Perinatal Experiences Research Articles

Supportive and Affirming Queer Perinatal Health Care: A Qualitative Study

Queer people may experience barriers to accessing safe and affirming perinatal care. Representative doula support may mitigate barriers to accessing care and improve outcomes. The objectives of this qualitative study were to understand priorities for key queer community stakeholders to address the needs of queer patients/families and to identify potential roles for doula support in improving care. Recruitment for this community-university partnership study was conducted using purposeful and snowball sampling. Interviews with key stakeholders in the field of perinatal health were conducted in summer and fall 2022. Data were analyzed using reflexive thematic analysis. A total of 12 participants participated in an interview. Key themes include the challenges accessing and navigating affirming care, steps forward for improving perinatal experiences and the role of doulas. Findings suggest gaps in care persist for Queer patients/families, and appropriately trained and representative doula support may interrupt heteronormative bias in perinatal care to improve experiences and outcomes.

Perinatal experiences of Ukrainian women at the beginning of the war

ABSTRACT Objective Pregnancy and childbirth are related to the experience of distress at their core. However, this distress is significantly increased under war conditions. The study aims to examine the perinatal experience of women during the war in Ukraine. Methods 12 Ukrainian women who were pregnant and lived in Kyiv or the suburbs of Kyiv from February to May 2022 took part in the study. In-depth interviews were conducted online in the form of semi-structured interviews, and the thematic analysis technique was used. Results The perinatal experiences of women during the war in Ukraine were divided into 2 basic groups: negative perinatal experiences and positive perinatal experiences during the war. The negative perinatal experiences were grouped into three main themes: 1) negative emotions experienced in association with war, 2) dissatisfaction with medical support during the war, 3) suffering associated with separation from a husband and relatives. The positive perinatal experiences include 6 main themes: 1) the joy of returning or/and staying home, 2) satisfaction with medical support during the war, 3) coping with stress during the war, 4) family relationships and support during the war, 5) positive attitudes towards the child (or unborn child), 6) patriotic sentiments. Conclusion The study revealed negative and positive aspects of the perinatal experience of Ukrainian women during the war. Providing access to medical advice, facilitating uncertainty reduction, and communication between women and their families contribute to positive perinatal experiences of pregnant women and new mothers during the war.

Exploring mothers’ experiences of perinatal care in Cyprus: Babies Born Better survey

IntroductionA positive perinatal experience facilitates a smooth transition to motherhood and enhances the development of a strong bond between mother and newborn, contributing to maternal and societal wellbeing. Given the medicalization of childbirth in Cyprus, the examination of mothers’ experiences of perinatal care becomes imperative.AimTo investigate mothers’ experiences of care during the perinatal period and to identify factors related to the provision of maternal care that contribute to the interpretation of these experiences.MethodsThe study draws on data from the European survey “Babies Born Better”, an online survey utilizing a mixed-methods approach to explore women’s experiences of maternity care across Europe. The study population were women who had given birth in Cyprus over a 5-year period (2013–2018). Quantitative data were analyzed using SPSS v22, while qualitative data were analyzed through inductive content analysis.FindingsA total of 360 mothers participated in the study. In rating their overall experience, 24.2% stated that they had a “bad experience”, 11.1% a “good experience”,13.9% a “very good experience”, and 13,3% a “very bad experience”. The top three sub-factors of the overall experience which received positive evaluation were “Relationship with health care professionals” (33.6%), “Birth environment and care” (11.4%), and “Breastfeeding guidance” (10.8%). The qualitative analysis yielded five themes: “Relationship with health care professionals”, “Breastfeeding establishment”, “Childbirth rights”, “Birth environment and services” and “Choice of mode of birth”.ConclusionMothers in Cyprus wish to have respectful maternity care. They need maternity health care professionals to respect their dignity and ask for evidence-based information with shared decision making. Mothers in Cyprus expect to have their childbirth rights safeguarded, to have better support from HCP, and to receive humanized care. The perinatal care provided in Cyprus needs significant improvements based on mothers’ needs and expectations.

