Perinatal Support Research Articles

"I Didn't Need People's Negative Thoughts": Women With Intellectual and Developmental Disabilities Reporting Attitudes Toward Their Pregnancy.

Background Since the illegalization of involuntary sterilization of persons with intellectual and developmental disabilities, there has been an increase in childbearing in this population. However, women with intellectual and developmental disabilities continue to experience prejudicial attitudes toward their pregnancies. Objective To analyze the experiences of women with intellectual and developmental disabilities regarding their perceptions of support persons’ attitudes toward their pregnancies. Methods Three case studies derived from grounded theory research exploring perinatal social support received by women with intellectual and developmental disabilities. Using inductive content analysis, we further analyzed the perceptions of women with intellectual and developmental disabilities regarding support persons’ attitudes toward their pregnancies. Findings: The nature of interactions with support persons and women’s characteristics, such as help-seeking behaviors, disability, mental illness, and age, influenced support persons’ attitudes toward childbearing. Women preferred support from caregivers perceived as nonjudgmental and tended to restrict contact with persons perceived as prejudicial. However, some attitudes improved following positive interactions with the women. The relationship between support persons’ attitudes and the women’s help-seeking behaviors is thus complex. Conclusions Education of families and medical and social services practitioners and opportunities for positive contact should be further explored. Caseworkers of women with intellectual and developmental disabilities may have invaluable roles in facilitating positive interactions between women with intellectual and developmental disabilities and caregivers.

Trends of Mortality, Time, and Causes of Death in Preterm Infants

Objective: Although survival rate of preterm infants in Korea has increased in the past several decades, it seems to be stable recently. The objective of this study is to evaluate the mortality rate of preterm infants in a single center in Korea between 2009 and 2018. Methods: Preterm infants with gestational age (GA) <30 weeks who were admitted to Busan Paik Hospital (January 2009 to December 2018) were enrolled. Results: The overall mortality rate was 20.8%. Mortality rate decreased from 21.9% in 2009 to 9.2% in 2012. It then increased and reached a plateau at 20%. Mortality rate was 80.0% in those with GA of 22 weeks. It then decreased with increasing GA. It was 2.9% in those with GA of 29 weeks. The risk of death decreased by 0.573 times when GA increased by 1 week. Death immediately after birth was high in infants with GA of 22 weeks. It was rare in infants with GA ≥25 weeks. Death within 24 hours after birth was high in infants with GA ≤24 weeks who were delivered precipitately without appropriate perinatal support. Sepsis was the leading cause of all deaths. High grade intraventricular hemorrhage was the second common cause of death, especially in infants with GA ≤24 weeks. Conclusion: Mortality rate of preterm infants in this study did not decrease. Modifiable factors including delivery with appropriate supports of neonatal resuscitation team and sufficient maternal obstetric care, especially maternal infection control might reduce mortality, especially immediate postnatal death.

Perinatal bereavement and support for siblings

When the premature death of a baby occurs in a family, brothers and sisters need support. Their silence, their absence of questions or reactions must set off alarm bells. The parents, beyond their own bereavement, have a key role to play in enabling their children to integrate this loss into their lives.

Support for Young Black Urban Women After Perinatal Loss.

To describe the bereavement support needs of black urban women in late adolescence after perinatal loss. Eight black women aged 18 to 21 years who had experienced recent perinatal loss were interviewed in person or by telephone at three points in the 12 weeks that followed their loss to describe their perinatal bereavement experience and support needs. Data from the interviews were analyzed using constant comparative analysis. Black adolescent women need culturally appropriate bereavement support targeted at key transition points along the bereavement trajectory. They need accurate information, compassionate and respectful communication, and support from their mothers, grandmothers, and other women from their community of faith who have experienced perinatal loss. They value mementos, such as photographs and footprints. Nurses are well-positioned to be consistent caregivers and to provide clear, compassionate communication and anticipatory guidance to young black women experiencing perinatal loss. Attending to spiritual needs, harnessing family support, providing mementos, and encouraging reflection through journaling may help adolescent women find meaning and new perspectives on their bereavement experience.

