Postpartum Well-being Research Articles

Delivery mode is associated with maternal mental health following childbirth.

Childbirth is a life-transforming event often followed by a time of heightened psychological vulnerability in the mother. There is a growing recognition of the importance of obstetrics aspects in maternal well-being with the way of labor potentially influencing psychological adjustment following parturition or failure thereof. Empirical scrutiny on the association between mode of delivery and postpartum well-being remains limited. We studied 685 women who were on average 3months following childbirth and collected information concerning mode of delivery and pre- and postpartum mental health. Analysis of variance revealed that women who had cesarean section or vaginal instrumental delivery had higher somatization, obsessive compulsive, depression, and anxiety symptom levels than those who had natural or vaginal delivery as well as overall general distress, controlling for premorbid mental health, maternal age, education, primiparity, and medical complication in newborn. Women who underwent unplanned cesarean also had higher levels of childbirth-related PTSD symptoms excluding those with vaginal instrumental. The risk for endorsing psychiatric symptoms reflecting clinically relevant cases increased by twofold following unplanned cesarean and was threefold for probable childbirth-related PTSD. Maternal well-being following childbirth is associated with the experienced mode of delivery. Increasing awareness in routine care of the implications of operative delivery and obstetric interventions in delivery on a woman's mental health is needed. Screening at-risk women could improve the quality of care and prevent enduring symptoms. Research is warranted on the psychological and biological factors implicated in the mode of delivery and their role in postpartum adjustment.

Maternal adverse childhood experiences, mental health, and child behaviour at age 3: The all our families community cohort study

Links between adverse childhood experiences (ACEs) and threats to health and well-being later in life are well established. The current study extends those findings into younger populations of pregnant women and their children; investigating how ACEs relates to maternal postpartum well-being, coping, and parenting, as well as child outcomes. Participants included 1994 mothers and children from the All Our Families community-based cohort in Alberta, Canada, followed from pregnancy (from 2008 to 2011) until child age 3 years. The sample is representative of the pregnant population in an urban Canadian centre. Mothers completed questionnaires on ACEs, postpartum mental health, as well as parenting morale, efficacy, coping, and personality. Child outcomes included internalizing and externalizing behavior, as well as temperament. Approximately 62% of participants experienced at least one ACE; 25% experienced 3 or more ACEs. The presence of 3 or more ACEs was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms, lower optimism and higher neuroticism, and lower reported parenting morale. In children, 3 or more maternal ACEs was associated with higher levels of internalizing (e.g., anxiety) and externalizing difficulties (aggression and hyperactivity), as well as temperament (surgency and negative affectivity). Cumulative maternal ACEs are associated with postpartum mental health and parenting morale, as well as maladaptive coping strategies. The demonstrated downstream consequences of maternal ACEs for child outcomes suggests that early intervention strategies and community resources to improve life course outcomes for parents and children are critical for breaking intergenerational continuities of risk.

Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China\u2019s one-child policy

BackgroundThe Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China’s one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China.MethodsA concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%.ResultsCompared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75).ConclusionCMC is the optimal service for low-risk primiparous women under China’s one-child policy, and is worthwhile for a general implementation across China.

S143. Steroid Hormone Analysis of Retrospective Maternal Hair and Newborn Nail Samples Indicate Effects of Prenatal Stress on Postpartum Well-being of Mother and Offspring

S143. Steroid Hormone Analysis of Retrospective Maternal Hair and Newborn Nail Samples Indicate Effects of Prenatal Stress on Postpartum Well-being of Mother and Offspring

Is there A Relationship between route of delivery, perinatal characteristics, and neonatal outcome in preterm birth?

Preterm birth is one of the most challenging problems in obstetric care and it is closely related to perinatal mortality and morbidity. The aim of the current study was to document our experience with preterm births and to analyze the association between perinatal variables and clinical outcomes. In this retrospective study, data were derived from the medical records of 785 singleton preterm births delivered in the obstetrics and gynecology department of our institution. Variables under investigation were maternal and gestational ages, fetal gender, route of delivery (vaginal vs. cesarean section [C/S]), causes of preterm birth, birth weight, placental weight, umbilical cord length, and Apgar scores at the 1st and 5th min. Pregnant women with advanced age (≥35 years) were more likely to undergo C/S (P < 0.001). Apgar score at the 1st and 5th min was influenced significantly by gestational age (P < 0.001), newborn birth weight (P < 0.001), placental weight (P < 0.001), and umbilical cord length (P < 0.001). Infants delivered due to antepartum fetal distress indication had remarkably lower Apgar scores at the 1st min and the birth weight seemed to be positively correlated with Apgar scores at both 1st (P < 0.001) and 5th min (P < 0.001). Apgar scores both at the 1st and 5th min were positively correlated with placental weight (R: 0.239 and 0.231, respectively, and P < 0.001 for both) and length of umbilical cord (R:0.228 and 0.211, respectively, and P < 0.001 for both). Advanced age pregnancies have higher C/S rates, but Apgar scores are significantly correlated with infant characteristics. Umbilical cord length and placental weight might be the new add-on predictors of postpartum well-being in premature infants.

