This study aimed to examine the impact of the 7 October 2023 terror attack in Israel on maternal mental health during the early postpartum period, among women who gave birth in the weeks immediately preceding or following the event. While not designed to directly assess broader sociopolitical contexts, the study aimed to situate postpartum mental health within the lived reality of large-scale terror, to better understand its potential psychological impact. A total of 216 postpartum women were sampled online following the 7/10/23 terror attack. They answered questions related to the consequences of the war and were compared to a control group of 265 postpartum women, sampled two years earlier, on mental health measures (City BiTS, EPDS, PBQ). Women sampled post-7/10 scored higher on all measured variables (City BiTS, EPDS, PBQ), including probable depression (EPDS ≥13; post-7/10: 39 women [18%], control: 8 women [3.7%]) and PTSD (post-7/10: 11 women [5.1%], control: 2 women [0.7%]). No group difference emerged in the number of women fulfiling Criterion A. Only direct physical or psychological exposure was associated with some childbirth-related PTSD measures, and having a spouse in the army was associated with postpartum depression. This study highlights the heightened vulnerability of women in the postpartum period within the context of war. The impact of terror was evident even in birth-related PTSD symptoms, suggesting that similar birth events may be experienced as more traumatic when occurring within a broader context of collective trauma.

ABSTRACT Introduction Women diagnosed with endometriosis often experience heightened anxiety, depression, and a diminished quality of life (QoL). To address these issues, mindful breathing exercises have been introduced aimed at reducing anxiety and depression and enhancing overall QoL. This study aims to evaluate the levels and differences in anxiety, depression, and QoL among women with endometriosis before and after a mindful breathing exercise, between the intervention and control groups. Methods This quasi-experimental study involved 108 women with endometriosis, selected through convenience sampling. Participants were divided into two groups: an intervention group (n = 54) and a control group (n = 54). Results The mean total anxiety score of the intervention group significantly decreased from 13.22 ± 2.84 at baseline to 6.70 ± 3.11 at T3 (p < 0.01). Similarly, the mean total depression score was reduced from 12.56 ± 3.95 at baseline to 4.31 ± 3.56 at T3 (p < 0.01). Additionally, the mean total QoL score improved from 70.48 ± 19.04 at baseline to 21.28 ± 14.53 at T3 (p < 0.01). These results indicate that the mindful breathing exercises led to statistically significant improvements in anxiety, depression, and QoL. Conclusion This finding recommended that nursing practices in clinical, educational, and management settings adopt and implement mindful breathing exercises to better support women with endometriosis.

ABSTRACT Background Maternal depressive symptoms are common during pregnancy and may negatively impact the mother-infant relationship, particularly the development of maternal prenatal representations. This study used a randomised controlled trial to examine whether the interactive ultrasound intervention could improve the quality of prenatal representations of the child among pregnant women with minor depressive symptoms. Methods Participants (n = 105) were recruited after the routine screening for structural abnormalities between gestational weeks 19 and 21. Prenatal representations were assessed twice during pregnancy, at gestational weeks M = 25 and M = 35, using the Working Model of the Child Interview. Participants were randomly selected either to the intervention group, which received three interactive ultrasound intervention sessions following the protocol, or the control group, receiving standard care. The intervention aimed to support the prenatal mother – infant relationship by facilitating and strengthening pregnant women’s representations of their foetuses, and by increasing maternal involvement and emotional connection with the foetus. Results Women in both groups showed high levels of nonbalanced, particularly distorted, representations. For 25% of participants, nonbalanced representations became balanced during the study period. However, the intervention did not improve the quality of representations beyond changes observed in both groups. Especially, balanced prenatal representations remained substantially stable in both groups. Conclusion The interactive ultrasound intervention did not have a significant effect. However, the findings provide unique insights into the quality of prenatal representations among women with minor depressive symptoms and highlight the importance of supporting their representational processes during pregnancy.