Stigma Experienced by Perinatal Women with Opioid Dependency in the United States: A Qualitative Meta-Synthesis.

Stigma is a barrier to accessing care and treatment for perinatal women with pain and opioid dependency, resulting in increased maternal/neonatal morbidity and mortality, prolonged neonatal hospitalizations, and increased healthcare-related costs. This theory-generating qualitative meta-synthesis includes 18 qualitative research reports and describes the stigma-related experiences of perinatal women with opioid dependency. A model emerged consisting of cyclical yet pivotal care points, facilitators/deterrents of stigma, and stigma experiences including infant-associative stigma. Findings of this qualitative meta-synthesis include the following: (a) Perinatal stigma experiences may prevent women from accessing care; (b) Infant-associative stigma may influence the woman to deflect stigma from her infant onto herself; and (c) There is the risk of mothers withdrawing their infants from healthcare to protect from future anticipated stigma. Implications reveal ideal time points to enact healthcare interventions to reduce perinatal stigma experiences and its consequences on maternal/child health and wellness.

Жіночий досвід у перинатальному періоді

Perinatal experience is an important stage in the life of every mother and her child. The childbirth process can be a source of emotional satisfaction and strengthen the bond between the mother and the newborn baby. However, a negative childbirth experience can create feelings of fear towards future deliveries, the need for cesarean section, the risk of developing post-traumatic stress and postpartum depression, as well as problems with breastfeeding. Purposе - to study the level of women’s satisfaction with childbirth in order to improve perinatal care. Materials and methods. A prospective cohort study was conducted involving 321 mothers who completed the satisfaction scale for childbirth and delivery. Descriptive statistics were utilized for data analysis. It was found that the data distribution deviates from the normal distribution. The median value (Me) and the interquartile range (Q I - Q III) were calculated for the dataset. Results. The satisfaction scale helped identify the advantages and disadvantages of the childbirth experience in four key aspects of vaginal delivery. 1. Own capacity: a) Advantages: 76% of women felt strong; 79.3% - felt confident; 67.4% - felt happy. b) Disadvantages: 54% - felt that their childbirth experience matched their plans; 76.2% - felt tired. 2. Professional support: a) Advantages: 86.8% - felt they received sufficient attention and information from their caregivers; 84.8% - felt a comfortable and warm atmosphere; 84.8% - felt their needs were understood; 89.3% - felt they received proper care and assistance; b) Disadvantages: None, as the majority of women felt satisfied with the professional support. 3. Perceived safety: a) Advantages: 86% - felt safe; 89% - had trust in the professional abilities of the healthcare team; 68% - had many positive memories, while 1% had many negative memories; b) Disadvantages: 31% - experienced a low level of anxiety, while 16% - experienced a high level of anxiety. 4. Participation: a) Advantages: 67% - had the opportunity to choose a pain relief method; 60% - had the opportunity to change positions, while 21% did not; 86% - felt they received sufficient attention and information from the medical team; b) Disadvantages: Some women did not have the opportunity to choose a pain relief method (33%) or change positions during childbirth (21%). Conclusions. The study of women’s satisfaction with childbirth indicated the need for improvement in the aspect of «perceived safety». «Own capability», «professional support», and «participation» demonstrate high satisfaction, indicating the quality of perinatal care. The level of satisfaction can become a key indicator of the quality of perinatal care, contributing to the improvement of hospital efficiency assessment and quality of medical services». The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethical Committee of the institution specified in the work. Informed consent for participation in the study was obtained from the women. No conflict of interests was declared by the authors.