Infant's sex, birth control policy and postpartum well-being: a prospective cohort study in Shanghai, China

ObjectivesThe majority of Chinese families were under either one-child or two-child birth control policy status from 2001 to 2015. We explore the association between an infant's sex and the mother's...

Prenatal Education and Postpartum Well-being

Background: Postpartum adjustment to the first-time parents is a great challenge in life. Failure to adjust and adapt in the early period of postpartum could lead to a more serious psychological disorders in the mothers as well as the fathers. Therefore, this study aimed to review the effectiveness of prenatal education as an early intervention toward postpartum adjustment and psychological well-being among the parents. Methods: An online electronic database searched was conducted and the relevant studies were selected and included based on the selection criteria. Result: Six studies were included in this review, however no consistent results were found in the studies. Three of the studies reported significant differences between the intervention and standard care groups. One of the study indicate a significant difference of the intervention in the prenatal period but no differences during the postpartum period. Studies which focused on specific psychological issues in the postpartum period would show a more significant result if the issues were presented during prenatal intervention. Conclusion: Prenatal education had different level of effectiveness in the postpartum adjustment and psychological well-being of a parent. The early intervention aimed at specific psychological issues during the postpartum period would yield a more effective result as compared to a more general postpartum adjustment issues. There were no standardized prenatal education program for the expecting parents but most of the studies structured the education programs according to their targeted needs of the study.

The ups and downs of early mothering

Introduction: The maternal experience of having a young infant is often viewed through a negative lens focused on psychological distress due, in part, to a historical focus on identifying threats to prenatal, perinatal and postpartum well-being of women and infants. This report examines maternal appraisal of both positive and negative experiences during and after pregnancy and introduces a new scale that assesses both uplifts and hassles that are specific to early motherhood.Methods: The sample included 136 women who began study participation during pregnancy and completed an existing scale designed to evaluate pregnancy-specific hassles and uplifts. When infants were 6 months old, participants completed the newly developed Maternal Experience Scale (MES) along with questionnaires related to anxiety, depression, attachment, parenting stress and infant temperament characteristics.Results: In general, women with 6-month-old infants rated their maternal experiences far more positively than negatively. MES hassles and uplift scores reflected both convergent and discriminant validity with general measures of psychological well-being and parent-specific measures. Appraisal of the pregnancy experience significantly predicted appraisal of early motherhood for hassles, uplifts and a composite score reflecting emotional valence. Women became relatively more uplifted and less hassled from pregnancy to 6-month postpartum; this was particularly true for multiparous women.Discussion: The maternal perception of motherhood corresponds to her perception of pregnancy. The MES provides a balanced view of motherhood by including maternal appraisal of the uplifting aspects of caring for an infant.

The HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year): design of a large prospective cohort study.

BackgroundThe HAPPY study is a large prospective longitudinal cohort study in which pregnant women (N ≈ 2,500) are followed during the entire pregnancy and the whole first year postpartum. The study collects a substantial amount of psychological and physiological data investigating all kinds of determinants that might interfere with general well-being during pregnancy and postpartum, with special attention to the effect of maternal mood, pregnancy-related somatic symptoms (including nausea and vomiting (NVP) and carpal tunnel syndrome (CTS) symptoms), thyroid function, and human chorionic gonadotropin (HCG) on pregnancy outcome of mother and foetus.Methods/designDuring pregnancy, participants receive questionnaires at 12, 22 and 32 weeks of gestation. Apart from a previous obstetric history, demographic features, distress symptoms, and pregnancy-related somatic symptoms are assessed. Furthermore, obstetrical data of the obstetric record form and ultrasound data are collected during pregnancy. At 12 and 30 weeks, thyroid function is assessed by blood analysis of thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibodies (TPO-Ab), as well as HCG. Also, depression is assessed with special focus on the two key symptoms: depressed mood and anhedonia. After childbirth, cord blood, neonatal heel screening results and all obstetrical data with regard to start of labour, mode of delivery and complications are collected. Moreover, mothers receive questionnaires at one week, six weeks, four, eight, and twelve months postpartum, to investigate recovery after pregnancy and delivery, including postpartum mood changes, emotional distress, feeding and development of the newborn.DiscussionThe key strength of this large prospective cohort study is the holistic (multifactorial) approach on perinatal well-being combined with a longitudinal design with measurements during all trimesters of pregnancy and the whole first year postpartum, taking into account two physiological possible markers of complaints and symptoms throughout gestation: thyroid function and HCG. The HAPPY study is among the first to investigate within one design physiological and psychological aspects of NVP and CTS symptoms during pregnancy. Finally, the concept of anhedonia and depressed mood as two distinct aspects of depression and its possible relation on obstetric outcome, breastfeeding, and postpartum well-being will be studied.

