Postpartum Recovery Research Articles

Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery

Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery. To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended). In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations). This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.

Deconstructing Current Postpartum Recovery Research—The Need to Contextualize Patient-Reported Outcome Measures

Deconstructing Current Postpartum Recovery Research—The Need to Contextualize Patient-Reported Outcome Measures

A Randomized Controlled Trial of Liposomal Bupivacaine for Pain Following Obstetrical Laceration

(Am J Obstet Gynecol MFM. 2020;2:100115) Following a second-, third-, or fourth-degree laceration in a vaginal delivery, pain management is important. Correct pain management methods can positively impact the postpartum recovery period and the desire to decrease use of opioids has led to the search for long-acting non-opioid medications. Liposomal bupivacaine is bound by liposomes, allowing for a slow release of bupivacaine (and therefore prolonged analgesia). While studies exist referencing the effectiveness of bupivacaine as a postoperative pain management treatment, its use as a treatment following lacerations after vaginal delivery have yet to be documented. The primary aim of this study was to assess the effectiveness of liposomal bupivacaine as a pain control method following vaginal deliveries involving a second-, third-, or fourth-degree obstetric laceration on postpartum day (PPD) 3.

Ethnobotanical Study of Postnatal Medicinal Plants in the Ethnic Madurese in Bangkalan Regency, East Java, Indonesia

Postnatal period is a time for women to recover and take on new roles. Plants have an important role in the traditional posnatal care in many cultures around the world especially in rural areas. The use of medicinal plants is common among Madurese women especially to aid postpartum care. This research aimed to record the use of plants for postnatal care among the Madurese in Bangkalan Regency, East Java, Indonesia. Data were collected from local informants consisting of traditional birth attendants, herbal medicine makers, and herbal medicine sellers through open and semi-structured interviews. The data were analyzed quantitatively using the Use Value (UV), Family Use Value (FUV), and Index of Cultural Significance (ICS) parameters. There were 143 species of medicinal plants from 55 families identified as plants used for recovery during the postnatal period. Ginger is a plant that has the highest use value (1.84), followed by turmeric (1.81). There are five plant species which have very high ICS value. Ginger has the highest ICS value (168), followed by turmeric (132). The family with the highest FUV value was Zingiberaceae (0.79). Among the Madurese, medicinal plants are mostly used in multiherbal forms consisting of 2 to 30 plants. There are 13 kinds of concoctions used in postnatal care consisting of 8 multiherbal potions used orally and 5 herbs for external uses. Madurese women believe that the use of these herbs will speed up the postpartum recovery process and reduce postnatal diseases. This valuable knowledge should be continued to be applied by the young generation in order to maintain its existence and to conserve the plants used in this region.

Ethnobotanical study of plants used as food and for maternal health care by the Malays communities in Kampar Kiri Hulu, Riau, Indonesia

Abstract. Susandarini R, Khasanah U, Rosalia N. 2021. Ethnobotanical study of plants used as food and for maternal health care by the Malays communities in Kampar Kiri Hulu, Riau, Indonesia. Biodiversitas 22: 3111-3120. Studies to reveal the diversity of food plants on communities living in remote areas with limited access to the market are important as an effort in documenting the traditional knowledge. The same applies to the diversity of medicinal plants used in maternal health care for communities that have limited access to public health facilities. The documentation of ethnobotanical knowledge is not only for the purpose of developing the potential of these plants, but also could have an impact on their conservation in nature. This study aims to document the traditional knowledge on the diversity of food plants and medicinal plants used in maternal health care by Malays tribes living within the Bukit Rimbang Bukit Baling Wildlife Reserve, Kampar Kiri Hulu Subdistrict, Kampar District, Riau Province, Indonesia. The research was conducted in three villages by collecting data through interviews and followed by fieldwork to collect plant specimens for identification. Data on food plant diversity data were obtained from 20 informants, while data on the diversity and use of medicinal plants for maternal health care were obtained from 73 informants. The results showed that there were 76 species of food plants from 35 families. These food plants were used as secondary food ingredients, vegetables, fruit and spices with most of these plants were obtained from the yard of the house. Plants used for maternal health care identified from this study were 34 species from 26 families. These plants were used for various purposes during pregnancy, child delivery, postpartum recovery, and infant health care. The diversity of food plants and medicinal plants for maternal health care documented in this study showed the valuable role of plant resources in supporting daily needs and health care of the communities living in the fringe of forest area.

