Perinatal Health Professionals Research Articles

Perception of health risk linked to environmental factors by pregnant women

Abstract Bacground Recently, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products during pregnancy. To date, the chemicals, and the risks related, are not well-known, as well by perinatal health professionals (PHP) as by pregnant women (PW). AIMS: to estimate the sensitivity to the environment and the perception of risks related to chemical substances by pregnant women. Methodology A descriptive cross-over study was carried out among pregnant women ((followed or hospitalized in different health establishments in Auvergne). The collection of data (socio-demographic characteristics, sensitivity to the environment, use of cosmetics, perception of environmental risks) was carried out by interviewers, using a standardized questionnaire. The statistical analysis (logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris). Results Three hundred questionnaires were analyzed. The sensitivity to the environment is estimated at 6.3 ± 1.7 (scale 0 to 10). For the majority of women, exposure to chemicals is primarily related to the use of cleaning products, DIY products, and gardening products. Food can also be a source of exposure (especially for pesticides). On the other hand, cosmetics are not perceived as products containing chemical substances, with potential risk to health. This vision of chemical substances is related to age, educational level, socio-professional category and sensitivity to the environment. Only 5% (19/300) of PW considered health professionals as referents on chemical substances and environmental problems. Conclusions This study highlighted the sensitivity of pregnant women to environmental issues, but a lack of knowledge of chemicals and the risks which they represent for health. It is important to reinforce the information given to pregnant women by perinatal health professionals about healthy behaviors. Key messages Pregnant women don’t know all sources of exposure to chemical substances. Training in environmental health must be increased for perinatal health professionals.

A French network for prevention and reduction of reproductive risk in couples and pregnant women

Abstract Background Since 2013, several international (ASRM, FIGO, ACOG) and French (ANSES) learned societies and the French National Health and Environment Plan (2015-2019) urged to take into account exposures to environmental reprotoxic substances during standard care of infertile couples and pregnant women. However perinatal health professionals hardly incorporate this recommendation into practice. Objectives To create a network of platforms to addressing the environmental aspects that can impact the pregnancy chances of infertile couples after ART and pregnancy outcomes. We asked regional health authorities in France to provide funding for multidisciplinary hospital structures, in conjunction with clinical-biological reproductive health and gynecology-obstetric centers. Expertise, as well as information leaflets and risk detection tools have been shared. Results Platforms of counselling and prevention have been set up in the University Hospitals of Bordeaux, Marseille, Rennes, Créteil and Paris Fernand-Widal. Infertile couples and pregnant women, referred by reproductive physicians, benefit from personalized management of their domestic/professional reprotoxic exposures by addictology/tobacco, dietetics, occupational health and environmental pathology professionals. The network organizes an annual scientific day and a common database of exposure is being set up. Conclusions The PREVENIR (PREVENTION - ENVIRONMENT - Reproduction) network of platforms allows perinatal health professionals to refer their patients in order to optimize their chance of pregnancy through personalized and multidisciplinary care. The lifestyle changes initiated through this approach will also improve pregnancy outcomes and child health. Key messages A French network for the prevention and reduction of reproductive risk in infertile couples and pregnant women: the PREVENIR platforms (PREVENTION - ENVIRONMENT - Reproduction) is being established. Perinatal health professionals of multidisciplinary platforms engage into preventive actions to limit the exposure to environmental hazards during preconception and pregnancy.

The Experiences of Male Partners of Women with Postnatal Mental Health Problems: A Systematic Review and Thematic Synthesis

