Care For New Mothers Research Articles

Improving care for new mothers with postnatal morbidity in Ireland

Background Pathways to dedicated clinics for women in Ireland who experience morbidity during the antenatal, intrapartum or postnatal periods are lacking. In view of this, a postnatal morbidity clinic was set up and an evaluation was conducted with clinic attendees with the aim of improving the service by using the results to guide the expansion and improvements. Methods A survey was developed using two validated questionnaires of women who were discharged from the clinic over 6 months. Surveys were self-completed and returned by 92 women, then analysed using descriptive statistics for quantitative data and thematic analysis for qualitative data. Results Several areas were highlighted for improvement, such as expanding debriefing services, making a more precise plan of action upon discharge and improving continuity of care. Conclusions Postnatal morbidities exert a considerable toll on new mothers. Listening to women's experiences of attending the clinic guided the successful expansion of advanced midwife practitioner-led supports and improved efficiencies within the clinic as well as highlighting the importance of such a service for all women.

Obstetric violence a qualitative interview study

ObjectiveTo investigate the meaning of the concept of ‘obstetric violence’ to women in Sweden, who reported a negative birth experience. DesignAn inductive qualitative approach with individual narratives. A thematic qualitative content analysis was used. SettingThree midwifery clinics in southwest Scania. ParticipantsTwelve women who had given birth less than three years previously and reported a negative/traumatic birth experience. FindingsThe key findings showed that the women had experienced psychological and physical abuse during childbirth which may be interpreted as ‘obstetric violence’. Four categories emerged from the analyses describing the women's experiences: Lack of information and consent including poor information and no right to participate in decisions concerning the process of labour, Insufficient pain relief, which encompassed unbearable pain without pain relief, Lack of trust and security where the women experienced staff with bad attitudes and jargon, and The experience of abuse including threats of violence from midwives and where the birth experience was compared to rape. Key conclusionsThe study shows that physical and psychological abuse during childbirth exists in Sweden and that women experience this as being subjected to ‘obstetric violence’ during childbirth. The phenomenon of obstetric violence is very complex. The abuse of women during childbirth might be a significant problem and quality assurance is required to secure the rights of women giving birth. Implications for practiceIn order to secure the rights of birthing women and to promote respectful and supportive care for new mothers, quality development programs are required.

Moving Forward From COVID-19: Bridging Knowledge Gaps in Maternal Health With a New Conceptual Model.

As the world faces the health crisis of a global pandemic—with healthcare protocols in overhaul, and patients and care teams experiencing unprecedented levels of stress and unpredictability—we predict that current knowledge gaps in maternal health will inevitably have a lasting impact on the health of women giving birth now and in the near future. Since we are decades away from closing the knowledge gaps we need filled today, we recommend shifting thinking toward a comprehensive conceptual model that merges knowledge of stress physiology, neurobiology, and pregnancy physiology. The model we present here, the Maternal Reactive Scope Model, is an expansion of the Reactive Scope Model built upon the concept of Homeostasis and Allostasis. The model provides a framework to consider pathways and interactions across physiological systems to attribute a physiological basis for considering stress exposure and bridge research gaps on mechanisms to measure or target for treatment. Our intention is to provide an adaptable, heuristic framework for discussion of research considerations and new healthcare models that aim to provide the best care for new mothers during and after the COVID-19 pandemic.

First-time mothers’ satisfaction with their birth experience – a cross-sectional study

ObjectiveTo explore first-time mothers´ satisfaction with their birth experience using Visual Analog Scale and to identify possible risk factors for a negative birth experience. DesignA cross-sectional design using retrospective data collection from electronic medical files. SettingA birthing center in southern Sweden, which has approximately 1400 births annually. ParticipantsPrimiparous women (N = 584) who gave birth during 2017. The cut-off point for a negative birth experience was set as ≤ 4 on the Visual Analog Scale. Measurements and findingsThe mean age of the women was 29 years (SD 5.1; range 16–47 years). Prevalence of a negative birth experience was 9.6%. The strongest risk factors for a negative birth experience were having obstetric anal sphincter injuries (AOR 2.8 CI 95% 1.1–7.2) and oxytocin augmentation started in the first stage of labor (AOR 2.2 CI 95% 1.1–4.4). Key conclusionsWomen who had their labours augmented with oxytocin or sustained an anal sphincter injury were statistically significantly more likely to have a negative birth experience. However, it is uncertain whether the women scored pain experience or birth experience when they reported their satisfaction on the Visual Analog Scale; further investigation is required. Implications for practiceIt is important to use a reliable and validated instrument to measure birth experience in order to promote respectful and supportive care for new mothers.