Translation and validation of the German version of the Mother-Generated Index and its application during the postnatal period

Objectivethe Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum. Designprospective two-stage survey. Settingtwo rural hospitals in the south of Germany and in the north of Switzerland. Participantsall women giving birth between 1st October and 15th December 2012 with sufficient knowledge of German and whose babies were not referred to a neonatal care unit; 226 women were eligible to participate. Measurement instrumentstwo questionnaires including questions relating to socio-demographic factors and perinatal care, and incorporating the MGI, the Hospital Anxiety and Depression Scale (HADS) and the Postnatal Morbidity Index (PMI). All instruments were subjected to forward and back translation and pilot-tested; the first questionnaire was then administered in the first two days after birth and the second six weeks post partum. Parametric and non-parametric tests were computed using SPSS. Findings129 surveys were returned an average of three days after birth and 83 after seven weeks. Higher postnatal quality of life showed a significant correlation with a lower anxiety and depression score (p<0.01), fewer maternal physical complaints (p<0.05) and more favourable baby adjective scores (p<0.05) after birth. Significant associations were found between MGI scores and sufficient help (p=0.03) as well as ability to cope at home (p<0.01). MGI scores three days and seven weeks after birth correlated highly significantly and positively (p<0.001). Key conclusionsconvergent validity of the MGI with the HADS and the PMI suggests that the German version of the MGI is a valid indicator of physical and emotional post partum well-being. Implication for practicethe German version of the MGI can be used in the post partum period to identify women whose quality of life is impaired during the first days after birth, in order to initiate extended midwifery care and referral if necessary.

Effect of music therapy during vaginal delivery on postpartum pain relief and mental health

BackgroundChildbirth is an important experience in a woman's life, and unfavorable birth experiences have been shown to negatively impact postpartum maternal health. Aim of this study was to evaluate the effects of music therapy on postpartum pain, anxiety level, satisfaction and early pospartum depression rate. MethodsTotally 161 primiparous women were recruited and randomized either music group (n=80) or a control group (n=81). Women in the music group listened to self-selected music during labor. Postpartum pain intensity, anxiety level and satisfaction rate were measured using the visual analog scale (VAS), postpartum depression rate was assessed with Edinburg Postpartum Depression Scale (EPDS) at postpartum day one and day eight. ResultsMothers in the music therapy group had a lower level of postpartum pain and anxiety than the control group and it was statistically significant at all time intervals (1, 4, 8, 16 and 24h, p<0.001). A significant difference was observed between the two groups in terms of satisfaction rate (p<0.001) and postpartum depression rate at postpartum day one and day eight (p<0.05). LimitationsWe only measured the effect of music therapy on early postpartum depression rate. Effect of music on late postpartum depression rate should be investigated in future. ConclusionsUsing music therapy during labor decreased postpartum anxiety and pain, increased the satisfaction with childbirth and reduced early postpartum depression rate. Music therapy can be clinically recommended as an alternative, safe, easy and enjoyable nonpharmacological method for postpartum well-being.

In search of health: quality of life among postpartum Palestinian women

Objectives: The postpartum period is a very important period for the health of the mother and the newborn. Despite its importance, research on this period is limited and tends to be more focused on biomedical aspects of the postpartum period. In the Occupied Palestinian Territory, little is known regarding women’s postpartum wellbeing. This study utilizes the Maternal Postpartum Quality-of-Life instrument to assess Palestinian women’s postpartum quality of life and the factors associated with variations in their quality-of-life scores. Methods: A cross-sectional survey utilizing the adapted Maternal Postpartum Quality-of-Life Questionnaire was completed in the Occupied Palestinian Territory with a final sample size of 1020 women. Results: The mean overall quality-of-life score for the sample was 21.53 (maximum = 30), suggesting that women are slightly satisfied with their lives in the postpartum period. Main variations in quality-of-life scores were associated with regional district, refugee status, the loss of a relative due to Israeli occupation violence, standard of living and pregnancy wantedness. Conclusion: The results of this study highlight the diversity and complexity of the social context, in particular the region where women live, and the issue of pregnancy wantedness in postpartum quality of life. They also call into question the services currently offered to postpartum women.