ObjectivesThis systematic review thematically synthesised qualitative research exploring men’s experiences of their partner’s postnatal mental health problems and their impact on men’s emotional wellbeing, relationships and support needs. Maternal postnatal mental health problems impact women and their infants. Recognition of the role that men play in supporting women’s’ recovery and infants’ development is growing. However, less is known about how maternal postnatal mental health problems affect men and how they wish to be supported.MethodsA systematic review of the literature was conducted in January 2018 by searching five electronic databases (PsycINFO, EMBASE, MEDLINE, PubMed and Web of Science). Qualitative research studies published in English exploring men’s experiences of having a partner with postnatal mental health problems were included. Twenty papers met the inclusion criteria and were appraised for methodological quality. Data were thematically synthesised.ResultsIn addition to nineteen subthemes, 5 main themes were identified: (1) Being a father, (2) Being a partner, (3) Experiencing negative emotions, (4) The ways in which men cope and (5) Where support is needed.ConclusionsMaternal postnatal mental health problems impacted men’s roles of being a father and a partner and gave rise to negative emotions. Men coped with these experiences in a number of ways, which were both helped and hindered by personal, social and professional factors. Participants’ coping methods were understood in relation to Coping Theory. Recommendations for perinatal mental health professionals included the need for increased public awareness of postnatal mental health.

Phthalate Exposure in Pregnant Women: Risk Perception and Preventive Advice of Perinatal Health Professionals.

Objectives The main objective of the PERI-HELPE study (Perception of Risk-HEaLth Professionals and Environment Study) was to describe the knowledge of perinatal health professionals about phthalates and the preventive advice they give to pregnant women about exposure to these chemicals. The secondary objective was to determine whether giving preventive advice was associated with the perception of phthalates. Methods A cross-sectional study was performed in 2015 in France. One hundred and eighty-nine perinatal health professionals (obstetricians, midwives and general practitioners) replied to an online self-administered questionnaire (participation rate: 11%). Results Only 17% of health professionals felt able to provide appropriate answers to pregnant women about phthalates. Advice was given by 23% (avoid plastic kitchen cling film) to 75% (prefer homemade dishes) about eating habits, by less than 42% for the use of cosmetics and less than 25% for that of consumer products. After adjusting for covariates, the awareness that pregnant women are daily exposed to phthalates (44% of professionals) was associated with dietary advice [avoid pre-packaged food (OR 2.2; 95% CI 1.1-4.4), prefer homemade dishes (OR 2.6; 95% CI 1.2-5.9) and avoid plastic kitchen cling film (OR 2.4; 95% CI 1.0-5.6)] but not with advice about cosmetics or consumer products. The perception of phthalate exposure as a high risk (66%) was not associated with preventive advice. Conclusions for Practice Our sample size was not very large but the findings nevertheless show the lack of knowledge of perinatal health professionals about phthalates. If they are to take on a preventive role, health professionals in France need to be better informed about phthalates and more fully trained in environmental health in general.

Environmental Health in Perinatal and Early Childhood: Awareness, Representation, Knowledge and Practice of Southern France Perinatal Health Professionals.

The exposure of adults of reproductive age as well as pregnant women and children to environmental contaminants is of particular concern, as it can impact fertility, in utero development, pregnancy outcomes and child health. Consequently, the World Health Organisation (WHO) and international societies advocate including Environmental Health (EH) in perinatal care, yet perinatal health professionals (HPs) hardly put these recommendations into practice. In 2017, a cross-sectional study was performed in a large panel of perinatal HPs in south-eastern France with the aim of painting a picture of their current attitudes, representation, knowledge, and training expectations. Quantitative and qualitative information was collected via auto-questionnaire. Questionnaires were completed by 962 participants, mainly midwives (41.1%), physicians (25.6%) and nursery nurses (11%). Indoor/outdoor air quality and endocrine disruptors were the best-mastered topics, whereas electromagnetic fields and diet gave rise to unsure responses. Overall, perinatal HPs were ill-trained and -informed about the reproductive risks linked to daily environmental exposure. HPs reported scarce knowledge, fear of patient reaction and lack of solutions as the main barriers to providing information regarding EH to the public. Our findings highlight the need to set up EH training programmes focused on scientific knowledge and to provide simple messages and tips to help perinatal HPs deliver advice to populations to mitigate exposure to environmental toxicants.

Hospital-based child protection teams that care for parents who abuse or neglect their children recognize the need for multidisciplinary collaborative practice involving perinatal care and mental health professionals: a questionnaire survey conducted in Japan.