'I need help': Reasons new and re-engaging callers contact the PANDA-Perinatal Anxiety and Depression Australia National Helpline.

In Australia, the PANDA-Perinatal Anxiety & Depression Australia National Helpline (the Helpline) offers support to callers impacted by emotional health challenges in the perinatal period. Callers receive counselling from professional staff and peer support from volunteers. An understanding of factors that contribute to callers' experiences of emotional distress, as well as potential barriers and facilitators to help-seeking, can be used to inform future service design and delivery. A caller intake form is completed by Helpline staff when an individual contacts the service for the first time, or re-engages after a period of non-contact. We analysed all intake forms of individuals calling about their own emotional wellbeing from the middle month of each season in 2014: January, April, July, and October. Content analysis was undertaken, focusing on caller profile, patterns of help-seeking, and reasons for caller engagement. Of the 365 calls, the majority were from women (n=358, 98%) who were pregnant (n=59, 16%) or had a child ≤12months of age (n=241, 75%). Many were seeking support regarding depression (n=186, 51%) or anxiety (n=162, 44%), with a number seeking help for both (n=71, 20%). Almost a third were identified as being 'at risk', including a number who were experiencing thoughts of suicide or self-harm. Complex interrelating factors contributed to callers' emotional distress, including: stressful life events; pregnancy, birthing and parenting experiences; social isolation; and histories of mental health difficulties. Significant numbers of parents experience emotional health challenges in the perinatal period, but many do not receive adequate treatment. Complex factors contribute to callers' distress, highlighting the need for health professionals to undertake thorough psychosocial assessments during the perinatal period so those that need additional support are identified, and appropriate care provided. Telephone Helplines like PANDAs assist overcoming barriers to care and provide specialised perinatal mental health support to families.

Assistance with parenthood for new mothers with mental health problems

Women with mental health problems during the perinatal period need support with parenthood. Guidance from professionals providing the paediatric nursing care must favour the baby's development, but also help the mother assume her role and support the establishment of the mother-baby bond. Mediation when providing paediatric nursing care is a means of supporting parenthood.

Abstracts from the NIH Office of Research on Women's Health 2018 Annual BIRCWH Meeting – Building Interdisciplinary Research Careers in Women's Health November 28, 2018

Abstracts from the NIH Office of Research on Women's Health 2018 Annual BIRCWH Meeting – Building Interdisciplinary Research Careers in Women's Health November 28, 2018

Psychosocial Implications of Stillborn Babies on Mother and Family: A Review from Tertiary Care Infirmary in India.

When a mother loses a baby after the period of viability, there is no way to fathom her grief, neither any words, nor an explanation. It is an unexpected event. Stillbirth presents a situation where the early activation of the grief process primarily in mother is exacerbated by the circumstances surrounding the loss. It thus becomes imperative for the healthcare providers to evaluate the significance of parent's perception on the loss and the factors contributing to it before the initiation of therapy. To evaluate the psychosocial impact of stillbirth among mothers and its contributing factors. A WHO-funded prospective study was conducted in VMMC and Safdarjung Hospital from September 2015 to August 2016 on all women who gave birth to a stillborn baby, using a questionnaire based on EPDS, after taking their written informed consent. Data were entered on the predesigned proforma and analyzed after applying Chi-square test, keeping a null hypothesis value of 15% for all the variables. Out of the 709 women who delivered stillborn babies, 645 respondents, who willingly consented to participate, were included in the study. There was a significant relationship between psychosocial impact after perinatal loss and support from caregiver and family. Mothers with stillborn fetuses should be screened for psychosocial impact and offered support when needed. Appropriate counseling by healthcare providers and continued psychosocial and emotional support by family members must be provided.

“Getting help for yourself is a way of helping your baby:” Fathers’ experiences of support for mental health and parenting in the perinatal period.

