference presentations, dissertations, and unpublished studies were also considered.

Selection criteria

Published studies with birth spacing or contraceptive use outcomes were included.

Data collection and analysis

Standard abstract forms and the US Preventive Services Task Force grading system were used to summarize and assess the quality of the evidence.

Main results

Thirty-four studies were included. Prenatal care, home visitation programs, and educational interventions were associated with improved family-planning outcomes, but should be further studied in low-resource settings. Mother–infant care integration, multidisciplinary interventions, and cash transfer/microfinance interventions need further investigation.

Conclusions

Programmatic interventions may improve birth spacing and contraceptive uptake. Larger well-designed studies in international settings are needed to determine the most effective ways to deliver family-planning interventions.     

Domains of Postpartum Doula Care and Maternal Responsiveness and Competence

Objective: To describe the domains of postpartum doula care and illustrate how doulas facilitate development of maternal responsiveness and competence.
Design: Qualitative study using ethnographic method of participant observation.
Setting: Homes of mothers who received postpartum doula care.
Participants: Thirteen women and their infants; 4 postpartum doulas.
Results: Eleven domains emerged: emotional support, physical comfort, self-care, infant care, information, advocacy, referral, partner/father support, support mother/father with infant, support mother/father with sibling care, and household organization. Emotional support was used consistently and in combination with the other domains. Activities in all of the domains were used to facilitate the development of maternal responsiveness and maternal competence with 3 issues: resolution of infant feeding, integrating the infant into the family, and supporting developmental care and attachment.
Conclusions: Data suggest that by using 11 domains of care, postpartum doulas facilitate maternal responsiveness and competence. Development of a long-term relationship, mother-centered care, and education and support related to infant feeding, integrating the infant into family, and developmental care and attachment may contribute to these outcomes.     

Comparative Analyses of Stressors Experienced by Rural Low-Income Pregnant Women Experiencing Intimate Partner Violence and Those Who Are Not

Objective: To describe the daily lives of rural pregnant women who smoked during pregnancy, with a focus on their sources of stress and the compounding effects of intimate partner violence.
Design: A qualitative study using content analysis of research nurses' telephone logs from a large smoking cessation randomized controlled trial ( N =695) in which 33% of the sample ( n =227) experienced intimate partner violence in the past year.
Participants: Fifty pregnant women, 25 who had experienced intimate partner violence in the past year and 25 who had never experienced intimate partner violence, were randomly selected from those who received a nurse-delivered telephone intervention for smoking cessation ( n =345). The mean age of the sample was 22 years, and the majority were White and living in a married-like relationship.
Results: Women experiencing intimate partner violence discussed certain stressors significantly more often than nonabused women. These stressors included finances, lack of social support, legal issues, transportation issues, and abuse by the intimate partner and others.
Conclusion: Health care providers need to recognize that intimate partner violence creates a stress, which can compound the stressors of pregnancy and poverty in rural areas. Offering these women a chance to talk about their lives can help them not only to locate necessary resources, but also to break down the barriers of isolation.     

A Selective Review of Maternal Sleep Characteristics in the Postpartum Period

Objective: To determine the current knowledge of postpartum womens' sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers.
Data Sources: A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance.
Study Selection: A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum womens' sleep and implications for health care providers.
Data Extraction: Literature was reviewed and organized into groups with similar characteristics.
Data Synthesis: An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women.
Conclusions: Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns.     

Intimate partner violence and adverse pregnancy outcomes: a population-based study

OBJECTIVES: The purpose of this study was to measure the prevalence of exposure to intimate partner violence during pregnancy and to determine whether such exposure is associated with adverse pregnancy outcomes. STUDY DESIGN: We measured the prevalence of exposure to intimate partner violence and fear of a partner during pregnancy among 4750 residents of Vancouver, British Columbia, who gave birth between January 1999 and December 2000. We undertook a multivariate analysis to examine the associations with second- or third-trimester hemorrhage, preterm labor and delivery, intrauterine growth restriction, and perinatal death. RESULTS: We report a prevalence rate of 1.2% for exposure to physical violence by an intimate partner during pregnancy and 1.5% for fear of a partner. Physical violence was associated with an increased risk of antepartum hemorrhage (adjusted odds ratio [OR]: 3.79, 95% CI 1.38-10.40), intrauterine growth restriction (OR: 3.06, 95% CI 1.02-9.14), and perinatal death (OR: 8.06, 95% CI 1.42-45.63). Fear of a partner in the absence of physical violence was not associated with an elevated risk of adverse pregnancy outcomes. CONCLUSION: Our study confirms prior work reporting an association of physical abuse during pregnancy with intrauterine growth retardation and, in addition, reports an association with antepartum hemorrhage and perinatal death.     