Perinatal depression.

Perinatal depression is a common and debilitating complication of pregnancy and childbirth. Recent studies have elucidated relationships between acute birth events on depression risk, and novel treatments for postpartum depression have been discovered and approved. This article reviews current understandings about birth events on depression, new screening standards, and novel treatments for postpartum depression. Pain, analgesia, and depression are complex traits that are inter-related during and after pregnancy. Certain individuals may benefit more than others from addressing pain and suffering around childbirth. Exposures to general anesthesia or postdural puncture headache are associated with postpartum depression symptoms, although a causal relationship is unlikely. Brexanolone, ketamine and its related compounds, and nonpharmacologic options offer new or alternative therapies for depression, although safety information for some of these treatments in pregnancy and lactation are needed. Maternal health bundles call for close attention to perinatal mental health screening with validated instruments, and for timely treatment referrals in the 'fourth trimester'. Clinical monitoring and timely treatment of depression in the perinatal and postpartum periods is critical for maternal postpartum health and recovery. Perinatal specialists and researchers should continue to focus on tailored treatments specific to this special population.

ANALYSIS OF THE QUALITY OF LIFE DYNAMICS OF WOMEN AFTER ABDOMINAL ACCOUCHEMENT IN THE POSTPARTUM PERIOD UNDER THE INFLUENCE OF THE PHYSICAL THERAPY PROGRAM

Резюме. Мета: визначення впливу розробленої програми фізичної терапії на динаміку якості життя жінок після абдомінального родорозрішення (кесарів розтин – КР) у післяпологовому періоді
 Методи. Обстежено 112 жінок після пологів. Групу порівняння склали 47 жінок, у яких пологи відбулись природним шляхом. Основну групу 1 склали 32 жінки після КР, які відновлювались самостійно. Основну групу 2 склали 33 жінки після КР, які проходили післяпологову реабілітацію впродовж 12 місяців. Розроблена програма включала: кінезітерапію, бандаж черевної порожнини, кінезіологічне тейпування, масаж живота та загальний; оздоровче харчування, психологічну релаксацію, освіту жінок. Визначення якості життя проводили за опитувальником SF-36 4 рази: у ранньому та пізньому післяпологовому періодах; через 6 та 12 місяців після пологів.
 Результати дослідження. Визначено, що у жінок після пологів знизились показники фізичних та психічних компонентів якості життя. У ранньому післяпологовому періоді жінки після КР мали гірші показники фізичного та рольового функціонування, загального здоров’я, життєздатності за SF-36 порівняно із жінками після родорозрішення природним шляхом (р<0,05). Застосування засобів фізичної терапії дозволило до кінця пізнього пологового періоду жінкам після КР за всіма досліджуваними параметрами досягнути якості життя жінок групи порівняння (р>0,05). Жінки, які перенесли КР, але відновлювались самостійно, за більшістю критеріїв якості життя (крім соціального функціонування), змогли досягнути рівнів жінок, що народжували природним шляхом, тільки через рік.
 Висновки. Засоби фізичної терапії доцільно призначати з першого дня післяпологового періоду з метою покращення якості життя і, відповідно, післяпологового відновлення жінок та швидкого повернення їх до повноцінного функціонування.

