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At least 217 records · Page 12Linked to original sources
PubMed2001

A psychiatric epidemiological study of postpartum Chinese women.

OBJECTIVE: Epidemiological studies in the 1980s have suggested that depression is rare in the Chinese population and there is no postpartum depression among Chinese women. However, subsequent small-scale studies of postpartum depression in China have yielded contradictory and inconsistent findings. Furthermore, after two decades of profound socioeconomic transformation, depression may no longer be rare in the contemporary population. The authors conducted a psychiatric epidemiological study among postpartum Chinese women using rigorous methodology and a representative sample. METHOD: A total of 959 consecutive women were recruited at the antenatal clinic of a university hospital in Hong Kong. At 3 months postpartum, the prevalence and incidence rates of depression were measured with a two-phase design. The participants were first stratified by means of the 12-item General Health Questionnaire. Subsequently, all high scorers and 10% of low scorers were assessed with the nonpatient version of the Structured Clinical Interview for DSM-III-R. The 1-month and 3-month prevalence and incidence rates were estimated by using reverse weighting. RESULTS: The 1-month prevalence rates for major and minor depression were 5.5% and 4.7%, respectively. At 3 months, the corresponding prevalence rates were 6.1% and 5.1%. Together, 13.5% of the participants suffered from one or more forms of psychiatric disorder in the first 3 months postpartum. CONCLUSIONS: Postpartum depression is common among contemporary Chinese women. A universal postpartum depression-screening program would be useful for early detection. Our data suggest that depression may no longer be rare in the Chinese population.

Adult↗
PubMed2000

Smoking Relapse During Postpartum.

PURPOSE: While many women quit smoking when learning of their pregnancy, the majority relapses within one year of giving birth. This paper provides an integrative review of studies that assess the contributing factors to maternal smoking relapse within the first year of giving birth. The framework for this review is the relapse prevention model, which seeks to uncover the contributing factors, or high-risk situations, that lead to relapse. Additionally, this paper examines existing practice interventions aimed at reducing postpartum relapse and provides recommendations for best practice. CONCLUSIONS: Research evidence to date shows that two main factors are associated with smoking relapse among postpartum women: (1) their association with other smokers and (2) their choosing not to breastfeed. Since maternal smoking results in poor health outcomes for both mothers and children, relapse prevention is a health issue worthy of examination. Nurses can use this information in planning, implementing, and evaluating smoking prevention and cessation programs for pregnant and postpartum women.

Journal Article↗
PubMed1997

What do women want to know after childbirth?

BACKGROUND: Postpartum women have demonstrated a variety of health care concerns. This study, conducted in Washington state in 1991, investigated predictors of primiparas' and multiparas' desire to receive more information about 18 self-care and baby care topics at 7 weeks postpartum in relation to prenatal class attendance, short postpartum hospital stay, and other variables. METHODS: Data from 1161 women who completed a survey were analyzed. Percentages of women desiring more information on each topic were calculated stratified by parity; mean numbers of chosen health topics were calculated in relation to prenatal education, length of postpartum hospitalization, maternal age, education, social support, and type of delivery; and association between desire for more information on specific topics and length of postpartum hospitalization, maternal age, maternal education, and social support were calculated. RESULTS: Over three-fourths of women wanted more information on at least one topic, and the highest percentage wanted more information on exercise, diet, and nutrition; getting along with their other children; and recognizing infant illness. Primiparas and multiparas who desired more information were under 25 years of age and had low levels of social support; in addition, multiparas with unmet information needs had low education and short postpartum stays. Prenatal education was unrelated to postpartum desire for more information. CONCLUSION: Most postpartum women want self-care and baby care information, a need that is not completely met by prenatal or postpartum education. Postpartum follow-up programs with a strong educational component and special targeting of high-risk women may enable health caregivers to better address this need.

Adolescent↗
PubMed1993

Effects of maternal nutritional status and maternal energy supplementation on length of postpartum amenorrhea among Guatemalan women.

To investigate the extent to which better maternal nutrition leads to reduction in length of postpartum amenorrhea, multivariate-logistic and linear-regression analyses were applied to data on 339 mother-infant pairs from the longitudinal Guatemalan Four Village Study, 1969-1977. Maternal triceps skinfold thickness was negatively associated with length of amenorrhea when infant supplementation (a proxy for reduced suckling) was accounted for. However, its effect was small: amenorrhea was only 0.5 mo shorter among women at the 75th percentile than among those at the 25th, equivalent to less than even one additional child during the women's reproductive years. Maternal supplementation was not associated with length of amenorrhea when infant supplementation was controlled. This is in contrast to previous studies in which breast-feeding or infant supplementation was not controlled. These results suggest that infant, not maternal, supplementation influences length of postpartum amenorrhea, and that maternal nutritional status has minimal influence.