Validation of the Edited Tromsø Infant Faces Database (E-TIF): A study on differences in the processing of children's emotional expressions

Images of emotional facial expressions are often used in emotion research, which has promoted the development of different databases. However, most of these standardized sets of images do not include images from infants under 2 years of age, which is relevant for psychology research, especially for perinatal psychology. The present study aims to validate the edited version of the Tromsø Infant Faces Database (E-TIF) in a large sample of participants. The original set of 119 pictures was edited. The pictures were cropped to remove nonrelevant information, fitted in an oval window, and converted to grayscale. Four hundred and eighty participants (72.9% women) took part in the study, rating the images on five dimensions: depicted emotion, clarity, intensity, valence, and genuineness. Valence scores were useful for discriminating between positive, negative, and neutral facial expressions. Results revealed that women were more accurate at recognizing emotions in children. Regarding parental status, parents, in comparison with nonparents, rated neutral expressions as more intense and genuine. They also rated sad, angry, disgusted, and fearful faces as less negative, and happy expressions as less positive. The editing and validation of the E-TIF database offers a useful tool for basic and experimental research in psychology.

The evolved nest, oxytocin functioning, and prosocial development.

Prosociality, orientation to attuned, empathic relationships, is built from the ground up, through supportive care in early life that fosters healthy neurobiological structures that shape behavior. Numerous social and environmental factors within early life have been identified as critical variables influencing child physiological and psychological outcomes indicating a growing need to synthesize which factors are the most influential. To address this gap, we examined the influence of early life experiences according to the evolved developmental niche or evolved nest and its influence on child neurobiological and sociomoral outcomes, specifically, the oxytocinergic system and prosociality, respectively. To-date, this is the first review to utilize the evolved nest framework as an investigatory lens to probe connections between early life experience and child neurobiological and sociomoral outcomes. The evolved nest is comprised of characteristics over 30 million years old and is organized to meet a child's basic needs as they mature. Converging evidence indicates that humanity's evolved nest meets the needs of a rapidly developing brain, optimizing normal development. The evolved nest for young children includes soothing perinatal experiences, breastfeeding, positive touch, responsive care, multiple allomothers, self-directed play, social embeddedness, and nature immersion. We examined what is known about the effects of each evolved nest component on oxytocinergic functioning, a critical neurobiological building block for pro-sociomorality. We also examined the effects of the evolved nest on prosociality generally. We reviewed empirical studies from human and animal research, meta-analyses and theoretical articles. The review suggests that evolved nest components influence oxytocinergic functioning in parents and children and help form the foundations for prosociality. Future research and policy should consider the importance of the first years of life in programming the neuroendocrine system that undergirds wellbeing and prosociality. Complex, interaction effects among evolved nest components as well as among physiological and sociomoral processes need to be studied. The most sensible framework for examining what builds and enhances prosociality may be the millions-year-old evolved nest.

The effect of the COVID-19 pandemic on substance use patterns and physiological dysregulation in pregnant and postpartum women.

The SARS-CoV-2/COVID-19 pandemic has been associated with increased stress levels and higher alcohol use, including in pregnant and postpartum women. In the general population, alcohol use is associated with dysregulation in the autonomic nervous system (ANS), which is indexed by heart rate variability (HRV). The objectives of this study were to: (1) characterize changes in substance use during the SARS-CoV-2/COVID-19 pandemic via a baseline self-report survey followed by mobile ecological momentary assessment (mEMA) of substance use; and (2) examine the associations between momentary substance use and ambulatory HRV measures in pregnant and postpartum women. Pregnant and postpartum women were identified from the ENRICH-2 prospective cohort study. Participants were administered a baseline structured phone interview that included the Coronavirus Perinatal Experiences (COPE) survey and ascertained the prevalence of substance use. Over a 14-day period, momentary substance use was assessed three times daily, and HRV measurements were captured via wearable electronics. Associations between momentary substance use and HRV measures (root mean square of successive differences [RMSSD] and low frequency/high frequency [LF/HF] ratio) were examined using a mixed effects model that included within-subject (WS) and between-subject (BS) effects and adjusted for pregnancy status and participant age. The sample included 49 pregnant and 22 postpartum women. From a combination of a baseline and 14-day mEMA surveys, 21.2% reported alcohol use, 16.9% reported marijuana use, and 8.5% reported nicotine use. WS effects for momentary alcohol use were associated with the RMSSD (β = -0.14; p = 0.005) and LF/HF ratio (β = 0.14; p = 0.01) when controlling for pregnancy status and maternal age. No significant associations were observed between HRV measures and instances of marijuana or nicotine use. These findings highlight the negative effect of the SARS-CoV-2/COVID-19 pandemic on the psychological health of pregnant and postpartum women associated with substance use, and in turn, ANS dysregulation, which potentially puts some women at risk of developing a substance use disorder.