Bridging the postpartum gap: best practices for training of obstetrical patient navigators

The postpartum period represents a critical window of opportunity to improve maternal short- and long-term health, including optimizing postpartum recovery, providing effective contraception, caring for mood disorders, managing weight, supporting lactation, initiating preventive care, and promoting cardiometabolic health. However, inadequate postpartum care, especially for individuals facing social and structural barriers, is common in the United States and contributes to suboptimal health outcomes with lasting consequences. Patient navigation is a patient-centered intervention that uses trained personnel to identify financial, cultural, logistical, and educational obstacles to effective healthcare and to mitigate these barriers to facilitate comprehensive and timely access to needed health services. Given the emerging evidence suggesting that patient navigation may be a promising method to improve health among postpartum individuals, our team developed a postpartum patient navigator training guide to be used in the Navigating New Motherhood 2 and other obstetrical navigation programs. Navigating New Motherhood 2 is a randomized trial exploring whether patient navigation by a trained, lay postpartum navigator for individuals with a low income can improve health and patient-reported outcomes during and after the postpartum period. Hiring and training patient navigators without health professional degrees are integral components of initiating a navigation program. However, patient navigator training is highly variable, and no guideline regarding key elements in such a training program exists for obstetrics specifically. Thus, this paper aimed to describe the core principles, content, and rationale for each element in a comprehensive postpartum patient navigator training program. Training should be centered around the following 6 core elements: (1) principles of patient navigation; (2) knowledge of pregnancy and postpartum care; (3) health education and health promotion principles; (4) cultural sensitivity and health equity; (5) care coordination and community resources; and (6) electronic medical record systems. These core elements can serve as a basis for the development of adaptable curricula for several institutions and contexts. In addition, we offer recommendations for the implementation of a navigator training program. A curriculum with built-in flexibility to meet community and institutional needs may promote the effective and sustainable use of patient navigation in the postpartum context.

Traditional food taboos and practices during pregnancy, postpartum recovery, and infant care of Zulu women in northern KwaZulu-Natal

BackgroundTraditional practices and beliefs influence and support the behavior of women during pregnancy and childbirth in different parts of the world. Not much research has been conducted to examine whether and how cultural traditions continue to shape maternity experiences of Zulu women. The aim of this study is to establish the extent at which women in certain rural communities adhere to traditional food taboos and practices during pregnancy, postpartum recovery, and infants feeding, in comparison to what is recommended by health care workers.MethodsA survey was conducted in the rural northern KwaZulu-Natal between 2017 and 2020. A total of 140 women between the ages of 18 and 90 years were interviewed and they were chosen purposively based on their experiences in pregnancy, postpartum recovery, infant care, and their willingness to share the knowledge. Data were analyzed using descriptive statistics.ResultsMost (64%) of the participants said that they adhered to these cultural food taboos and practices. The most common foods avoided were certain fruits [mango, naartjie, orange, papaya, and peach], butternut, eggs, sweets (sugar, commercial juice, sweet food, and honey), chili, ice, and alcohol. The most recommended foods during pregnancy were leafy vegetables, fruits (except the avoided ones), liver, and fish. For postpartum recovery, women mostly consumed soft porridge, all fruits and vegetables, beetroot, and tea. Food not allowed for children younger than 2 years included meat, sugar and sweets, and chewable foods.ConclusionDifferences on food taboos and practices between participants who received formal education and those who did not received it were insignificant. The beliefs about the detrimental effects of some foods were not backed up by scientific research. Restriction of some orange/yellow colored fruits during pregnancy that are rich in vitamin A and/or C may affect daily requirements of these micronutrients, and the foods recommended during pregnancy and postpartum period would not provide all the essential nutrients required for successful pregnancy. However, some of the food taboos would protect women from unhealthy eating. Our findings provide a basis for developing culturally appropriate nutritional mediation programs for Zulu women with a view to provide effective nutritional counseling.

