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PubMedDate not supplied

Early postpartum discharge: implications for HMOs.

Early postpartum discharge, defined as discharge of the postpartum mother and newborn infant from the hospital 12-24 hours after delivery, has been shown to be a safe, well-accepted, economical alternative to the traditional hospital stay. Because of consumer pressure to treat pregnancy and birth as a healthy rather than an illness state, the current trend is toward decreased medical intervention and increased self-care for the postpartum mother and infant. Many HMOs have instituted such programs, and others may want to consider this consumer preference and implement early postpartum discharge programs to increase consumer satisfaction and, at the same time, decrease health care costs. This literature review summarizes various early discharge programs including preadmission criteria, early discharge criteria, procedures, complications, consumer satisfaction, staff training, and cost effectiveness.

Adolescent↗
PubMed2005

Predictors of smoking cessation in pregnancy and maintenance postpartum in low-income women.

OBJECTIVE: To describe factors associated with smoking status of low-income women during pregnancy and postpartum. METHODS: Data from a randomized clinical trial were used to conduct separate analyses on 327 women who smoked at baseline (time at enrollment) and for whom smoking status was available at delivery, and on 109 women who reported not smoking at delivery (quit spontaneously or after study enrollment) and for whom smoking status was available at 6-months postpartum. Salivary cotinine was used to assess the accuracy of self-reported smoking status for the sample as a whole. Data were collected between May 1997 and November 2000. RESULTS: 18% of the 327 baseline smokers stopped smoking before delivery. Cessation was less likely in older women, those reporting Medicaid coverage (vs. commercial or no insurance), who were at a later week of pregnancy at baseline, were more addicted, had a husband/partner who smoked, and did not receive the study intervention. 37% of the 109 women who reported not smoking at delivery maintained abstinence at 6-months postpartum. Factors associated with abstinence were later week of pregnancy at baseline and quitting spontaneously with pregnancy, while women who lived with a smoker were less likely to report abstinence. Spontaneous quitters were less likely to relapse by 6 months postpartum than women who quit smoking later in pregnancy. CONCLUSIONS: Partner participation in smoking cessation programs for pregnant and postpartum women merits exploration. Lower relapse rates among spontaneous quitters indicate a need to foster an environment that encourages quitting at pregnancy.

Adult↗
PubMed2004

Promoting urinary continence in postpartum women: 12-month follow-up data from a randomised controlled trial.

A physiotherapist-delivered continence promotion program was recently implemented with postpartum women in Australia. A previous randomised controlled trial demonstrated that the program was effective in promoting pelvic floor exercises and continence at 3 months postpartum. The present study compares pelvic floor exercise frequency and continence status for women in the intervention and 'usual care' control groups at 12 months postpartum. While there was no significant difference in continence status, women in the intervention group were more likely than those in the control group to be practising pelvic floor exercises at adequate frequencies. In turn, continued adherence to pelvic floor exercises at 12 months was predictive of continence at that time. Potential strategies for enhancing women's adherence to pelvic floor exercise regimes during and beyond the postpartum year are discussed.

Adolescent↗
PubMedDate not supplied

Postpartum family planning and health needs of women of low income in Istanbul.

This study was designed to learn what types of postpartum health and family planning services are most appropriate for couples with low incomes living in Istanbul, Turkey. The methods used included focus groups, site visits, questionnaires for postpartum women, and a self-administered questionnaire for health-care providers. By five months postpartum, 86 percent of the women surveyed were using some method of family planning. Many couples used withdrawal, starting immediately upon resumption of intercourse after childbirth, intending to use a medical method after menses resumed. However, only 34 percent of users had begun to use a medical method by five months after childbirth. The health facilities visited provide little information and counseling about the postpartum period. Women said that they wanted information on infant care, breast-feeding, and family planning, either before becoming pregnant or while they are pregnant. Most women prefer that postpartum services address the needs of the whole family, not only those of the baby or the mother. Recommendations for the timing, mode, and content of postpartum health and family planning services are made based on the study's findings.

Contraception Behavior↗
PubMed1992

A comparison study of treated and untreated pregnant and postpartum cocaine-abusing women.

The purpose of this study was to determine whether untreated pregnant and recently post-partum cocaine-abusing women could be differentiated from women who enrolled in drug treatment programs. The experimental sample was selected from women referred to the Georgia Addiction, Pregnancy, and Parenting Project, an intervention program for pregnant and postpartum addicted women, between January 1987 and January 1988 (n = 45). The comparison group was randomly selected from women who were admitted to two (2) day treatment programs during the same time period (n = 50). Groups were compared using the Addiction Severity Index (ASI) and the Psychiatric Symptom Checklist-90 (SCL-90). Results indicated that untreated women were less impaired socially and exhibited fewer symptoms of psychiatric distress. These findings confirm the commonly held belief that the severity of psychosocial distress may be an important motivating factor in the decision to enter drug treatment. Alternatively, the lack of gender-sensitive program components, such as childcare, and the social stigma attached to drug use in pregnancy may also account for the reluctance of pregnant and post-partum mothers to seek drug treatment. Implications for the development of intervention and treatment programs for women are discussed.