Prescribed and Penalized: The Detrimental Impact of Mandated Reporting for Prenatal Utilization of Medication for Opioid Use Disorder

ObjectivesSome states, including Massachusetts, require automatic filing of child abuse and neglect for substance-exposed newborns, including infants exposed in-utero to clinician-prescribed medications to treat opioid use disorder (MOUD). The aim of this article is to explore effects of these mandated reporting policies on pregnant and postpartum people receiving MOUD.MethodsWe used modified grounded research theory, literature findings, and constant comparative methods to extract, analyze and contextualize perinatal experiences with child protection systems (CPS) and explore the impact of the Massachusetts mandated reporting policy on healthcare experiences and OUD treatment decisions. We drew from 26 semi-structured interviews originally conducted within a parent study of perinatal MOUD use in pregnancy and the postpartum period.ResultsThree themes unique to CPS reporting policies and involvement emerged. First, mothers who received MOUD during pregnancy identified mandated reporting for prenatally prescribed medication utilization as unjust and stigmatizing. Second, the stress caused by an impending CPS filing at delivery and the realities of CPS surveillance and involvement after filing were both perceived as harmful to family health and wellbeing. Finally, pregnant and postpartum individuals with OUD felt pressure to make medical decisions in a complex environment in which medical recommendations and the requirements of CPS agencies often compete.Conclusions for PracticeUncoupling of OUD treatment decisions in the perinatal period from mandated CPS reporting at time of delivery is essential. The primary focus for families affected by OUD must shift from surveillance and stigma to evidence-based treatment and access to supportive services and resources.

Association between the person-centered maternity care experience and mental health after delivery in urban and rural Dhading, Nepal: a cross-sectional study

BackgroundPerson-centered maternity care is a component of quality care, which includes effective communication, respect, and dignity. Supportive care has a positive effect on mothers’ perinatal experience. In contrast, negative childbirth experiences can cause psychological problems. However, the impact of person-centered maternity care experience on mothers’ mental health after delivery remains unknown. Therefore, in this study, we examined the association between person-centered maternity care experience at healthcare facilities and maternal mental health after delivery among Nepali women.MethodsWe conducted a cross-sectional study in urban and rural areas in Dhading District, Nepal. Participants were women who gave birth at public healthcare facilities, and their baby’s age was between 1 and 12 months. After purposively selecting the target areas, we recruited the women from July to August 2019 and interviewed them using questionnaires. We conducted multiple regression analyses to analyze the association between delivery care experience and depressive symptoms and the association between delivery care experience and mental well-being.ResultsIn total, 595 women were included in the data analysis. The experience of better person-centered maternity care was associated with lower depressive symptom scores in urban (unstandardized coefficient [B]= − 0.09, p < 0.001) and rural areas (B= − 0.10, p < 0.001). Moreover, the experience of better person-centered maternity care was associated with higher mental well-being scores in both urban (B= 0.30, p < 0.001) and rural areas (B= 0.15, p = 0.017).ConclusionsPerson-centered maternity care was associated with lower depressive symptom scores and higher mental well-being, regardless of the setting in Nepal. Person-centered maternity care during childbirth can potentially improve mental health after delivery. Maternity care should be improved with more attention to person-centered maternity care aspects.

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers.

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood.Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF educationand practice among Kenyan mothers who delivered infants during the COVID-19 pandemic.We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya.While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers' access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employmentand food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months.The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social supportand food insecurity limit EBF practices for mothers in this context.