Traditional and biomedical maternal and neonatal care practices in a rural Indigenous population of the Bolivian Amazon

ABSTRACT In recent decades, Bolivia has expanded maternal and child health insurance coverage to improve access to prenatal and early life health care. Nationally, however, maternal and child health disparities persist along a rural-urban divide. Research is needed among rural populations to better understand local barriers to health care access and usage. Particularly among Indigenous populations, disparities may be compounded by differences in preferences for and access to traditional versus biomedical health care. We examined prenatal care and birth practices among Tsimane forager-farmers of El Beni, Bolivia. From 2012-2013, we interviewed 151 Tsimane mothers (0-35 months postpartum) from nine villages about birth and neonatal care practices, prenatal care, and pharmaceutical usage during labour and postpartum recovery. Results demonstrate local disparities in biomedical care usage by ease of access (e.g. proximity to market town, Spanish fluency), and maternal experience (e.g. parity and prior offspring death or miscarriage). While 59% of interviewed mothers had received at least one prenatal screening, services performed in screenings were limited. Nearly all women continue to birth at home with family assistance. Inconsistent access to health care services may be exacerbated by regional, generational, and educational disparities within the population.

Furosemide for Accelerated Recovery of Blood Pressure Postpartum in women with a hypertensive disorder of pregnancy: A Randomized Controlled Trial.

[Figure: see text].

532 Comparison of N-terminal pro-brain natriuretic peptide levels in healthy obese and non-obese pregnant women

NT-proBNP, a marker of ventricular dysfunction, varies by BMI outside of pregnancy with a lower threshold proposed for obesity. We sought to compare NT-proBNP levels between healthy obese and non-obese pregnant women. Prospective observational study of healthy pregnant women in the 3rd and 4th trimesters. Subjects were excluded if they had significant medical comorbidities or if their fetus had anomalies, growth restriction or aneuploidy. NT-proBNP was measured at 28 weeks(3TM), prior to delivery(PD), 1-2 days postpartum(IP), and 4-6 weeks postpartum(PP). LogNT-proBNP at these time points was analyzed using linear mixed effects models, including BMI< or ≥30, time, and time-by-BMI interactions with adjustment for hypertensive disorders of pregnancy (PIH) and race. 55 pregnant women (28 BMI≥30 and 27 BMI<30) enrolled. Obese women were more likely to develop PIH (50% vs 15%, p=0.010), be black (75% vs 29.6%, p=0.002), and have higher systolic blood pressure at all time points (p <0.05). Median NT-proBNP in pg/mL was 18 vs 26 at 3TM, 16 vs 43 at PD, 58 vs 63 at IP, and 33 vs 23 at PP for obese vs non-obese women (Figure 1). In linear mixed effects models, logNT-proBNP was significantly lower in obese women at 3TM (β=-0.89, 95%CI -1.51, -0.26) and PD (β=-1.05, 95%CI -1.72, -0.38) and trended lower IP (β=-0.52, 95%CI -1.16, 0.13; Table 1). The logNT-proBNP trends over time differed by BMI category, with higher values in obese women at both postpartum time points compared to the 3TM (IP β=1.24, 95% CI 0.75, 1.73); PP β=1.08, 95%CI 0.52, 1.63), but only IP for non-obese women (β=0.87, 95%CI 0.36, 1.38). Obese women have significantly lower NT-proBNP than non-obese women during pregnancy, but not postpartum. While NT-proBNP increases in the immediate postpartum period in obese and non-obese women, this increase persists to 4-6 weeks postpartum for obese women. These findings suggest that healthy obese pregnant women have lower baseline NT-proBNP levels than non-obese women, but that their cardiac recovery postpartum may be more prolonged.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Global survey of medicinal plants during lactation and postpartum recovery: Evolutionary perspectives and contemporary health implications