Amenorrhea↗
PubMed1994

Selective rubella vaccination programmes: a survey of districts in England and Wales.

A survey of district immunisation coordinators in the 183 health districts of England and Wales was carried out to assess the implementation of selective rubella vaccination programmes. The survey showed that school health services vaccinate schoolgirls against rubella in 161 (93%) of the 173 districts whose immunisation coordinators responded. The accuracy of data on vaccination coverage of schoolgirls is limited because districts interpret the numerator and denominator required by the Department of Health in different ways. Districts have also experienced problems in monitoring the uptake of vaccination through general practitioners. Comprehensive antenatal screening programmes for rubella immunity operate in 164 districts (95%), but few districts are auditing the postpartum vaccination of seronegative women. If child health computer records were maintained and updated until children left school, it would be possible to produce reliable data on the percentage of girls who had been vaccinated against rubella by the age of 14.

Adolescent↗
PubMed1998

Prevention of chickenpox in reproductive-age women: cost-effectiveness of routine prenatal screening with postpartum vaccination of susceptibles.

OBJECTIVE: To evaluate economic and clinical outcomes of a program of routine prenatal serotesting for varicella and postpartum vaccination of seronegative women. METHODS: An analytic cost-effectiveness model was constructed to compare the current strategy of no serotesting with 1) selective serotesting of pregnant women without a prior history of chickenpox and 2) serotesting of all pregnant women. In both serotesting strategies, seronegative women were vaccinated postpartum. The model followed a hypothetical cohort of 4 million women over 20 years. Costs and chickenpox disease outcomes during and outside of subsequent pregnancies were considered. The incremental cost-effectiveness (cost per adult chickenpox case prevented) of selective serotesting compared with the current strategy was measured. RESULTS: Compared to no testing, selective serotesting would prevent 43% (48,577 of 112,654) of adult chickenpox cases, save $21.8 million in discounted medical and work loss costs from the societal perspective, and cost $1126 per case prevented from the health payer's perspective (medical costs only). The model was sensitive to varicella seroprevalence and incidence of chickenpox among susceptible women but was relatively insensitive to the cost of serologic testing and vaccination. Compared with selective serotesting, the serotest-all strategy would prevent an additional 15,645 cases, at a societal cost of $7653 per additional case prevented. CONCLUSION: The selective serotesting strategy could prevent nearly half of chickenpox cases among this cohort and is cost-saving from the societal perspective. From the health payer's perspective, it compares favorably with other generally accepted preventive practices. It should be considered for prevention of chickenpox among women of childbearing age.

Adult↗
PubMed1997

Cervical cancer screening in a rural population of Zimbabwe.

OBJECTIVE: To review cervical cancer screening since its introduction to a rural district hospital in Zimbabwe. DESIGN: Retrospective, descriptive. SETTING: Rural district hospital. SUBJECTS: Data from 419 cervical smears performed on women who had cervical cancer screening as part of a routine post partum visit from 1994 to 1996 was available for analysis. MAIN OUTCOME MEASURE: Rates of abnormal cervical smears. RESULTS: The majority of the patients were of age 20 to 29 years (47.2%) and of low gravidity (Zero to three children) 62.6%). A total of 173 slides (41.3%) were normal. Of the abnormal smears, 158 (37%) had inflammation, and 65 cases (15.5%) demonstrated abnormal cytology of which 50 (12%) were low grade squamous epithelial lesions (atypia/CINI), and the remaining 15 (3.6%) high grade squamous intra-epithelial lesions (CIN II/III and carcinoma in situ). CONCLUSION: There was a high frequency of abnormal smears at this rural district hospital. Furthermore, there were problems in sampling the population at highest risk, shortages of supplies, technical problems in sampling and interpretation, and difficulties in follow up of patients. These problems are discussed including the confounding effect of the Human Immunodeficiency Virus.

Adult↗
PubMedDate not supplied

A new paradigm for postpartum care.