The impact of the second COVID-19 lockdown on anxiety and depressive symptoms in pregnant women: A case study of pregnant women in northern Italy

Backgroundthe different lockdown phases due to COVID-19 may have negatively impacted pregnant women's mental health. Concerning antenatal stress, most studies focused more on the effect of pandemic onset than on the impact of the following phases and restrictions. Aimthe present study aimed to assess levels of anxiety and depression in a group of Italian pregnant women during the second COVID-19 phase and possible risk factors. MethodWe recruited 156 pregnant women through our Perinatal Psychology Outpatient Clinic. We divided the sample into women recruited before the pandemic (N = 88) through a face-to-face antenatal class and pregnant women recruited during the second lockdown (Covid-19 study group) (November 2020–April 2021) through the same antenatal class via Skype (N = 68). To investigate depressive and anxiety symptoms, we administered the Edinburgh Postnatal Depression Scale (EPDS) and the State and Trait Anxiety Inventory (STAI-Y) scales; women's medical history and obstetric data were collected. Findingswomen belonging to the Covid-19 study group reported higher depressive and anxious levels than the pre-pandemic group. Moreover, during the second lockdown previous psychopathology and being close to childbirth were related to increased depression; a history of abortion was related to higher levels of trait anxiety instead. Conclusionrecurrent restrictive measures due to COVID-19 negatively affected the antenatal mental well-being of pregnant women, particularly worsening depressive and anxious feelings. Pregnant women during the pandemic represented a vulnerable population to be monitored more closely and timely to prevent psychological problems in the postpartum period and their consequences on the child. Keywordsanxiety, depression, pregnancy, COVID-19, mental health, lockdown.

Embryo as Person: As in the Womb, So in the World

Findings in the field of pre- and perinatal psychology reveal that, even as little embryos, we are having experiences, and that these experiences profoundly affect how we live our lives1. Our earliest days establish lifelong tendencies influencing how we connect with ourselves, each other, and our planet.2 This paper examines the intersection of embryo and psyche, how development of one relates to development of the other. Evidence of cellular intelligence, responsiveness, memory, and learning is offered as a foundation for understanding the profound effects of very early experience.3,4 Specific developmental milestones of conception, implantation, and discovery are considered in relation to their psychological effects, underlining the importance of treating the embryo as a sentient, sensitive human being that both models and thrives on love and connection5. It is proposed that supporting new parents from the time of pre-conception in providing a welcoming, safe, loving environment for their baby contributes to a world characterized by these qualities, where we can return to our original potential.

SUPPORTING CONNECTIONS BETWEEN FIRST MOTHERS AND THEIR UNBORNS: AN ANTIDOTE TO DISSOCIATION?

The old saw in child welfare circles— “A baby is the only living thing without a past, only a future”—was always self-serving. Now we know it was always patently false. The new science in infant mental health and prenatal psychology makes it possible to reconsider the matter of various risks in prenatal life. We are then released to wonder what life is like in there, for example, for a child scheduled to be surrendered for adoption. While we don’t yet proclaim to have special avenues into the mental life of prenates—or even systematic means to investigate it—evidence mounts that there IS such life, that it’s responsive to the mother’s mental life, and that such early and interactive mental life is of consequence for the baby’s later development. While there is still much to learn, we can surely say that it’s incomprehensible that the first nine months of the life of a child whose mom does not intend to keep him is anything but innocuous. What if we considered these questions non-rhetorically and non-judgmentally: “How could a woman ever be expected to forget a baby she had carried for nine months? What would it take to ‘move on’ from the experience…” (Glaser, 2021, p. 4). Might we even conclude that we’re disrespecting first mothers to assume that they pay no attention to what is happening, and have no psychological response to it? And if moms do have a response, is it detectable by the babies within? Finally, are early and primitive working models of self and other created in utero? Might these early working models be brought by the adoptee to his relationship with his adoptive mother? If so, to what effect? This paper focuses on one aspect of the mental life of a mother who intends to surrender her child for adoption: the possibility that she may, as a defense, dissociate—a kind of withdrawal from her own experience—and that such withdrawal may be experienced by the baby as maternal absence and rejection. We will try to show what this experience is like for the unborn, what defenses may be erected, and how such early experience may shape later relationships.