Linkages among reproductive health, maternal health, and perinatal outcomes

Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention packages, emergency obstetrical care, elective induction for postterm delivery, Cesarean delivery for breech presentation, and prophylactic corticosteroids in preterm labor reduce perinatal mortality; and early initiation of breastfeeding and birth and newborn care preparedness through community-based intervention packages reduce neonatal mortality. This review demonstrates that RHMNH are inextricably linked, and that, therefore, health policies and programs should link them together. Such potential integration of strategies would not only help improve outcomes for millions of mothers and newborns but would also save scant resources. This would also allow for greater efficiency in training, monitoring, and supervision of health care workers and would also help families and communities to access and use services easily.     

Eliminating health inequities: national goals and developing programs

In the 20th century, infant and maternal mortality declined dramatically and the life span and quality of life for women and infants increased. At the end of the century, the rate of decline slowed and policy makers began to look for new ways to address the problem. A significant challenge now is to eliminate the persistent disparities in maternal and infant health among various racial and ethnic groups, particularly between black and white women and infants. To improve perinatal outcomes, programs are needed that focus on community-based interventions that reduce infant mortality across all racial and ethnic groups. Two promising programs that are expected to receive additional federal funding through the Children's Health Act are the Fetal and Infant Mortality Review Program and home visiting programs. Expansion of these programs may provide the vehicle to reduce disparities in maternal and infant mortality and morbidity. New programs are needed to meet the ambitious goals of Healthy People 2010.     

Limited access to care and home healthcare

Access to perinatal healthcare services for women living in poverty is complicated by many barriers and directly affects rates of premature births, low birthweight infants, and maternal and infant deaths. Health and social services delivered in the home can help improve pregnancy outcomes. Home visiting programs need sustainable funding and support from physicians and other healthcare providers. Ongoing research is needed to develop, refine, and evaluate systems of care that integrate home visiting components and different service delivery models that address pregnancies complicated by various psychosocial and medical complications.     

Depression screening during pregnancy

Depression in the antepartum period is more commonly missed by clinicians than is intimate partner violence, although more women and families suffer from this debilitating disease. Early identification and appropriate psychotherapeutic interventions significantly reduce the risk of adverse effects for the mother, infant, and family. Despite debate regarding specificity and sensitivity, 2 instruments have been predominantly referenced for use in antepartum screening: the Edinburgh Postnatal Depression Scale and the Center for Epidemiologic Studies Depression Scale. Routine screening combined with interview methods provides high reliability for predicting a risk for depression in pregnancy and postpartum. Caution should be exercised when new onset is identified or when women who were using psychotropic medications before pregnancy are being treated, because the relative risk of prenatal exposure to medication is counterbalanced by the risk of relapse of maternal psychiatric disorders.     

Domestic violence: an approach from gynecology and obstetrics

Violence against women represents a serious violation of women's human rights and has been recognized as a clinical and public health problem, independently of nationality, ethnicity, cultural norms and socioeconomic status. One of the most common forms of violence against women is that perpetrated by an intimate male partner. The intimate partner violence has short-term and long-term negative health consequences, which provoke a poor quality of life with high use of health services, and even the suicide and homicide of women. Specifically, abuse during pregnancy is associated with sexually transmitted diseases, anemia, first and second trimester bleeding, less than optimal weight gain, deleterious perinatal outcomes (low birth weight, miscarriage, and fetal distress) and maternal or infant deaths. The purpose of this review is to emphasize the serious health consequences of the partner violence, and to compile the studies that have measured violence during pregnancy, particularly in Latin America.     

A Systematic Review of the Effectiveness of Breastfeeding Intervention Delivery Methods

Objective: To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions.
Data Sources: Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO.
Study Selection: Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion.
Data Extraction: Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis.
Data Synthesis: Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d =0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d =0.03).
Conclusions: Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support.     

Perinatal Outcomes of Obese Women: A Review of the Literature

Objective: To review the literature addressing the effect of obesity on pregnancy outcomes and to identify practice and research implications.
Data Sources: Computerized searches in Medline and CINAHL , as well as references cited in articles reviewed. Key words used in the search were as follows: pregnancy and obesity; pregnancy complications; weight gain and pregnancy; weight gain and complications; fat distribution and pregnancy and complications; and obstetrics and obesity.
Study Selection: Articles and comprehensive works from indexed journals in the English language relevant to key words and published after 1978 were evaluated.
Data Extraction: Data were extracted and organized under the following headings: methodologic issues; physiologic adjustments; antepartum, intrapartum, postpartum and newborn outcomes; and cost.
Data Synthesis: Obese pregnant women experience more gestational diabetes, neural tube defects, preeclampsia, induction, primary cesarean, and postpartum infection than pregnant women who are not obese.
Conclusions: Pregnant women who are obese are at increased risk for certain complications during pregnancy, birth, and postpartum. Little is known about the effect that fat distribution (upper versus lower, which is influential in nonpregnant populations) has on obstetric complications. Even less is known about obese pregnant women's perceptions of risk, changes in lifestyle, functioning, health behaviors, and symptoms experienced during pregnancy.     