Adult↗
PubMed2001

Improving the number of mothers breastfeeding in the postpartum period.

The objective of this study was to review an experience at Jackson Memorial Hospital, Miami, Florida that has resulted in an increase in the percentage of mothers breastfeeding at postpartum discharge. Data was obtained from postpartum interviews in 1993, which provided the percentage of mothers breastfeeding at discharge. Staff members and personnel involved in the care of postpartum mothers and babies were educated about breastfeeding, and rounds were made to problem solve and reinforce. Patients who elected to breastfeed from April to September 1994 were followed for a duration of 3 months. These early efforts led to the implementation of a Baby-Friendly initiative and intent in 1996 and the formation of a mother-baby unit in 1997. Ten percent of mothers were breastfeeding at postpartum discharge. After implementing a program in 1994, 41% were breastfeeding at discharge. There was a decline in the number of mothers breastfeeding during the postpartum period from discharge. At 3 days postpartum, 80% of patients were breastfeeding followed by 64%, 37%, and 17% at 2 weeks, 6 weeks, and 3 months from discharge, respectively. The percentage of mothers opting not to breastfeed at 3 days after discharge was 20%, followed by 12% from 3 days to 2 weeks postdischarge, by 21% 2 weeks to 6 weeks postdischarge, and finally by 16% from 6 weeks to 3 months postdischarge. In 1998, 70% of patients were breastfeeding, and in 1999, 71% of patients were breastfeeding upon postpartum discharge. The data show that by implementing programs to promote breastfeeding, through education, encouragement, and reinforcement, one can increase the number of mothers who breastfeed at postpartum discharge. However, there is an inverse relationship between the duration of the postdischarge period and the number of mothers breastfeeding.

Journal Article↗
PubMed1990

The effect of breastfeeding promotion on the infertile postpartum period.

A new project is testing whether a breastfeeding promotion program will change breastfeeding behavior and the length of postpartum amenorrhea. The control group and 100 of the eventual 400 experimental subjects have been recruited. The program consists of workshops, prenatal care, maternity ward postpartum care, early home visits, and a breastfeeding outpatient clinic. Early results seem to indicate decreased use of pacifiers and foods and fluids other than breast milk by women in the study group.

Breast Feeding↗
PubMed1998

Adolescent satisfaction with postpartum contraception and body weight concerns.

PURPOSE: To explore factors that could be related to adolescents' satisfaction with postpartum contraceptives. METHODS: Three focus groups were conducted with a total of 22 adolescent mothers. The groups covered four content areas: feelings about birth control since becoming a mother, decision making about contraceptive use, factors that would influence contraceptive discontinuation, and the perceived side effects of the current contraceptive. Audiotapes from the groups were analyzed to identify major themes. RESULTS: Nineteen subjects received Depo-Provera when they were discharged after delivery and the majority reported that menstrual irregularities and weight gain were side effects. Two body weight-related themes were dominant: dissatisfaction with heavier than desired body weights and resignation about not returning to prepregnancy weights. CONCLUSIONS: Depo-Provera may be an effective contraceptive for adolescent mothers who are generally at high risk for rapid repeat pregnancy. This qualitative study suggests that contraceptive continuation may be enhanced with specific counselling to manage body weight concerns.

Adolescent↗
PubMedDate not supplied

From practice to midrange theory and back again: Beck's theory of postpartum depression.

This article presents a brief overview of theory as background for a more detailed discussion of midrange theory-its origins, the critical role for midrange theory in the development of nursing practice knowledge, and the criteria for evaluating midrange theory. We then chronicle Cheryl Tatano Beck's program of research on postpartum depression (PPD) and advance the thesis that her theory of PPD, titled Teetering on the Edge, is an exemplar of a substantive midrange nursing theory. We demonstrate Beck's progression from identification of a clinical problem to exploratory-descriptive research, to concept analysis and midrange theory development, and finally to the application and testing of the theory in the clinical setting. Through ongoing refinement and testing of her theory, Beck has increased its generalizability across various practice settings and continually identifies new issues for investigation. Beck's program of research on PPD exemplifies using nursing outcomes to build and test nursing practice knowledge.

Attitude to Health↗
PubMedDate not supplied

A public health nursing early intervention program for adolescent mothers: outcomes from pregnancy through 6 weeks postpartum.