ABSTRACT Background Fertility decision-making has consistently emerged as a key aspect of longer-term recovery for women who have experienced postpartum psychosis (PP). However, there remains a paucity of research regarding an in-depth exploration of the experience of fertility decision-making after first-onset PP. Women who have experienced first-onset PP have no prior history of mental health difficulties but have a significantly higher risk of recurrent PP in subsequent postpartum periods. The study aimed to explore women’s experiences of fertility decision-making, including the meaning of decisions and experience of support, after an experience of first-onset PP. Method Nine women were recruited through purposive sampling. Qualitative data was gathered via semi-structured interviews and analysed using Interpretative Phenomenological Analysis (IPA). Results Six Group Experiential Themes (GETs), associated with twelve subthemes, were identified: Decision-making as ‘a bit of a process’, Fear of recurrence, Desire to have more children, Grief, Support needs, and Accepting the decision. Conclusion Findings represented the complex, emotional, and deeply personal process of fertility decision-making, shaped by the experience of first-onset PP. Future research and clinical implications, such as the need for specialist, psychologically informed preconception support, are discussed.

ABSTRACT Aims Maternal attachment mental state is critical in stress regulation and caregiving behaviours. However, most existing research relies on cross-sectional designs and self-reported attachment measures, which capture distinct but complementary aspects of attachment relative to interview measures. This longitudinal study examines the associations between maternal attachment mental states during pregnancy, postpartum stress and mother–infant bonding at 6-months postpartum. Methods The study followed 98 White expectant mothers in Italy, assessing attachment mental states during the third trimester of pregnancy (M = 35.20 gestational weeks, SD = 2.20; Time 1, T1) using the Adult Attachment Interview (AAI). At 2-months postpartum (T2), maternal stress was measured via the Perceived Stress Scale, and at 6-months postpartum (T3), mother–infant bonding was evaluated using the Maternal Postnatal Attachment Scale. Of the initial sample, 91 mothers continued to T2, and 90 to T3. Mediation analyses examined whether postpartum stress mediated the relationship between maternal attachment coherence of mind and bonding. Results Mothers with lower coherence of mind during pregnancy─which is considered the single best indicator of attachment security in the AAI─reported higher postpartum stress at T2, which, in turn, was associated with lower-quality mother–infant bonding at T3. Conclusion Postpartum stress mediates the relationship between maternal attachment mental states and bonding quality. These findings suggest that addressing attachment-related vulnerabilities and stress during the perinatal period may help support positive mother–infant relationships and developmental outcomes, although future research is needed to directly evaluate the effectiveness of specific interventions.

ABSTRACT Objective This study aimed to compare the effects of guided imagery, and diaphragmatic breathing exercise using a breathing exercise device on nausea-vomiting severity and anxiety levels in pregnant women with hyperemesis gravidarum (HG), considering their implementation alongside routine antiemetic treatment. Materials and methods This randomised controlled experimental study was conducted between August 2022 and August 2023 at the pregnant women’s follow-up service. Participants were assigned to three groups: Breathing Exercise (n = 60), Guided Imagery (n = 60), and Control (n = 60). Data were collected using the Personal Information Form, the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) test, and the Pregnancy-Related Anxiety Scale-Revision-2 (PRAQ-R2). Statistical analyses included the Shapiro – Wilk test, paired t-test, repeated-measures ANOVA, one-way ANOVA, and multiple regression. Significance was set at p < 0.05. The study is registered with ClinicalTrials.gov (NCT05829473). Results While there were no significant baseline differences among the groups, the Breathing Exercise Group (BEG) showed the most substantial improvements in PRAQ-R2 and PUQE scores. Significant reductions were also observed in the Guided Imagery Group (GIG) compared to the Control Group (CG) (p < 0.05). On the first day, post-test PUQE scores were significantly lower in the BEG compared to the GIG and CG (p < 0.001 and p < 0.05, respectively). Although pre-test PRAQ-R2 fear of childbirth scores were similar across groups (p = 0.069), post-test scores differed significantly in favour of both intervention groups (p < 0.001). Conclusion The results show that guided imagery and diaphragmatic breathing exercises reduce nausea, vomiting, and pregnancy-related anxiety in women with HG.