Systematic Review of the Effect of Technology-Mediated Education Intervention on Maternal Outcomes in the First Year After Birth

ObjectiveTo synthesize the findings on the effect of technology-mediated education intervention in the first year after birth on maternal health outcomes and to evaluate interventions for participant perspectives and health equity.Data SourcesWe conducted a systematic review of the literature using the electronic databases PubMed, Embase, and CINAHL for articles published between 2010 and 2020. The search strategy was developed by a health sciences librarian.Study SelectionWe included articles if the following criteria were met: they reported studies conducted in the United States or a resource-similar nation on the evaluation of a technology-mediated education intervention within the first year after birth and they included the assessment of at least one maternal health outcome.Data ExtractionThe lead author extracted data from the full-text articles and entered them into Microsoft Excel. We assessed the quality and risk of bias using the Cochrane Collaboration’s tool for examining the potential risk of bias.Data SynthesisWe identified 21 articles that met the inclusion criteria. Videos were the most commonly reported technology-mediated education intervention, followed by text messages, phone calls, and websites. Maternal health outcomes addressed in the included articles were mental health, weight loss, breastfeeding, general postpartum education, perineal care, and substance use. Technology-mediated education interventions positively affected mental health, weight loss, and breastfeeding outcomes.ConclusionThe current evidence suggests that technology-mediated education intervention is beneficial for the physical and mental health outcomes of women during the first year after birth. Future work may benefit from more attention to health equity and design in collaboration with women to gain a better understanding of the information needs and desired technology features.     

Disclosure and police reporting of intimate partner violence postpartum: a pilot study

Objective

intimate partner violence is a significant health problem. Fear of retaliation and shame may prevent women from telling anyone about the violence. This study investigated the prevalence of disclosure and police reporting of intimate partner violence during the first year postpartum.

Design

a prospective longitudinal Swedish cohort study based on information from 2563 women who answered a postal questionnaire in early pregnancy and 12 months postpartum.

Findings

of 52 women who had been exposed to violence by their partner during the first year postpartum, four (8%) had filed a police report while 19 (37%) had not told anyone about the violence. All single women in the study had disclosed the violence to a friend, a relative or filed a police report.

Key conclusions

few women file a police report when they are being hit by their partner during the year after childbirth. Many women do not tell anyone that they have been hit.

Implications for practice

these data may encourage health professionals to undertake sensitive questioning about violence, giving an opening for support.     

Breastfeeding and Use of Social Media Among First‐Time African American Mothers

ObjectiveTo describe the use of social media during the antepartum and postpartum periods among first‐time African American mothers and their support persons.DesignA qualitative critical ethnographic research design within the contexts of family life course development theory and Black feminist theory.SettingParticipants were recruited from community‐based, public health, and home visiting programs.ParticipantsA purposive sample was recruited, consisting of 14 pregnant African American women and eight support persons.MethodsPregnant and postpartum African American women and their support persons were interviewed separately during the antepartum and postpartum periods. Data were analyzed thematically.ResultsParticipants frequently used social media for education and social support and searched the Internet for perinatal and parenting information. Most participants reported using at least one mobile application during their pregnancies and after giving birth. Social media were typically accessed through smartphones and/or computers using different websites and applications. Although participants gleaned considerable information about infant development from these applications, they had difficulty finding and recalling information about infant feeding.ConclusionSocial media are an important vehicle to disseminate infant feeding information; however, they are not currently being used to full potential. Our findings suggest that future interventions geared toward African American mothers and their support persons should include social media approaches. The way individuals gather, receive, and interpret information is dynamic. The increasing popularity and use of social media platforms offers the opportunity to create more innovative, targeted mobile health interventions for infant feeding and breastfeeding promotion.     

The importance of resources and information in the lives of battered mothers

An increasing body of research has documented the overlap between intimate partner violence and child abuse. To date, very little research has explored mothers' perspectives on how child protection services (CPS) actually investigates and intervenes in families where intimate partner violence (IPV) as well as child abuse or neglect have occurred. The current research explores the complex role of information and resources in child protection investigations and interventions. In-person interviews were conducted with 19 mothers who had been battered and who had been involved with CPS because of the violence. Mothers reported difficulties in sharing information with and receiving information from CPS workers, but some also reported benefiting from information they received. Moreover, for a handful of women, the CPS intervention was a source of emotional strength. Implications for improving CPS interventions when IPV is occurring are discussed.