A Call for Comprehensive Care in the Fourth Trimester

Childbirth is an event that is remembered for years to come. At the time of discharge from a hospital, new mothers are sent home with many instructions on how to properly care for their newborns, but many may be unprepared for the changes to their bodies and their emotions. Unfortunately, the postpartum period can be a time of great angst and unanswered questions. This commentary describes the personal experience of one of the authors, who encountered difficulty navigating the health care system during the postpartum period. She shares her experience with the hope of promoting change for other women. After reading the account of her birth and recovery, individuals are encouraged to advocate for regular care of new mothers in the fourth trimester. The time to advocate for change is now.

Trends in Hospital Breastfeeding Policies in the United States from 2009-2015: Results from the Maternity Practices in Infant Nutrition and Care Survey.

Having a written breastfeeding policy that is routinely communicated to staff is important. Furthermore, hospitals seeking the Baby-Friendly designation are required to purchase infant formula at fair market value. We sought to determine the trends of model policies and receipt of free infant formula among hospitals with maternity care in the United States. The Maternity Practices in Infant Nutrition and Care (mPINC) survey obtained information, every 2 years, on breastfeeding-related practices and policies from hospitals in the United States. We examined the prevalence of hospitals with a model breastfeeding policy, individual policy elements, and how policies were communicated as well as the receipt of free infant formula from 2009 to 2015. Statistical testing is not included because mPINC is a census. The proportion of hospitals with a model breastfeeding policy increased from 14.1% in 2009 to 33.1% in 2015. More hospitals incorporated policy elements on limited use of pacifiers (+21.0% points), early initiation of breastfeeding (+15.5% points), and limiting non-breast milk feeds of breastfed infants (+14.1% points). Fewer hospitals disseminated policies by word of mouth (-2.0% points), whereas, more posted policies (+8.1% points). The percent of hospitals not receiving free infant formula increased from 7.4% in 2009 to 28.7% in 2015. While more hospitals in the United States are implementing model breastfeeding policies and not receiving free infant formula, the majority do not adhere to these practices. Hospitals may consider reviewing their policies around infant feeding to improve care for new mothers.

Meeting the contraceptive and sexual health needs of women in the postnatal period

Pregnancy and childbirth is a special period in a woman's life and involves significant physical, hormonal, psychological, social and cultural changes. Maintaining health and wellbeing during this time is imperative for both mother and child. Holistic care for new mothers includes all aspects of health, and sexual health is an important part of this. The antenatal contact is an ideal opportunity for health visitors to discuss contraception options, particularly if the client is seen on her own. This article will discuss the role of the health visitor in providing evidence-based information on contraception and sexual health to women in the postnatal period.

The care needs of postpartum women taking their first time of doing the month: a qualitative study

Background: In contemporary Taiwan, after giving birth, many women undertake a traditional postpartum practice called ‘doing the month’, which occurs in the medical context of postpartum nursing centres instead of at home. Thus, healthcare workers must identify and address the care needs of new mothers in this setting to improve the care of new mothers and their baby and family.Aim: To explore new mothers’ care needs from their own perspectives during the period of doing the month.Methods: A qualitative study was performed. Eligible participants recruited through purposive sampling were interviewed comprehensively.Results: Twenty-seven primiparous women participated (mean age: 32 years; mean marriage length: 3.4 years). Four themes were identified: the need to increase energy to gain more yang force, the need to internalise mothering, the need to be supported by the family and friends, and the need to be understood.Conclusions: For effective care, sufficient support and guidance must be provided to first-time mothers and their families, especially when mother–baby rooming-in is the standard of care.

Skin-to-Skin Care and Rooming-In: Safety Considerations.

Over the last several decades, hospital care of new mothers and their newborns has changed dramatically. There was a time when newborns were almost immediately taken to the nursery and then brought out infrequently for visits. This was likely done with good intentions to promote maternal rest and be