Ethnopharmacological relevanceCross-cultural comparison of plants used during lactation and the postpartum period offers insight into a largely overlooked area of ethnopharmacological research. Potential roles of phytochemicals in emerging models of interaction among immunity, inflammation, microbiome and nervous system effects on perinatal development have relevance for the life-long health of individuals and of populations in both traditional and contemporary contexts. Aim of the studyDelineate and interpret patterns of traditional and contemporary global use of medicinal plants ingested by mothers during the postpartum period relative to phytochemical activity on immune development and gastrointestinal microbiome of breastfed infants, and on maternal health. Materials and methodsPublished reviews and surveys on galactagogues and postpartum recovery practices plus ethnobotanical studies from around the world were used to identify and rank plants, and ascertain regional use patterns. Scientific literature for 20 most-cited plants based on frequency of publication was assessed for antimicrobial, antioxidant, anti-inflammatory, immunomodulatory, antidepressant, analgesic, galactagogic and safety properties. ResultsFrom compilation of 4418 use reports related to 1948 species, 105 plant taxa were recorded ≥7 times, with the most frequently cited species, Foeniculum vulgare, Trigonella foenum-graecum, Pimpinella anisum, Euphorbia hirta and Asparagus racemosus, 81, 64, 42, 40 and 38 times, respectively. Species and use vary globally, illustrated by the pattern of aromatic plants of culinary importance versus latex-producing plants utilized in North Africa/Middle East and Sub-Saharan Africa with opposing predominance. For 18/20 of the plants a risk/benefit perspective supports assessment that positive immunomodulation and related potential exceed any safety concerns. Published evidence does not support a lactation-enhancing effect for nearly all the most-cited plants while antidepressant data for the majority of plants are predominately limited to animal studies. ConclusionsWithin a biocultural context traditional postpartum plant use serves adaptive functions for the mother-infant dyad and contributes phytochemicals absent in most contemporary diets and patterns of ingestion, with potential impacts on allergic, inflammatory and other conditions. Polyphenolics and other phytochemicals are widely immunologically active, present in breast milk and predominately non-toxic. Systematic analysis of phytochemicals in human milk, infant lumen and plasma, and immunomodulatory studies that differentiate maternal ingestion during lactation from pregnancy, are needed. Potential herb-drug interaction and other adverse effects should remain central to obstetric advising, but unless a plant is specifically shown as harmful, considering potential contributions to health of individuals and populations, blanket advisories against postpartum herbal use during lactation appear empirically unwarranted.

Effect of spray-dried porcine plasma in peripartum sow feed on subsequent litter size

BackgroundNutritional strategies for sows designed to reduce peripartum stress are suggested to support postpartum recovery and productivity. Spray-dried plasma (SDP) in sow feed has been reported to benefit sow and litter performance. Stressed animals fed diets with SDP have a more efficient immune response supporting animal recovery and health. The objectives of the present study using 452 sows (147 parity 1 sows, 148 parity 2 sows) were to determine if 0, 0.5 or 2.5% spray-dried porcine plasma (SDPP) in peripartum feed provided from entry in maternity through day 5 of lactation affects sow productivity and serological immune and oxidation status markers around parturition. Post-weaning sow productivity parameters including litter size at the next parturition was evaluated, but peripartum diets were only provided during the first parturition.ResultsIn the first parturition, total born litter size was lower (P < 0.05) especially for sows allotted to the peripartum diet with 2.5% SDPP. Percentage of stillborn pigs decreased quadratically (P < 0.05) for sows fed 0.5% or 2.5% SDPP compared to 0% SDPP in peripartum feed and this result was not affected by total born litter size. Serum glutathione peroxidase activity linearly increased (P < 0.01) with increased dietary SDPP for both prepartum and postpartum sampling periods. In the next parturition, total born pigs from combined data of parity 1 and 2 sows linearly increased (P < 0.05) and live born pigs tended (P = 0.09) to linearly increase as level of SDPP increased and this result was not affected by total born litter size in the first parturition. The change in total and live born pigs from the first to the next parturition linearly (P < 0.01) increased as dietary SDPP increased for parity 1 and 2 sows.ConclusionsThe reduced percentage of stillborn pigs and increased litter size of parity 1 and 2 sows in the next parturition was independent of total born litter size in the first parturition suggesting SDPP in peripartum sow feed may have merit for reducing stillborn pigs and benefit litter size in the next parturition for parity 1 and parity 2 sows.

Regional anaesthesia for labour, operative vaginal delivery and caesarean delivery: a narrative review.