Shortened hospital stays have decreased women's access to postpartum nursing care. Providers and payers together must address clinical and cost issues to develop a model of maternity care that covers the postpartum period. A short-stay maternity program was developed in 1989 by Professional Nurse Associates, Inc., in conjunction with Kaiser Permanente. The program includes prenatal preparation of families, a brief hospital stay, postpartum home visits, and postvisit case management. Readmission rates or mothers and newborns in the program have been less than 1%. The program has saved about $1 million a year since 1991, and consumer satisfaction has been measured at 99%.

Cost-Benefit Analysis↗
PubMed1988

Use-effectiveness of the ovulation method initiated during postpartum breastfeeding.

Between April 1981 to March 1984, 419 urban middle class postpartum women entered the Natural Family Planning (NFP) program of the Pontificia Universidad Catolica de Chile. This NFP program teaches the Ovulation Method (Billings). Only 1.9% of the women did not learn how to recognize the mucus pattern of fertility awareness. The sample of 378 women who were practicing the method to avoid a pregnancy completed 4,935 months of use of the OM. The cumulative life table unplanned pregnancy rate at the 12th postpartum month was 11.1 +/- 1.9 and the Pearl Rate was 12.1 per 100 woman-years. The Pearl Rate calculation of method-related failure was only 2.1 pregnancies per 100 woman-years. The breastfeeding group showed a significantly lower rate of unplanned pregnancies than the nonbreastfeeding group and there was no significant increase in unplanned pregnancy at the time of menstruation among previously amenorrheic women as compared to later intervals. The protection against unplanned pregnancy shown in this study should be viewed as the combination of two factors: breastfeeding and the Ovulation Method (OM) of NFP.

Adult↗
PubMedDate not supplied

A perinatal education consortium: improved resource utilization.

Maternal Newborn Nurse Professionals of Southeastern Michigan is an organization of nurses from more than 30 hospitals. The organization formed a committee to provide a comprehensive, cost-effective educational program for new nurses or nurses who were being cross trained, which would improve resource utilization in the region. Twice a year the organization offers a 5-day educational program covering antepartum, fetal monitoring, intrapartum, postpartum, and neonatal issues. The development, implementation, and evaluation of the program are outlined.

Costs and Cost Analysis↗
PubMed2003

Treatment of substance abuse during pregnancy and infant outcome.

The objective of this study is to analyze the effects of residential substance abuse treatment on pregnancy outcome among gravidas in a gender-specific program. All clients (cases) who entered a residential substance abuse program for pregnant and postpartum women were eligible for inclusion in the study (n=95). Only those who were in treatment at the time of delivery were included in the present analysis (n=57). Two comparison groups were used: (1) substance abusers who received no treatment during pregnancy (positive control group) and (2) pregnant women who were not substance abusers (negative control group). Cases were matched to controls on ethnicity (negative and positive controls) and drug of choice (positive controls only). Medical records were reviewed and abstracted for cases and controls. The primary drug of choice was cocaine for 56% of clients in the study, heroin 15.8%, and alcohol 10.8%. Average length of time in treatment before delivery was 11.7 weeks. The frequency of pregnancy complications allowing treatment and position controls was significantly higher than the negative control group (p<0.0001). The frequency of perinatal infant complications was increased among treatment group infants (p<0.0001). Two infants in the treatment group were positive for a substance of abuse at birth. In the treatment versus positive control group, mean birth weight (BW) was 3227 versus 2800 g (p<0.01), estimated gestational age (EGA) was 38.9 versus 39 weeks, average head circumference (FOC) was 33.8 versus 32.5 cm (p<0.05), and mean birth length (BLT) was 48.7 cm versus 46.9 (p<0.05). No significant differences were found between treatment and negative control groups. Maternal syphilis was increased in frequency in the positive control group compared with the negative control group (p<0.07). Thirty-percent of mothers had sexually transmitted diseases (STDs) for which infants were at risk and treated prophylactically; no infant in the treatment group contracted a vertically transmitted STD. For every 10 weeks in treatment, BW was increased 340 g, EGA 1 week, FOC 0.8 cm, and BLT 1.8 cm. Thus, substance abuse treatment for pregnant women in the program increased fetal growth, which significantly decreased the risk for poor neonatal outcomes. Importantly, maternal and infant perinatal complications in the treatment group were increased in frequency compared with the two control groups. This may possibly have occurred because healthcare providers were not blinded to maternal treatment status.