A scoping review of maternal health among resettled refugee women in the United States.

Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion. Electronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. We included all peer-reviewed study designs; qualitative, quantitative, and mixed method if they reported on refugee women's perinatal health experiences and outcomes in the US. A total of 2,288 records were identified, with 29 articles meeting the inclusion criteria. Refugee women tend to initiate prenatal care late and have fewer prenatal care visits compared to women born in the US. Some of them were reluctant to get obstetric interventions such as labor induction and cesarean delivery. Despite numerous risk factors, refugee women had generally better maternal health outcomes. Studies have also highlighted the importance of health care providers' cultural competency and sensitivity, as well as the potential role of community health workers as a bridge between refugee women and health care providers. The scoping review emphasizes the need for early prenatal care initiation and more frequent prenatal care visits among refugee women. Furthermore, more needs to be done to mitigate resistance to obstetric interventions and mistrust. The mechanism by which healthy migrant effects occur could be better understood, allowing protective factors to be maintained throughout the resettlement and acculturation process. The scoping review identifies critical gaps in the literature, such as the underrepresentation of different ethnic groups of refugee women in refugee maternal studies in the US. Since this invisibility may indicate unspoken and unaddressed needs, more attention should be paid to underrepresented and understudied groups of refugee women in order to achieve health equity for all.

The disability-related education and training experiences of perinatal care providers in Ontario

Women with disabilities are at increased risk of perinatal health complications and experience barriers to perinatal care, including unmet physical and communication needs and providers with limited disability knowledge. This study aimed to understand the disability-related education and training experiences of perinatal care providers in Ontario.

The socio-demographic profile associated with perinatal depression during the COVID-19 era

BackgroundCoronavirus disease 2019 (COVID-19) has caused an increase in perinatal depression. The aim of this research was to identify which sociodemographic variables are related to the increase in perinatal depression due to the pandemic. In addition to estimating to what extent they predict perinatal depression, differentiating the prenatal and postnatal periods.MethodsThe sample consisted of 3,356 subjects, 1,402 in the prenatal period and 1,954 in the postnatal period. The Edinburgh Postnatal Depression Scale was used to assess depressive symptomatology. A subset of 14 questions was included to collect demographic data. Items from the Spanish version of the Coronavirus Perinatal Experiences Survey were also included.ResultsExperiencing the change of environment due to COVID-19 as negative and having a history of mental health predict perinatal depression, otherwise having higher education decreases the risk. In the prenatal stage having symptoms compatible with COVID-19 is a predictor of perinatal depression and having more than 3 years living together with the partner and being a housewife decreases the risk. In the postnatal stage being unemployed is a predictor of prenatal depression and being a first-time mother decreases the risk.ConclusionsThis study highlights the relevance of sociodemographic status. It is essential to be aware of the risk factors of perinatal depression, to make adequate prevention, and to create health policies to alleviate the consequences of the pandemic.

Exploring Tandem Breastfeeding Motivations Via Self-Determination Theory: An Interpretative Phenomenological Study.

Tandem breastfeeding is defined as a situation in which a mother continues breastfeeding her child through a subsequent pregnancy, including after the new baby is born. In some countries where motherhood may be delayed and the time between births may be reduced, support for the promotion of tandem breastfeeding is necessary to help mothers continue to breastfeed their eldest child and avoid early weaning. There is no existing research about mothers' motivations to breastfeed in tandem. To explore the motivations of women to initiate and maintain tandem breastfeeding, based on their lived experience, framed within the self-determination theory. A prospective, cross-sectional, interpretive, phenomenological study was carried out through in-depth interviews with 15 mothers in Madrid, who had practiced tandem breastfeeding for more than 6 months, and whose weaning of their eldest child had occurred within the previous year. Convenience and snowball sampling were used. The data were analyzed using an established interpretive phenomenological analysis process. Among the motivations for initiating tandem breastfeeding, the following themes were identified: "avoid wasting the effort invested," "desire such life experience," and "exercise the freedom to decide." The motivations for maintaining tandem breastfeeding were classified as "pass on parenting values" and "benefits of teamwork." The participants based their motivation to tandem breastfeed to follow their freely chosen motherhood model. They discovered the advantages of its implementation, forming a team of themselves and their children, and healing their traumatic perinatal experiences.