The need for services targeting fathers in the perinatal period is increasingly apparent. To maximize engagement, such interventions need to be father focused, but men’s experiences and needs around support have not been adequately examined. Therefore, the aims of this qualitative study were to explore men’s experiences of seeking support for their mental health and parenting in the perinatal period, and identify their specific support needs during this time. Australian fathers (N = 20) who were expecting or parenting an infant less than 2 years of age participated in individual semistructured face-to-face or telephone interviews. Thematic content analysis was used to analyze the data. Five broad themes were explored: experiences of support, support needs, barriers to support, facilitators to support, and timing of support. Several subthemes were identified within each category, illustrating a diverse range of issues that fathers experience across the perinatal period. The findings have implications for our understanding of fathers’ help-seeking behaviors, their perinatal support needs and for the development of resources, services, and interventions aiming to engage fathers in maternity health services.

Creation of a Perinatal Mood and Anxiety Disorder Support Group

Creation of a Perinatal Mood and Anxiety Disorder Support Group

A Nurse-Driven, Community-Based Program to Support Rural Women With Perinatal Substance Use Disorder

To partner with the local Perinatal Support Coalition and collaborate across systems to address barriers to care for women, reduce stigma, and improve outcomes in women with perinatal substance use disorders (PSUD). In 2014, the nurse practice team at a rural community hospital in western Massachusetts identified a critical practice issue: The percentage of substance-exposed neonates had increased to 7%, three times more than the state average. Practice gaps included lack of adequate maternal screening and referral as well as limited knowledge of PSUD and neonatal abstinence syndrome.

A randomized controlled trial of financial incentives to low income pregnant women to engage in smoking cessation treatment: Effects on post-birth abstinence.

Evaluate the effectiveness of monetary incentives for increasing engagement in smoking cessation treatment and improving 6-month abstinence in low-income pregnant smokers. Two-group randomized clinical trial recruiting low-income (Medicaid-registered) pregnant smokers receiving assistance through a perinatal support program. Participants were randomized to either an incentive (n = 505) or control condition (n = 509). All participants were offered identical smoking cessation counseling at contacts. Incentive condition participants received incentives for attending pre- and postbirth treatment contacts: $25 for each of 6 prebirth provider visits, $25-40 for each of 4 postbirth home visits at Weeks 1, 2, 4, and 6 (total = $130), $20 for each of 5 postbirth counseling calls and $40 for biochemically verified abstinence at the Week 1 and 6-month visits. Control condition participants received only $40 for attendance at the Week 1 and 6-month postbirth visits ($40 each). Primary outcome was biochemically confirmed 7-day point-prevalence abstinence at 6-month postbirth follow-up. Secondary outcomes included number of home visits and phone calls taken over the first 6 months postbirth; biochemically confirmed abstinence at postbirth Week 1 visit; and self-reported smoking status at 2- and 4-month visits. Incentive condition participants had a higher biochemically confirmed abstinence rate at 6-month postbirth than controls (14.7% vs. 9.2%, respectively: p < .01). This effect was mediated by incentive condition participants' greater acceptance of postbirth home visits and counseling calls. Moderate incentive payments for smoking treatment engagement (a mean of ≈$214 paid) increased low-income pregnant smokers' engagement and success in smoking cessation treatment. (PsycINFO Database Record

Policy and Legal Protection for Breastfeeding and Incarcerated Women in Canada

Most incarcerated women in Canada are mothers. Because women are the fastest growing population in carceral facilities, protecting the rights of incarcerated women to breastfeed their children is increasingly important. There is considerable evidence that incarcerated women in Canada experience poor physical and mental health, isolation, and barriers to care. Incarcerated women and their children could benefit significantly from breastfeeding. This Insight in Policy explores policy and legal protection for breastfeeding in Canada as it relates to carceral facilities, considers key cases regarding breastfeeding rights among incarcerated women, and presents recommendations for policy development and advocacy. The Canadian Constitution and human rights legislation across Canada prohibits discrimination on the basis of gender and includes pregnancy and the possibility of becoming pregnant as a characteristic of gender. Some provinces note that breastfeeding is a characteristic of gender. Women's Wellness Within, a nonprofit organization providing volunteer perinatal support to criminalized women in Nova Scotia, conducted a scan of all provincial and territorial correctional services acts and the federal Corrections and Conditional Release Act: none mention breastfeeding. Protocols for breastfeeding during arrest and lockup by police were not available in any jurisdiction across Canada. International law, including the Convention on the Rights of the Child, the Nelson Mandela Rules, and the Bangkok Rules, have application to the rights of incarcerated breastfeeding women. The Inglis v. British Columbia (Minister of Public Safety) (2013) and Hidalgo v. New Mexico Department of Corrections (2017) decisions are pivotal examples of successful litigation brought forward by incarcerated mothers to advance breastfeeding rights. Improved application and understanding of existent law could advance breastfeeding rights.