BACKGROUND: Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing intervention programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. OBJECTIVE: To evaluate the effects of an early intervention program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. METHODS: Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). RESULTS: Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). CONCLUSIONS: The early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.

Adolescent↗
PubMedDate not supplied

Reclaiming normal life: mother's stages of recovery from drug use.

OBJECTIVE: Pilot study to describe the process and stages of pregnant and postpartum women's recovery from drug addiction. DESIGN: Naturalistic inquiry directed by the grounded theory approach of constant comparison and theoretical sampling, including individual interviews and a focus group. SETTING: A hospital-affiliated, nurse-directed comprehensive drug treatment program for pregnant and postpartum women. PARTICIPANTS: Fourteen pregnant and postpartum women enrolled in substance abuse treatment completed individual interviews, and 3 substance abuse counselors completed a focus group. MAIN OUTCOME MEASURES: Grounded theory analysis of the process and stages of addiction and recovery. RESULTS: Abstinence was short-lived unless supported by the long, intensive process of reconstructing an identity as a member of society. The basic process of recovery, "reclaiming normal life," consisted of four stages: "rescue or refuge," "no fun any more," "leaving drugs but not the life," and "building a life." An important transition point, "clearing up," was identified between the third and fourth stages. Nine dimensions of attitude changed across the stages. CONCLUSIONS: Nurses can assess women's stage of drug use or recovery, considering attitudes typical of each stage in nurse-patient interactions. Future research may enable tailoring of interventions to women's stages of addiction and recovery.

Adaptation, Psychological↗
PubMed1991

Energy balance and size and number of ovarian follicles detected by ultrasonography in early postpartum dairy cows.

Multiparous Holstein cows (n = 52) were fed one of six diets consisting of a totally mixed ration (corn silage, corn grain, soybean meal, dried distillers grains, and whole cottonseed) plus either alfalfa hay, alfalfa cubes, or bermuda-grass hay fed chopped as a component in the mixed ration or separate as long hay. Predicted energy balance was calculated from DM intake, milk yield and composition, and BW. On d 25 postpartum, ovarian status was programmed by injecting 25 mg of prostaglandin F2 alpha and treating cows for 15 d with an intravaginal device containing 1.9 g progesterone. Before d 25, number of class 1 follicles (3 to 5 mm; detected by ultrasonography) decreased with increasing days postpartum, and number of class 3 (10 to 15 mm) and class 4 (greater than 15 mm) follicles increased. The number of class 1 and 2 follicles (6 to 9 mm) decreased with increasing energy balance, and number of class 3 follicles increased with energy balance. Before d 25, predicted energy balance explained treatment differences in the number of follicles within each size class. After d 25, energy balance did not affect the average number of follicles per cow, but diet affected the number of follicles within each class. Predicted energy balance and dietary treatments influenced number of follicles at different times after calving. These results identify the importance of diet and energy balance to follicular and ovarian function in postpartum lactating dairy cows.

Animal Feed↗
PubMedDate not supplied

The importance of (early) folate status to primary and secondary coronary artery disease prevention.

Folate, methionine, betaine, choline, zinc and Vitamins B(12), B(6) and B(2) are involved in one-carbon metabolism, which includes S-adenosylmethionine (SAM) substrated methylation. Inadequate enzyme activities and imbalances of substrates and cofactors in one-carbon metabolism, together referred to as the 'methyldietary' constituents, may cause homocysteine and S-adenosylhomocysteine accumulation. Hyperhomocysteinemia is associated with many disorders including coronary artery disease (CAD). CAD at adult age is also associated with low birth weight-induced 'programming', which prepares for unfavorable postpartum conditions and carries the potential of transgenerational transmission. CAD risks of hyperhomocysteinemia and 'programming' might find a common biochemical basis in epigenetics, which, among others, operates via SAM-substrated methylation of DNA and histones. Folic acid-responsive global and locus-specific hypomethylation were found in hyperhomocysteinemia and CAD. Currently, there is no hard evidence that folic acid supplementation of CAD patients is beneficial or that improved folate status in pregnancy prevents CAD in the offspring at adult age. The folate RDA as derived from CAD primary prevention might require embracement of the assumption that 'what nutritional measures are best for CAD patients are most probably best for the general population'. We have no knowledge on the optimal 'methyldiet' balance on which our genome has become adapted during millions of years of evolution and on which our genome consequently functions best. More insight may derive from the study of methyldietary constituents and soft endpoints such as plasma homocysteine and gene methylation, in healthy, pregnant and non-pregnant, subjects and CAD patients and in populations with high and low CAD risks and those consuming diets more closely related to our ancient diet. Folic acid supplementation is obviously unnecessary at sufficient intake of naturally occurring folates, implying that continuing efforts should aim at meeting the recommendations by making the right choice of food products, that are either or not folate-enriched by genetic modification.

Adult↗