Maternal health equity in Georgia: a Delphi consensus approach to definition and research priorities

BackgroundPregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia has one of the highest maternal mortality rates—almost twice the national rate. Furthermore, inequities exist in rates of pregnancy-related deaths. In Georgia, non-Hispanic Black women are nearly 3 times more likely to die from pregnancy-related complications than non-Hispanic White women. Unlike health equity, a clear definition of maternal health equity is lacking, overall and in Georgia specifically, but is needed to reach consensus and align stakeholders for action. Therefore, we used a modified Delphi method to define maternal health equity in Georgia and to determine research priorities based on gaps in understanding of maternal health in Georgia.MethodsThirteen expert members of the Georgia Maternal Health Research for Action Steering Committee (GMHRA-SC) participated in an iterative, consensus-driven, modified Delphi study comprised of 3 rounds of anonymous surveys. In round 1 (web-based survey), experts generated open-ended concepts of maternal health equity and listed research priorities. In rounds 2 (web-based meeting) and 3 (web-based survey), the definition and research priorities suggested during round 1 were categorized into concepts for ranking based on relevance, importance, and feasibility. Final concepts were subjected to a conventional content analysis to identify general themes.ResultsThe consensus definition of maternal health equity created after undergoing the Delphi method is: maternal health equity is the ultimate goal and ongoing process of ensuring optimal perinatal experiences and outcomes for everyone as the result of practices and policies free of interpersonal or structural bias that tackle current and historical injustices, including social, structural, and political determinants of health impacting the perinatal period and life course. This definition highlights addressing the current and historical injustices manifested in the social determinants of health, and the structural and political structures that impact the perinatal experience.ConclusionThe maternal health equity definition and identified research priorities will guide the GMHRA-SC and the broader maternal health community for research, practice, and advocacy in Georgia.

Links between perceived social support, sense of parental efficacy and postpartum paternal depression

ObjectiveAlthough fathers are strongly encouraged to get involved in parenthood since pregnancy, there is still little research on the perinatal experience of fatherhood. In order to better understand and appreciate the experience of fathers during the first months after their child's birth, in this study we investigated the links between perceived social support, sense of parental efficacy and postpartum depression. Similar to studies on mothers, several risk factors may increase the fathers’ vulnerability to the development of postpartum depression symptoms. The objective of this study was to determine whether higher levels of perceived social support and sense of parental efficacy are predictive of lower levels of postpartum depression symptoms in a sample of fathers living in France. Material and methodThe study population is made up of 376 fathers aged 18 to 59 years old, living in France, and having had a child in the past 6 months. Fathers answered to measures of depression symptoms (Edinburgh Postnatal Depression Scale), perceived social support (Social Provisions Scale), and sense of parental efficacy (Parenting Expectations Survey). ResultsIn accordance with our hypotheses, fathers who reported the lowest perceptions of their parental efficacy and the lowest levels of perceived social support are those who reported the highest levels of postpartum depression symptoms. Low levels of perceived social support and of sense of parental efficacy predicted higher postpartum depression symptoms in fathers. Multiple linear regression analyses also showed that the oldest fathers in our sample (30 years and more) had the highest depression scores, as well as lower levels of perceived social support and sense of parental efficacy than younger fathers. Primiparous fathers had higher postpartum depression scores and lower parental efficacy scores than multiparous fathers. ConclusionThe considerable involvement of fathers in the study and the large size of our sample are strengths of our study that substantiate the interest of fathers in issues related to their parenthood, well-being and mental health. Our results encourage caregivers to give them more attention and well-tailored support to better respond to their specific needs during the transition to parenthood. Couple and individualized care for each parent should be proposed throughout the perinatal period in order to promote parental social support and sense of parental efficacy, particularly for first-time fathers, and to prevent postpartum disorders.