This narrative review discusses recent evidence surrounding the use of regional anaesthesia in the obstetric setting, including intrapartum techniques for labour and operative vaginal delivery, and caesarean delivery. Pudendal nerve blockade, ideally administered by an obstetrician, should be considered for operative vaginal delivery if neuraxial analgesia is contraindicated. Regional techniques are increasingly utilised in clinical practice for caesarean delivery to minimise opioid consumption, reduce pain, improve postpartum recovery and facilitate earlier discharge as part of enhanced recovery protocols. The evidence surrounding transversus abdominis plane and quadratus lumborum blockade supports their use when: long-acting neuraxial opioids cannot be administered due to contraindications; if emergency delivery necessitates general anaesthesia; or as a postoperative rescue technique. Current data suggest quadratus lumborum blockade is no more effective than transversus abdominis plane blockade after caesarean delivery. Transversus abdominis plane blockade, wound catheter insertion and single shot wound infiltration are all effective techniques for reducing postoperative opioid consumption, with transversus abdominis plane blockade favoured, followed by wound catheters and then wound infiltration. Ilio-inguinal and iliohypogastric, erector spinae plane and rectus sheath blockade all require further studies to determine their efficacy for caesarean delivery in the presence or absence of long-acting neuraxial opioids. Future studies are needed to: compare approaches for individual techniques; determine which combinations of techniques and dosing regimens result in optimal analgesic and recovery outcomes following delivery; and elucidate the populations that benefit most from regional anaesthesia in the obstetric setting.

Lived Experience of Participants of a Korean Medicine-Based Postpartum Program: A Protocol for a Qualitative Research Study

Background: The postpartum period is the most critical period in the mother’s and child’s lives, and integrative medical approaches, including Korean medicine, are preferred for promoting postpartum recovery and managing postpartum symptoms. The socially disadvantaged class is known to be more vulnerable to postpartum depression, obesity, and bleeding, and the National Medical Center is undertaking Korean medicine-based postpartum health management projects for the socially disadvantaged mothers. However, clinical evidence and research data on integrative medicine-based postpartum care to expand the scope of these postpartum programs to help these women are lacking. Aim: To investigate the barriers, benefits, and limitations of integrative medical postpartum health management programs for the socially disadvantaged mothers and investigate the experiences of this population. Methods: A qualitative research methodology is used, and a semi-structured, open-ended interview will be conducted. The interview will be conducted among 10 or fewer participants, with each interview session lasting for 60–120 min. Data will be analyzed using grounded theory framework proposed by Strauss and Corbin. Significance: This study will shed light on the users’ experiences and benefits, unmet needs, and limitations of Korean medicine-based postpartum management programs for the socially disadvantaged mothers. The findings will be useful for the improvement of postpartum care programs and used as foundational data for the protocols of quantitative studies in the future.

Exploratory Study on Family Leisure Constraints of the Twochild Family in China

Driven by the two-child policy, there are more and more two-child families in China. The purpose of this research was to examine the leisure constraints of these families in Chinese urban areas. Based on interviews with the parents from 12 families and the leisure constraint theory, the main factors are identified. First, intrapersonal constraints, which include personal physical constraints (such as insufficient postpartum recovery) and psychological constraints(such as stress). Second, interpersonal constraints, which mainly come from family members (such as family support) and friends (such as narrowing social circles). Third, structural constraints, like family income, climate conditions, facilities, free time for leisure. Besides, the study also discovered a new type of constraint-cultural constraints, which is embodied in familism. This factor is close to the other three constraints and affects them. Based on this, the research proposed a new hierarchical model of leisure constraints. Finally, the article puts forward some suggestions for future research on family leisure under the influence of the two-child policy.

Effects of yoga on the intervention of levator ani hiatus in postpartum women: a prospective study.