BackgroundChild abuse and/or neglect is a serious issue, and in many cases, parents are the perpetrators. Hospital-based child protection teams (CPTs) play pivotal roles in the management of not only abused and/or neglected children but also of their parents; this is generally conducted through multidisciplinary practice. The aim of this study is to survey hospital-based CPT members to determine the professions they perceive to be most applicable to participation in CPTs.Participants and methodsThe participants were members of CPTs affiliated with hospitals that had pediatric emergency departments and which were located in Chiba Prefecture; specifically, 114 CPT members from 23 hospitals responded to this survey. The two main questionnaire items concerned are as follows: 1) each respondent’s evaluation of conducting assessments, providing support, and implementing multidisciplinary collaborative practice in the treatment of abusive and negligent parents, and 2) each CPT member’s opinion on the professions that are most important for CPT activities. An exploratory factor analysis (EFA) was performed to explore the factor structure of the data, and a correlation analysis was performed using the result obtained.ResultsThe EFA returned two factors: multidisciplinary collaborative practice (α = 0.84) and assessment and support (α = 0.89). A correlational analysis showed that multidisciplinary collaborative practice had a positive correlation for obstetricians (r = 0.315, p = 0.001), neonatologists (r = 0.261, p = 0.007), midwives (r = 0.248, p = 0.011), and psychiatrists (r = 0.194, p = 0.048); however, assessment and support was only significantly correlated with midwives (r = 0.208, p = 0.039).ConclusionThis study showed that hospital-based CPT members highly evaluate multidisciplinary collaborative practice for the management of abusive and/or negligent parents, and they believe that, in addition to pediatric physicians and nurses, perinatal care and mental health professionals are the most important participants in advanced CPT activities.

Psychotherapy Training on Psychological Mindedness in a Japanese Nurse Population: Effects and Personality Correlates.

Aims and objective: The aim of this study was to determine whether the training would influence the psychological mindedness of nurses and midwives. In addition, we explored the relationship of the change of psychological mindedness before and after the training and the correlation with their personality traits. Background: It is important for perinatal health professionals such as nurses and midwives to acquire intervention skills such as psychotherapy and counselling techniques. We think that one of the essential requisites is psychological mindedness. Method: A total of 45 perinatal health professionals who participated in the postpartum depression prevention programme were distributed a set of questionnaires including the Psychological Mindedness Scale (PMS) and Temperament and Character Inventory (TCI) at the beginning and end of the training. Results: The PMS scores increased significantly after the training. A structured equation modelling suggested that PMS and self-directedness predicted each other whereas PMS predicted low harm avoidance. Conclusion: These findings indicate that the psychological mindedness of nurses and midwives could be advanced by a course of training and that this could be supported by high self-directedness. The harm avoidance trait may be reduced by increased psychological mindedness. Relevance to clinical practice: Nurses and nursing students are apt to psychological skill training in the advancement of psychological mindedness.

Effects of Partners’ Attitudes towards Wife’s Aspirations on Depression after Childbirth

A lack of social support for pregnant women is associated with depression after childbirth. However, few studies have examined the impact of the partners’ understanding of and support for the women’s aspirations (personal goals in life) on the severity of depression after childbirth. To examine the relationship between a partner’s attitude to his wife’s aspirations and depression after childbirth, a longitudinal study was conducted of 290 primipara women from five university hospitals between October 1997 and March 2000. Three questionnaires were administered to participant women. During their third trimester, they were asked about their aspirations (Aspiration Index) and their perception of their partners’ understanding of and support for their aspirations. At one month and three months after childbirth, they were asked about the severity of their depression (Edinburgh Postnatal Depression Scale). Correlation analyses and structural equation modelling showed that the partners’ poor understanding and support predicted the severity of depression after childbirth. Perinatal health professionals should be encouraged to assess the pregnant women’s aspirations and their partners’ understanding and support regarding the women’s goals in life.