A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy

ObjectiveTo explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. DesignQualitative descriptive design with in-depth semi-structured interviews. SettingPostnatal wards at a tertiary specialized women's hospital in Shanghai, China. Participants21 nulliparous women 2–3 days postpartum were purposively sampled until data saturation. MethodsIn-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. ResultsTwo overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, ‘shy away’ and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, ‘shy away’ and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. Conclusion and implications for practiceAt the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them.

Maternal perceptions of family-centred support and their associations with the mother-nurse relationship in the neonatal intensive care unit.

To evaluate maternal perceptions of family-centred support with hospitalised preterm infants and their relationship between mothers and nurses in the neonatal intensive care unit (NICU). Mothers who gave birth to preterm infants tend to suffer more stress and need individual support based on family-centred care. However, there may be a shortage of support for mothers to obtain parent-crafting skills before bringing their infants home. This cross-sectional study used path analysis and multiple group analysis to evaluate a structural equationmodel of the relationship between maternal perception based on family-centred support in parent-crafting training and the mothers-nurses collaboration. We analysed data from 98 mothers (valid response proportion, 41.0%) whose infants were hospitalised in the NICU of two types of perinatal centres in Japan. We used three revised standardised questionnaires in Japanese: Measure of Process of Care in the NICU (Neo-MPOC 20), Enabling Practice Scale in the NICU (Neo-EPS) and the author-developed Mother and Infant Questionnaire. Path analysis revealed that the relationship between mothers and nurses was linked to three factors related to the perinatal centres' support: consideration of parents' feelings, ability to deal with specific needs and coordination in dealing with situations that interact with provision of parent-friendly visual information. Separate path analyses for each perinatal centre showed the same pattern, although the standard coefficients were different. Maternal perceptions of family-centred support with hospitalised preterm infants promoted better collaboration between mothers and nurses to obtain parent-crafting skills at two types of perinatal units in Japan. Clear visual information materials might promote better maternal understanding of their infants, help in acquisition of parent-crafting skills and improve mother-nurse collaboration, with the result that mothers are better able to care for their infants autonomously at home.

Peer supporters' experiences on an Australian perinatal mental health helpline.

Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy-Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents 'strongly agreed' that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role.

Aleitamento materno: o que mudou em 12 anos

Introduction: In recent decades initiatives for the promotion and protection of breastfeeding (BF) have been developed. This study was designed to evaluate the BF maintenance rate in a differentiated perinatal support hospital and compare results with those obtained in previous and similar studies.Methodology: Longitudinal prospective study including a convenience sample of newborns admitted to a maternity, from 1 February, to 30 April, 2012. Sociodemographic, perinatal and determinants of BF interruption data were collected in maternity, at three and six months and compared with similar data evaluated in studies conducted in 2000 and 2003 at the same institution.Results: Two hundred and ninety two mother/child pairs were included. Comparing with studies of 2000 and 2003, mothers had a higher mean age and educational level. In relation to the study of 2000, there was an increase in the preterm percentage and a reduction of caesarean section, infant formula needs and time to BF onset. It was found an improvement in BF rate at discharge compared to 2003. The hypogalactea remained the main cause of BF cessation. At six months, the BF interruption decision was mostly taken by the mother.Discussion/Conclusion: The demographic changes aware to the emergence of possibly different difficulties in BF promoting. At the hospital, reduction of infant formula use and time to BF onset represented improvements in this area. Such results highlight the importance of BF efforts over the years and must encourage other similar initiatives after discharge.