ABSTRACT Objective The Birth Satisfaction Scale-Revised (BSS-R) is a 10-item self-report questionnaire designed to assess satisfaction with the birth experience, an important aspect contributing to the well-being of birthing women, which can have potential long-term consequences for both maternal and infant health. While the BSS-R has been validated in several languages, it has not yet been validated in French. This study aimed to validate the French version of the BSS-R (F-BSS-R) in the French-speaking part of Switzerland. Method We performed forward-backward translation and cultural adaptation. Data were collected from 157 participants one week postpartum at a Swiss University Hospital, while obstetric data were extracted from hospital records. Two outliers were excluded, resulting in data from 155 participants for analysis. We applied confirmatory factor analysis to assess construct validity and also evaluated divergent validity. Internal consistency was determined using Cronbach’s alpha. Results The three-factor, second order, and bifactor models showed good fit indices for the data. The F-BSS-R total score indicated good internal consistency, and the quality of care (QC) subscale also showed good internal consistency. In contrast, stress experienced (SE) and women’s personal attributes (WA) subscales had moderate and low internal consistency, respectively. Moreover, the F-BSS-R total score demonstrated good divergent validity. Conclusion The F-BSS-R total score showed good internal validity and reliability to measure birth satisfaction in French-speaking Switzerland. We recommend using the total score to assess birth satisfaction. The QC subscale score can be used and interpreted with confidence as a distinct aspect. In contrast, the observed sum scores for the SE and WA subscales are not sufficiently reliable for standalone use.

ABSTRACT Background Emotionally Unstable Personality Disorder (EUPD) is a controversial and potentially stigmatising diagnosis, especially in women. Limited research exists on how mothers diagnosed with EUPD engage with perinatal mental health services and no United Kingdom studies have explored perinatal mental health staff perspectives on working with this population. Aim To explore perinatal mental health staff’s experiences of working with mothers diagnosed with EUPD and their views on service provision. Method Reflexive Thematic Analysis was used to analyse semi-structured interviews with 13 perinatal mental health staff from three National Health Service (NHS) trusts in England. All participants had direct involvement with mothers diagnosed with EUPD. Results Six themes emerged: 1) We’re in This Together: the importance of building therapeutic relationships; 2) The Fit Between Staff and Service: what draws staff to this work; 3) The Importance of Feeling Valued: support needs for staff; 4) Navigating a Complex System: service constraints affecting staff; 5) Let’s Talk About Labels: the stigma and complexity of the diagnosis and 6) Where Does the Responsibility Lie?: systemic service issues impacting mothers diagnosed with EUPD. Conclusion This study highlights the complexities faced by perinatal mental health staff supporting mothers with EUPD. Staff stressed the importance of relational working but also identified social, organisational and systemic barriers to effective care. Findings suggest the need for trauma-informed EUPD care pathways in perinatal services and enhanced staff support structures. Clearer role guidance for staff and improved cross-agency coordination of care would ensure sustainable, equitable care.

ABSTRACT Aims/Background Perinatal depression and anxiety (PNDA) may result in poor emotional and physical health, detrimental to the well-being of parents and their children. Primary health professionals have a role in the early detection of PNDA through screening to mitigate these adverse impacts. This meta-synthesis aimed to investigate perspectives on perinatal depression and anxiety screening in primary care settings. Design/Methods The search strategy exploring 4 key concepts: (i) the perinatal period, (ii) depression and anxiety disorders, (iii) qualitative research and (iv) screening, was conducted across Medline, PsycINFO, CINAHL and JBI databases on 3 November 2023. Included publications were written in English and reported on qualitative research exploring any perspectives of actual or hypothetical PNDA screening services in primary care settings. Studies conducted in unclear healthcare settings, focussing on screening tool validation or services peripheral to screening, were excluded. Qualitative data were thematically synthesised using an interpretivist epistemological approach. Results The search yielded 8260 publications. Following duplicate removal (n = 2788) and the systematic screening of 5472 publications, 24 publications were included for data extraction. Publications explored perspectives of consumers and health professionals receiving or conducting PNDA screening. Five overarching themes were identified: ‘playing detective with PNDA’, ‘standing up to stigma’, ‘setting the scene to screen’, ‘utility of the screening tool’ and ‘resources required to optimise screening services’. Conclusion Although the value of PNDA screening was acknowledged, health professionals require adequate training to conduct screening. Robust referral systems must be established to ensure impactful PNDA screening delivery.