Mother-To-Infant Bonding Disorder, but not Depression, 5 days After Delivery is a Risk Factor For Neonate Emotional Abuse: A Study in Japanese Mothers of 1-Month Olds

Background:Despite its clinical and public policy-making importance, neonatal abuse has been only minimally studied.Purpose:To identify predictors of mothers’ emotional abuse towards their infants at 1 month after childbirth.Methods:We studied a cohort of 252 women at three time points: late pregnancy and 5 days and 1 month after childbirth. At each time point, the women were administered a set of questionnaires about their depression (Edinburgh Postnatal Depression Scale), bonding towards the foetus or neonate (Maternal Antenatal Attachment Scale and Postnatal Bonding Questionnaire, respectively), and, at 1 month after childbirth, emotional abuse (Conflict Tactic Scale).Results:Structural equation modeling (SEM) analysis revealed that neonatal emotional abuse was predicted by bonding difficulties at 5 days after childbirth but not by depression at that time point.Conclusion:Assessment for maternal bonding problems in the early post-natal period should be routinely performed by perinatal health professionals.

Perception of Environmental Risks and Health Promotion Attitudes of French Perinatal Health Professionals.

The exposure of pregnant women to environmental contaminants is a subject of international concern. However, the risk perception of these contaminants by health professionals (HP) has not been extensively investigated. The main objective of the PERI–HELPE study (Perception of Risk–HEaLth Professionals & Environment Study) was to assess the risk perception of environmental exposure of pregnant women by perinatal HPs. The secondary objectives were to describe the preventive attitudes of perinatal HPs concerning chemicals exposure of pregnant women and to identify the barriers to preventive attitude. A cross-sectional study was performed in 2015 in France. One hundred eighty-nine HPs (obstetricians, midwives, and general practitioners) replied to an online self-administered questionnaire (participation rate: 11%). Carbon monoxide, pesticides and lead were the contaminants most frequently perceived as a high risk for pregnant women. A minority of HPs asked women about their chemical exposure and advised them to reduce exposure. The lack of information, training and scientific evidence in environmental health were the main difficulties declared by the HPs to advise pregnant women. Despite the low response rate, our findings provide important information to encourage French health authorities to take into account the difficulties encountered by HPs and set up appropriate training programs in Environmental health.

Perception of environmental risks by French perinatal health professionals

Perception of environmental risks by French perinatal health professionals

PRogram In Support of Moms (PRISM): Development and Beta Testing.

Most women with perinatal depression do not receive depression treatment. The authors describe the development and beta testing of a new program, PRogram In Support of Moms (PRISM), to improve treatment of perinatal depression in obstetric practices. A multidisciplinary work group of seven perinatal and behavioral health professionals was convened to design, refine, and beta-test PRISM in an obstetric practice. Iterative feedback and problem solving facilitated development of PRISM components, which include provider training and a toolkit, screening procedures, implementation assistance, and access to immediate psychiatric consultation. Beta testing with 50 patients over two months demonstrated feasibility and suggested that PRISM may improve provider screening rates and self-efficacy to address depression. On the basis of lessons learned, PRISM will be enhanced to integrate proactive patient engagement and monitoring into obstetric practices. PRISM may help overcome patient-, provider-, and system-level barriers to managing perinatal depression in obstetric settings.

Changes in Cosmetics Use during Pregnancy and Risk Perception by Women.

Cosmetic products contain various chemical substances that may be potential carcinogen and endocrine disruptors. Women’s changes in cosmetics use during pregnancy and their risk perception of these products have not been extensively investigated. The main objective of this study was to describe the proportion of pregnant women changing cosmetics use and the proportion of non-pregnant women intending to do so if they became pregnant. The secondary objectives were to compare, among the pregnant women, the proportions of those using cosmetics before and during pregnancy, and to describe among pregnant and non-pregnant women, the risk perception of these products. A cross-sectional study was carried out in a gynaecology clinic and four community pharmacies. One hundred and twenty-eight women (60 non-pregnant and 68 pregnant women) replied to a self-administered questionnaire. Cosmetics use was identified for 28 products. The results showed that few women intended to change or had changed cosmetics use during pregnancy. Nail polish was used by fewer pregnant women compared to the period before pregnancy (p < 0.05). Fifty-five percent of the women considered cosmetics use as a risk during pregnancy and 65% would have appreciated advice about these products. Our findings indicate that all perinatal health professionals should be ready to advise women about the benefits and risks of using cosmetics during pregnancy.

Associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms.

This study examined the associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1month postnatal. This study also examined if these relationships would be mediated by antenatal depressive symptoms. This study was a prospective cohort study that investigated effects between the third trimester of pregnancy and 1month after childbirth. The Japanese version of the Index of Spouse Abuse (ISA), the Japanese version of the Mother-Infant Bonding Scale (MIBS), and the Japanese version of the Hospital Anxiety and Depression Scale (HADS) were used to measure IPV during pregnancy, bonding failure with infants, and depressive symptoms during pregnancy and the postnatal period respectively. Structural equation modeling (SEM) was used to find the associations between those four variables. The final path model of the SEM showed good fit with the data. IPV during pregnancy was associated with mother-to-infant bonding failure at 1month postnatal, whereas IPV during pregnancy was not significantly associated with postnatal depressive symptoms at 1month postnatal. In addition, this study demonstrated that the associations between IPV during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1month postnatal were mediated by antenatal depressive symptoms. The results of this study indicated the need for interventions for IPV and psychological health care for abused pregnant women to prevent antenatal depressive symptoms in prenatal health settings. Those interventions by perinatal health professionals would help to prevent bonding failure with infants and postnatal depressive symptoms after childbirth.

Fatherhood in a New Country: A Qualitative Study Exploring the Experiences of Afghan Men and Implications for Health Services.

Fathers of refugee background are dealing with multiple, interrelated stressors associated with forced migration and establishing their lives in a new country. This has implications for the role of men in promoting the health and well-being of their families. Afghan community researchers conducted interviews with 30 Afghan women and men who had recently had a baby in Australia. Interviews and focus groups were conducted with health professionals working with families of refugee background. Fourteen men, 16 women, and 34 health professionals participated. Afghan men reported playing a major role in supporting their wives during pregnancy and postnatal care, accompanying their wives to appointments, and providing language and transport support. Although men embraced these roles, they were rarely asked by health professionals about their own concerns related to their wife's pregnancy, or about their social circumstances. Perinatal health professionals queried whether it was their role to meet the needs of men. There are many challenges for families of refugee background navigating maternity services while dealing with the challenges of settlement. There is a need to move beyond a narrow conceptualization of antenatal and postnatal care to encompass a broader preventive and primary care approach to supporting refugee families through the period of pregnancy and early years of parenting. Pregnancy and postnatal care needs to be tailored to the social and psychological needs of families of refugee background, including men, and incorporate appropriate language support, in order to improve child and family health outcomes.

The experience of post-traumatic stress disorder following childbirth

Post-traumatic stress disorder (PTSD) is a significant mental health problem, which women can develop following childbirth. Partners and staff are also at risk and a larger group of women develop sub-clinical trauma symptoms. PTSD can have an impact on future childbearing, the wider family, intimate sexual relationships and bonding. The relationship between mothers and maternity staff is crucial. Health visitors can help by: supporting realistic expectations of delivery antenatally; early identification of high-risk mothers via rigorous histories; facilitating communication and the father's role in the birth; early identification, screening and referral to specialist perinatal mental health professionals; supporting care pathways; supporting the parent–infant relationship; and facilitating access to social support.

Rôle du périnato-sexologue dans une équipe interdisciplinaire périnatale au Canada

Interdisciplinary health care teams are models of health care that are the way of the future. In this model, the sexologist has a unique and important role, particularly in perinatal health care where sexuality is a central component of health. Perinatal sexuality is a newly emerging discipline in which the perinatal sexologist has a double role to play: 1) to train other perinatal health professionals in sexuality; and 2) to educate and to intervene with future and new parenting couples by answering their multiple intimate and sexual questions and concerns during the transition to parenthood.