Adult↗
PubMedDate not supplied

Postnatal blues: a risk factor for postnatal depression.

Postnatal blues have been regarded as brief, benign and without clinical significance. However, several studies have proposed a link between blues and subsequent depression but have methodological problems. We report a prospective, controlled study of postpartum women with severe blues which uses systematically devised and validated instruments for that purpose which tests the hypothesis that severe blues increases the risk of depression in the six months following childbirth. 206 first-time mothers were recruited in late pregnancy. Blues status was defined using the Blues Questionnaire and those with severe blues and their controls who had no blues (matched for age, marital status and social class) were followed for 6 months with postal Edinburgh Postnatal Depression Scale. RDC diagnoses were made following SADS-L interview at the end of the protocol. Backwards stepwise Cox regression analysis found severe blues and past history of depression to be independent predictors each raising the risk by almost 3 times. Depression in those with severe blues onset sooner after delivery and lasted longer. The difference was largely accounted for by major depression. Severe postpartum blues are identified as an independent risk factor for subsequent postpartum depression. Screening and intervention programs could be devised.

Adolescent↗
PubMed1992

Postpartum IUDS: keys for success.

Intrauterine device (IUD) insertion is convenient and efficient in the postplacental and immediate postpartum periods. Insertion at these times is demonstrably safe, having a low incidence of infection, few bleeding problems, and low perforation rates. IUD expulsion rates can vary widely, and are a function of timing of insertion, type of IUD, and insertion technique. When a copper T device is inserted postplacentally or immediately postpartum by an experienced and trained clinician, expulsion rates of about 7-15 per 100 users at six months can be expected. Women must be told how to detect expulsions and instructed to return for reinsertion or for another method. Most investigators emphasize that high fundal IUD placement will reduce the expulsion rate. Unplanned pregnancy rates for postplacental IUD insertion range from 2.0-2.8 per 100 users at 24 months when using modern copper IUDs, correct insertion technique, careful postinsertion instructions and good follow-up. Postplacental insertions are performed manually or with a ring forceps. Immediate postpartum insertions (10 minutes to 48 hours after delivery) are performed with the ring forceps.

Contraception↗
PubMed1996

Who gives advice about postpartum contraception?

Women were interviewed to determine what advice they received about postpartum contraception and what they thought of it. Only 4% of women discussed postpartum contraception antenatally. Up to 84% discussed the issue with a midwife on the postnatal ward but discussion was often felt to be brief, limited and frequently held as the mother was leaving the hospital. Obstetricians appeared to have little interest in the subject and only 50% of mothers left the hospital with supplies of a contraceptive. Almost all women discussed contraception with their general practitioner at the postnatal check but a significant number felt that the choice of method was limited to condoms or pills. The postnatal check is traditionally held at six weeks--two to three weeks after the recommended time for starting contraceptive precautions. Women with short inter-pregnancy intervals were younger, less likely to be married and more likely to default from postnatal follow-up. Pregnant women should be offered the opportunity during the antenatal period to discuss postpartum contraception with someone who has a special interest in the subject. The postnatal ward is not an appropriate setting for discussion about future contraception.

Contraception↗
PubMed1996

Contraceptive use during lactational amenorrhea.

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users for all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.

Adult↗
PubMed1992

Effect of the maternity ward system on the lactation success of low-income urban Mexican women.

We compared the lactation performance of 165 healthy mothers who planned to breastfeed and gave birth by vaginal delivery, without complications to a healthy infant in either a nursery (NUR) (n = 58) or a rooming-in hospital where formula supplementation was not allowed. In the rooming-in hospital, women were randomly assigned to a group that received breastfeeding guidance during the hospital stay (RIBFG) (n = 53) or to a control group (RI) (n = 54). Women were interviewed in the hospital and at 8, 70 and 135 days post-partum (pp). The groups were similar in socio-economic, demographic, anthropometric, previous breastfeeding experience and prenatal care variables. Non-parametric survival analyses adjusting for potential confounding factors show that breastfeeding guidance had a positive impact (P < or = 0.05) on breastfeeding duration among primiparous women who delivered in the rooming-in hospital. Among primiparae, the RI and RIBFG groups had higher (P < or = 0.05) full breastfeeding rates than the NUR group in the short term. In the longer term, only the difference between the RIBFG and the NUR group remained statistically significant. The maternity ward system did not have a statistically significant effect on the lactation performance of multiparae.

Adolescent↗