The role of family and friends in providing social support towards enhancing the wellbeing of postpartum women: A Systematic Review

Review Objective: The objectives of this systematic review are: To evaluate the impact of social support provided by family and friends on the wellbeing of postpartum women. To identify and describe the role of family and friends in providing social support to mothers in the postpartum period. To identify and describe the various types of social support provided by family and friends. Review Questions: What is the impact of social support from family and friends on enhancing the wellbeing of postpartum women? Types of Participants: This component of the review will consider studies that include women in their postpartum period. Study participants include mothers within a 1 year postpartum period, with any number of children. Mothers who have co-existing morbidities will be excluded. Types of Interventions/Phenomena of Interest: Quantitative: This component of the review will consider studies that include the following intervention i.e. support from family and/or friends. Support from health care professionals will not be considered. As social support is often measured using a scale, the comparison will be made between the higher and lower scores and their respective relationship with the outcome measures. Social support may be measured in terms of frequency of family and friends providing help with the baby and household chores, as well as perceived level of support from friends and family. Qualitative: This component of the review will consider studies that include the following phenomena of interest, the experiences of social support from family and friends to postpartum women. Types of Outcome Measures: Maternal Self esteem in postpartum women Maternal stress levels in postpartum women Maternal Mental Health in postpartum women Maternal Adaptation in postpartum women Maternal Adaptation in postpartum women Wellness and wellbeing in postpartum women Breast feeding rates in postpartum women Infant care

Female Relatives or Friends Trained as Labor Doulas: Outcomes at 6 to 8 Weeks Postpartum

Data collected on more than 12,000 women in 15 randomized controlled trials provide robust evidence of the beneficial effects of doula support on medical outcomes to childbirth. The objective of this paper was to examine the association between doula support and maternal perceptions of the infant, self, and support from others at 6 to 8 weeks postpartum. The doula was a minimally trained close female relative or friend. Six hundred low-risk, nulliparous women were enrolled in the original clinical trial and randomized to doula support (n = 300) or standard care (n = 300). The mother-to-be and her doula attended two 2-hour classes about providing nonmedical, continuous support to laboring women. For the secondary study, presented here, research participants (N = 494) were interviewed by telephone using a 42-item questionnaire. Overall, when doula-supported mothers (n = 229) were compared with mothers who received standard care (n = 265), they were more likely to report positive prenatal expectations about childbirth and positive perceptions of their infants, support from others, and self-worth. Doula-supported mothers were also most likely to have breastfed and to have been very satisfied with the care they received at the hospital. Labor support by a minimally trained female friend or relative, selected by the mother-to-be, enhances the postpartum well-being of nulliparous mothers and their infants, and is a low-cost alternative to professional doulas.

Physical Activity and Postpartum Well-Being

Objective: To describe reported patterns of postpartum physical activity and to identify benefits or risks associated with postpartum physical activity at 6weeks postpartum. DesignSecondary analysis of longitudinal data collected prenatally and postpartum in a study of obstetric outcomes at a midwestern tertiary-care center and its ambulatory satellite and hospital clinics. ParticipantsOne thousand three women completed a questionnaire at the ό-week postpartum clinic visit. Mean age was 29.7years, and mean education level was 15.3years. Variables of InterestParticipation in vigorous exercise, change in postpartum activity level, postpartum weight retention, infant feeding method, maternal postpartum adaptation, and participation in activities for fun. ResultsNearly 35% reported doing vigorous exercise with a modal frequency of three times per week. More active women had retained significantly less weight (8.6lb [3.9kg]) than their less active counterparts (11.3lb [5.1kg]). Vigorous exercisers demonstrated a consistent pattern of better scores on measures of postpartum adaptation and were more likely than nonexercisers to participate in fun activities, such as socializing, hobbies, and entertainment. Breastfeeding was not adversely affected by vigorous exercise. ConclusionsThese exploratory results indicate that physical and psychologic benefits may accrue to postpartum women who are able to exercise vigorously and avoid decreasing their usual level of activity. A prospective randomized test of this relationship is warranted. Although positive outcomes of physical activity have been demonstrated in the population at large, exercise has rarely been an element in postpartum care plans. Nurses who care for women after childbirth should assess women’s exercise goals and support them in their desired activities.

Confinement in nulliparous women in the Netherlands: Subjective experiences related to actual events and to post-partum well-being

Abstract Subjective delivery experiences, obstetrical outcomes and post-partum well-being were studied in 170 nulliparous women who participated in a prospective study on the transition to parenthood. All of the women initially received antenatal care by midwives. Women who gave birth at home and those who gave birth in hospital voluntarily without referral did not differ either with regard to objective outcomes or subjective delivery experiences. Negative experiences were related to referrals during labour; other subjective experiences seemed to be related to the duration of the first and second stages of labour. Variables measured during pregnancy hardly predicted these experiences. Post-partum well-being was strongly related to well-being at the start of pregnancy, subjective experiences showing a minor predictive capacity of only 4%. As far as mode of delivery is concerned, the least well-being 6 weeks post-partum was found in women who had an instrumental delivery; low well-being at 34 weeks' gestati...