[Purpose] This study aimed to explore the application value of yoga intervention in early postpartum recovery of the levator ani muscle hiatus (LAH) area. [Participants and Methods] Females in natural labor from May 2020 to November 2020 in the Third People’s Hospital of Sun Yat-sen University Ultrasound Research Center were prospectively included for a pelvic ultrasound examination. The control group received no intervention. The experimental group received 60-min yoga once a week from week 1 to week 12 postpartum. A pelvic ultrasound examination was performed on the week 6 and week 12 postpartum. The LAH area was measured at rest, during contraction and Valsalva maneuver. [Results] A total of 128 participants who met the inclusion criteria were selected and randomly assigned to the control group (n=66) and the experimental group (n=62) in pre and post intervention design. No significant differences were found in age, parity, body mass index, and fetal weight between the control and experimental groups. Further, no significant difference was observed in the LAH area between the control and experimental groups at rest, during contraction and Valsalva maneuver on the week 6 postpartum. However, the LAH area in experimental group significantly reduced at rest, during contraction and Valsalva maneuver on the week 12 postpartum. The differences of LAH area (date week 6 minus date week 12) in the control group at rest, during contraction and Valsalva maneuver were 0.12 ± 3.12 cm2, 0.80 ± 2.29 cm2, and 0.80 ± 4.22 cm2, while in the control these were 1.95 ± 3.41 cm2, 1.39 ± 1.91 cm2, and 3.81 ± 5.49 cm2, respectively. Compared with control group, the differences of LAH area significantly increased in experimental group at rest and during Valsalva maneuver. [Conclusion] Yoga intervention can help in the recovery of LAH.

Topic modelling and opinion mining of user generated content on the internet using machine learning: An analysis of postpartum care centres in Shanghai

In order to reach a compromise between adhering to the traditional culture and embracing the modern lifestyle, more and more Asian moms are heading towards postpartum care centres for postpartum recovery. However, research regarding the quality of care of these postpartum care centres is nearly missing from the literature. This paper investigated the status quo of the postpartum care centres in Shanghai, China from mothers’ perspectives by means of analysing the 34280 pairs of ratings and reviews posted by postpartum care centre customers on the internet with machine learning and text mining. Results show that the mothers are generally satisfied with the studied care centres. Meanwhile, the 13 major topics in the customer online reviews were identified, which provide an overview of the interaction between a mother and a care centre. In addition, weight of topic analysis suggests that the studied care centres can further improve in the areas of support team, environment, and facility.

Association between Antenatal Vulvovaginitis and Birth-Related Perineal Trauma

Statement of the Problem Birth-related perineal trauma commonly affects women who give birth vaginally and adversely affects postpartum recovery. In general, women who had diagnostic of antenatal vulvovaginitis are more likely to have these injuries; however there is no robust evidence that support such association. Objective: To identify whether antenatal vulvovaginitis is associated with perineal trauma in normal birth. Method: A cross-sectional study with 100 primiparous women, at least 18 years of age, who gave birth to a single, live, full-term fetus in vertex presentation at a midwife-led birth center. Data were collected from the antenatal and birth record and by structured interview of the participants. Results: mean of participants’ age 23.1 years (SD: 4.8), 16% of labor induced with misoprostol, 54% of synthetic oxytocin infusion in labor, 83% of lithotomy birth position, 98% of “hands on” maneuver, 75% of perineal trauma (70.7% first degree and 29.3% second degree laceration), 54% of antenatal vulvovaginitis (42% treated in the antenatal period), mean of newborn birth weight, head and thoracic circumference: 3.102g (SD: 385), 33.3 cm (SD: 1.2) and 32.2 cm (SD: 1.7), respectively. Only the variables antenatal vulvovaginites and newborn birth weight and head circumference were associated with perineal trauma. Women who had antenatal vulvovaginitis were 4.7 more likely to have perineal trauma compared to those without vulvovaginitis, regardless of the newborn birth weight and head circumference. Each increase of 100g in the newborn’s birth weight and 1cm in the head circumference increased by 21% and 51% the chance of maternal perineal trauma in childbirth, respectively. There was no association between treating antenatal vulvovaginitis and perineal trauma or antenatal vulvovaginitis and perineal trauma severity. Conclusion: It is necessary to prevent antenatal vulvovaginites, as well as to offer special perineal care to women who had antenatal vulvovaginitis and to those who have had or is pregnant with a large baby.