Postpartum Preeclampsia

The reported prevalence of postpartum hypertension and postpartum preeclampsia is 0.3% to 27.5%. In contrast to classic pre-eclampsia, symptoms of postpartum pre-eclampsia manifest after childbirth. Most cases develop within 48 hours after birth, although the syndrome can occur up to 6 weeks after childbirth. Indeed, 10% of maternal deaths from hypertension occur during the postpartum period, possibly because this may be beyond the window of routine care for new mothers. Mothers with postpartum hypertension represent a significant number of the postpartum readmissions at the Texas Children's Pavilion for Women. However, there are no established predictive measures or preventative treatments for postpartum preeclampsia. Our goal is to reduce postpartum readmissions for postpartum hypertension and preeclampsia by using a formal management algorithm based on consensus practice guidelines and internal data. Statistical analysis of our readmission data identifies predictive risk factors that help identify which women may be at highest risk of a hypertensive readmission. By scoring each postpartum woman by number of risk factors, we can screen for high-scoring women and provide an appropriate intervention. Data indicate 47 readmissions in 2014 and 6 year to date postimplementation. In formalizing a management protocol, we can ensure that at-risk women consistently receive extra counseling on postpartum preeclampsia and monitoring home blood pressures. This along with early initiation of adjunctive blood pressure medications or additional inpatient monitoring may play an important role in reducing postpartum readmissions and improving maternal outcomes.

Prayer and meditation among Danish first time mothers—a questionnaire study

BackgroundMothers’ existential dimensions in the transition to motherhood have not been described thoroughly. They might experience disruption and new perspectives in existential ways and this may especially be the case in preterm birth. The aim of this study was twofold. First we investigated the existential dimension of motherhood transition in a secularized context, through practices of prayer and meditation. Second we described the relationship between time of birth (term/preterm) and the prayer/meditation practices of the mothers.MethodsData were gathered from a nationwide questionnaire survey among first time mothers conducted during the summer 2011. All Danish women who gave birth before the 32nd pregnancy week (n = 255), and double the number of mothers who gave birth at full term (n = 658) in 2010 were included (total n = 913). The questionnaire consisted of 46 overall items categorized in seven sections, which independently cover important aspects of existential meaning-making related to becoming a mother. The respondent rate was 57 % (n = 517).ResultsMoments of praying or meditation 6–18 months post partum were reported by 65 %, and mothers who responded affirmatively, practiced prayer (n = 286) more than meditation (n = 89), p < 0,001. We did not observe differences in affirmative responses to prayer or meditation between mothers of full term or preterm born children, not even after controlling for perinatal or post partum loss, mode of birth, age, status of cohabiting or education.ConclusionsIn this explorative study we found specific practices of existential meaning-making through prayer and/or meditation among first time mothers, living in a very secularized context. Yet we know only little about character or importance of these practices among mothers, and hardly anything about existential meaning-making among new fathers. Hence the implications of meaning-making practices related to other dimensions of health are difficult to address in a qualified way in care for new mothers and families.

Usefulness of the comfort theory in the clinical nursing care of new mothers: critical analysis.

The aim of this study was to evaluate the usefulness of the comfort theory for the clinical nursing care of new mothers. This is a reflexive-theoretical study conducted in November and December 2014, based on the usefulness criterion proposed in the critical analysis of the Barnum nursing theory. The comfort theory in nursing care for new mothers applied to study analysis revealed that this theory meets the criteria of usefulness because it provides applicable concepts that facilitated the clinical nursing care of women in the postpartum period and helped increase their comfort level. The verification of these concepts showed that the theory can be applied in different settings of clinical care for new mothers. The theory can be used to support and improve clinical nursing care for postpartum women, and help improve puerperal comfort.

Postnatal depression and its associated factors among Northeastern Nigerian women

Background: Postnatal depression is a serious psychiatric condition that occurs in puerperium. It is associated with increased morbidity and can overwhelm new mothers and interfere with the care of their babies. This study aimed to determine the prevalence rate of postnatal depression and assess factors that are associated with its development among northeastern Nigerian women. Materials and Methods: Edinburgh Postnatal Depression Scale (EPDS) questionnaire was administered to four hundred and eighty-three women who delivered at the maternity unit of a tertiary health institution in northeastern Nigeria. Their sociodemographic and clinical variables were also obtained using pro forma questionnaire designed by the researchers. Results: One hundred and eight respondents scored 13 or more points on EPNDS, making the prevalence rate of postnatal depression 22.4%. Factors that are associated with the development of postnatal depression are unemployment [odds ratio (OR) = 0.49, 95% (CI) = 0.27-0.86, P value = 0.018), lack of support from the husband (OR = 0.34, 95% CI = 0.19-0.60, P value = 0.000), and primiparity (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013); others are unplanned pregnancy (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013) and physical illness in the mother (OR = 1.81, 95% CI = 1.77-2.79, P value = 0.007). Conclusion: The study showed that a significant proportion of new mothers have postnatal depression. This may negatively affect their parenting skills and may have adverse effects on them and their children. Early detection and effective management, together with an efficient collaboration among psychiatrists, obstetricians, and other health workers who are involved in the care of new mothers, will go a long way in reducing the negative consequences that may result from this condition.