Perinatal mental health cultural responsiveness training – an evaluation

Purpose – Women from culturally and linguistically diverse communities face barriers to accessing perinatal mental health care. Victorian Transcultural Mental Health (VTMH) is a state-wide service in Victoria, Australia, that supports specialist mental health service providers to improve cultural responsiveness. VTMH provided training for perinatal health professionals in cultural responsiveness. The paper aims to discuss these issues. Design/methodology/approach – A curriculum was specifically developed based on a literature review, consultation forum, and input from members of an industry-based reference group. An Evaluation Tool was designed to collect participants’ feedback regarding the perceived relevance of the training content and its impact on practice. Responses were analysed using quantitative techniques and thematic analysis. Findings – Nine face-to-face training sessions were provided, in metropolitan and rural regions. In all, 174 professionals of various backgrounds (including midwives, mental health professionals, and maternal child health nurses) attended. In all, 161 completed evaluations were received and responses indicated that the training was of high relevance to the target workforce, that the training would have implications for their practice, and support was given for further training to be delivered using online methods. Research limitations/implications – First, an assessment of the cultural competence of participants prior to enrolment in the course was not conducted, and no matched control group was available for comparison with the participants. Second, generalisability of these findings to other settings requires further investigation. Third, the sustainability of the project is an area for further study in the future. Fourth, other methods including direct interviews of focus groups with participants may have yielded more detailed qualitative feedback regarding the effectiveness of the programme. Practical implications – To facilitate the sustainability of the project, following the face-to-face training, an online training module and a resource portal were developed, offering links to relevant web sites and resources for health professionals working in this field. Originality/value – The training addressed a significant unmet need for cultural responsiveness training for a diverse range of practitioners in the field of perinatal mental health. Online training can be adapted from face-to-face training and it is anticipated that online training will facilitate the sustainability of this initiative.

Perinatal Outcomes of Prenatal Probiotic and Prebiotic Administration

The purpose of this integrative review was to identify, critique, and synthesize the maternal and neonatal evidence on the prenatal use of probiotics and prebiotics to inform perinatal health professionals. A comprehensive literature search resulted in 37 studies of prenatal probiotics and 1 on antepartal prebiotics published from 1990 through 2011 that reported maternal, fetal, and/or neonatal outcomes. The methodologic quality of the studies reviewed was high, although investigators used different probiotic combinations and inconsistently reported perinatal clinical outcomes. The extraction of perinatal outcome variables resulted in identification of 9 maternal and 5 neonatal categories. Prenatal probiotics significantly reduced the incidence of bacterial vaginosis, increased colonization with vaginal Lactobacillus and intestinal Lactobacillus rhamnosus, altered immune markers in serum and breast milk, improved maternal glucose metabolism, and reduced the incidence of gestational diabetes and preeclampsia. Antepartally, probiotics were associated with significantly higher counts of Bifidobacterium and Lactococcus lactis (healthy intestinal flora) in neonatal stool. Prenatal prebiotics significantly increased maternal intestinal Bifidobacterium. No adverse events were reported and there was evidence of safety and tolerance of prenatal probiotics and prebiotics in the scientific investigations reviewed. It is recommended that in future investigations of prenatal probiotics researchers explicitly report maternal and neonatal outcomes.

Online Resources for New Mothers: Opportunities and Challenges for Perinatal Health Professionals

Studies have shown increasing Internet use for health information and service facilities. After consulting a convenience sample of new mothers, this study applied select terms and phrases to a widely accepted search engine and investigated its potential for providing resources for new mothers. Results of this quantitative content analysis showed that only four of the 13 phrases used in the search generated 50% or more websites containing content relevant to new mothers. Findings indicate that informational support by way of electronic fact sheets is available using the Google search engine. However, functional support (e.g., social networks, consultation phone details, and mother-infant activities) configured limited data resources using the Google search engine. In addition, because websites can be difficult to navigate, users' technical proficiency needs to be taken into consideration as well as the sites' up-to-date information. With Internet technology rapidly expanding, perinatal educators and other perinatal health-care professionals need to be informed about current online resources to help direct consumers to useful online resources and mitigate the often overwhelming and confusing information.