Grief, traumatic stress, and posttraumatic growth in women who have experienced pregnancy loss.

Pregnancy loss is common and can be devastating for those who experience it. However, a historical focus on negative outcomes, and grief in particular, has rendered an incomplete portrait of both the gravity of the loss, and the potential for growth in its wake. Consistent with contemporary models of growth following bereavement, this study explored the occurrence of posttraumatic growth following pregnancy loss and further assessed the role of core belief disruptions and common loss context factors across perinatal grief, posttraumatic stress symptoms, and posttraumatic growth. Women who had experienced a miscarriage or stillbirth (N = 328) were recruited through perinatal loss support groups and completed an online survey that assessed core belief disruption, perinatal grief, posttraumatic stress symptoms, posttraumatic growth, loss context factors, and demographics. Hypotheses were tested via hierarchical multiple regression. All hypotheses were supported. Specifically, (a) moderate levels of posttraumatic growth were reported; (b) core belief disruptions predicted perinatal grief, posttraumatic stress symptoms, and posttraumatic growth; and (c) perinatal grief predicted posttraumatic stress symptoms and growth. Findings suggest that pregnancy loss can be a traumatic event, that core belief disruptions play a significant role in posttrauma outcomes, and that other factors may contribute to grief, posttraumatic stress symptoms, and posttraumatic growth following pregnancy loss that warrant further research (e.g., rumination). Despite potential methodological and sampling limitations, the use of validated measures to assess posttraumatic growth in a large sample represents a robust attempt to quantify the occurrence of posttrauma change following pregnancy loss. (PsycINFO Database Record

The Prevalence and Risk Factors of Paternal Sleep Problems Across the Perinatal Period in Hong Kong - a Longitudinal Study

Background: The present study aimed to identify the prevalence of sleep problems among the fathers from the antenatal to postpartum period as well as their risk factors with an aim to develop strategies to assist the fathers during the transition period. Methods: A consecutive sample of 540 Chinese expectant fathers were recruited. Expectant fathers were administered a set of questionnaires at first presentation (12 weeks gestation), 36 weeks pregnancy and 6 weeks after childbirth. Sleep problems was assessed with the Pittsburgh Sleeping Quality Index (PSQI). Demographic and psychosocial risk factors were also assessed. Findings: An alarming 42.2%, 57.5% and 70.3% of the fathers were identified to have sleep problems at early, late pregnancy and six week postpartum respectively. Hierarchical multiple regression analysis showed that poor self-esteem and work family conflict were significant risk factors for sleep problems at early pregnancy and late pregnancy respectively, even after controlling for confounders. Poor social support and work family conflict significantly predicted sleep problems at six week postpartum. Discussions: The prevalence of sleeping problems among the fathers during perinatal period was alarmingly high and warrants serious attention. Given the potential adverse impact of sleep problems on fathers’ mental and physical health as well as caregiving abilities, findings from this study point to the need to equip fathers with psychosocial resources through perinatal psychoeducation, support group and counselling. Caution should be exercised in generalizing the results to fathers of other backgrounds as the sampling of the present study only include a certain area of Hong Kong.

NICE guideline for antenatal and postnatal mental health: The health visitor role

When the National Institute for Health and Care Excellence (NICE) guideline for antenatal and postnatal mental health was updated in December 2014, the intervention delivered by health visitors described as ‘listening visits’ was not included in the recommendations as one of a number of possible evidence-based options of support. Maternal mental health is one of the English Department of Health's six high impact areas designated as a fundamental component of health visiting practice. This review demonstrates how health visitors are uniquely placed to fulfil many of the recommendations in the updated NICE guideline, and have a pivotal part to play in prevention, early identification, prompt treatment and improved outcomes for mothers, their partners and their babies. The review also highlights the challenges of delivering the recommended levels of perinatal mental health information, advice and support amid budget cuts, re-organisation of services and conflicting policy priorities.