Maternal critical care: what can we learn from patient experience? A qualitative study

ObjectiveFor every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care...

Teamwork in diagnosing and treating peripartum cardiomyopathy

When the diagnosis of peripartum cardiomyopathy (PPCM) can be made very early in its course the systolic heart function will be better preserved [1]. When the echocardiographic left ventricular ejection fraction (LVEF) is better, recovery outcomes will also be better [2]. Earlier diagnosis depends upon earlier recognition of symptoms that may be very similar to normal term pregnancy symptoms. When all of those involved in the care of new mothers, including the subjects themselves, are aware of a possibility for the development of pregnancyassociated heart failure in someone who has previously had perfectly normal heart function, then earlier diagnosis can easily be confirmed by echocardiography.

Professionalisation of a breast-feeding peer support service: Issues and experiences of peer supporters

Objectivesto describe the issues faced by breast-feeding peer supporters as their roles altered from a voluntary to a professionalised role with targets, accountability and more formalised interface with health professionals. Designa descriptive qualitative study utilising group and individual semi-structured interviews, with thematic network analysis. Setting19 breast-feeding peer supporters were consulted from one peer support service located in the UK. Findingsthematic network analysis of the peer supporter data generated a global theme of ‘Professionalising Breast-feeding Peer Support’. The three underpinning organising themes (and their associated basic themes): ‘visibility and communication’, ‘guardianship of knowledge’ and ‘roles and boundaries’ revealed the early and transitional tensions and anxieties that peer supporters faced when their role altered from a voluntary position to a formal model of service delivery, particularly within the clinical environment. Conclusions and implications for practiceprofessionalisation of peer support can lead to benefits in terms of providing a standardised and comprehensive service with increased capacity for service provision. However, the transitional difficulties faced by the peer supporters as they moved from a voluntary into a professionalised role included a lack of identity; restricted time to care for new mothers; pressures and anxieties of meeting targets and accountability of case recording and the hostility and gatekeeping practices experienced amongst some of the health professionals. Flexible systems incorporating service-user involvement and needs-led strategies may help to overcome these issues.

Identification of Mothers at Risk for Postpartum Depression by Hospital-Based Perinatal Nurses

In the western world, most women deliver their infants in a hospital setting. The purposes of this article are to provide guidelines and suggest best practices related to hospital-based care for postpartum depression by perinatal nurses; with this information, policies, procedures, and educational programs can be implemented to improve nursing care of new mothers. Hospital-based perinatal nurses need to "launch" new mothers from the hospital into the community so that the new mothers are prepared for self-monitoring for symptoms of depression, and know what steps to take if they do experience depressive symptoms.

Oral health trends in Maryland

This paper describes the trends in oral health in Maryland over the past decade. Data were compiled from several surveillance systems and then summarized to assess the trends in oral health in Maryland over the past ten years. The percentage of Maryland children with dental sealants increased from 33.8 to 42.8 percent; the percentage of children that have had a dental visit increased from 18.9 to 47.5 percent; and the percentage of children that received "dental treatment" increased from 8.4 to 22.4 percent. Maryland has made considerable progress in improving the oral health care for children covered by Medicaid. The availability of affordable oral health care for new mothers, adults, and elderly persons is a problem that goes beyond the Maryland boundaries. Following national trends, edentulism and deaths due to oral cancer have declined.

Supporting Breast-feeding When a Woman Is Homeless

This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. This case shows that NANDA International (NANDA-I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA-I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.

Diagnosis and treatment of postpartum bipolar depression

The postpartum period is a time of increased risk of new-onset psychiatric illness, hospital admissions and out-patient psychiatric care for new mothers. Research into postpartum mood disorders has focused primarily on major depressive disorder, and has overlooked the study of bipolar disorder, particularly bipolar II disorder and bipolar disorder not otherwise specified. Failure to properly diagnose postpartum bipolar disorder may delay the initiation of appropriate treatment, lead to inappropriate treatment – thereby precipitating (hypo)mania, rapid cycling or a mixed episode – or result in polypharmacy and treatment refractoriness. The most serious consequence, however, is the high risk of infanticide and suicide among women with postpartum bipolar disorder. While no specific screening tools have been validated for postpartum mania or bipolar depression, symptoms of hypomania, atypical depression, a family history of bipolar disorder and a rapid onset of depressive symptoms following delivery may suggest a bipolar diathesis. In the absence of any pharmacological or psychotherapeutic treatments to guide clinical decision-making, it is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of non-postpartum bipolar depression, using medications that are compatible with lactation.