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PubMedDate not supplied

Mothers' intention, age, education and the duration and management of breastfeeding.

The authors examined the breastfeeding duration and management of two groups of mothers with different exposures to services of a Certified Lactation Consultant (CLC). One group of mothers, at hospital H1 (n = 46), had access to a CLC, while mothers at hospital H2 (n = 115) did not. Results showed that: (a) mothers at H1 had significantly (t = 2.33, p < .02) longer durations of breastfeeding (M = 3.1 months, SD = 1.2) than peers at H2 (M = 2.4 months, SD = 1.2); (b) a significantly greater proportion of mothers at H1 attained their intended duration of breastfeeding compared to mothers at H2 (Mann-Whitney U, one-tailed test, Z = 1.94, p < .05); and (c) in a stepwise multiple regression analysis, intended length of breastfeeding accounted for 18% of the variance in duration of breastfeeding, mothers' age 9%, and mothers' education 3%. The results support the theory of reasoned action and the theory of patient education.

Adult↗
PubMed1993

School-based adolescent pregnancy classes.

School-based adolescent pregnancy classes provide the childbirth educator with a unique opportunity to be visible to students. Attitudes about sexuality and pregnancy can be changed within the mainstream population by the presence of prepared childbirth classes at schools. The problems of absenteeism and denial of pregnancy that result in late reporting to health care providers can be minimized. The expectant teen-ager can be encouraged to attend school and given self-confidence in assuming the role of a parent after birth. Support can be engendered from faculty, students, and the teen-ager's support person.

Adolescent↗
PubMed1996

Tubal ligation candidates who did not get their operation.

OBJECTIVE: To identify bottlenecks in the delivery of comprehensive family planning to women in contact with the Health Services and to find ways to reduce unmet demand for contraception. DESIGN: Exploratory descriptive study. SETTING: Large Bulawayo Government Hospital and the high density areas in the same city. SUBJECTS: Case notes of 284 women who indicated together with their partners that they had completed families and who had their tubal ligation forms duly signed but who never had their operation. Follow up of a sample of patients. INTERVENTIONS: Non intervention study. MAIN OUTCOME MEASURES: Are reproductive rights taken seriously? Is there service related unmet demand for family planning. RESULTS: Even those who had all their paperwork in order for a durante or post partum sterilization did not have any guarantee that this service would be given. The main reason was found to be lack of well motivated health staff. CONCLUSION: Much can be improved in contraceptive service delivery. Reproductive rights are not respected.

Adult↗
PubMed1997

Maternal and infant health: effects of moderate reductions in postpartum length of stay.

BACKGROUND: The Newborns' and Mothers' Health Protection Act of 1996 prohibits payers from restricting "benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours." The law recognizes the basic right of women and physicians to make decisions about aptness of discharge timing. OBJECTIVE: To provide data as a basis for decisions about aptness of discharge timing by studying the effect of voluntary, moderate reductions in length of postpartum hospital stay on an array of maternal and infant health outcomes. DESIGN: A prospective cohort study. Patients were surveyed by telephone at 3 and 8 weeks postpartum. SETTING: A teaching hospital where 38% of the patients are in a managed care health plan with a noncompulsory reduced stay program offering enhanced prepartum and postpartum services, including home visits. PATIENTS: Consecutive mothers discharged after vaginal delivery during a 3-month period. MAIN OUTCOME MEASURES: The outcomes were health services use within 21 days, breast-feeding, depression, sense of competence, and satisfaction with care. Multivariate analyses adjusted for sociodemographic factors, payer status, services, and social support. RESULTS: Of 1364 eligible patients, 1200 (88%) were surveyed at 3 weeks; of these 1200, 1015 (85%) were resurveyed at 8 weeks. The mean length of stay was 41.9 hours (SD, 12.2 hours). Of patients going home in 30 hours or less, 60.8% belonged to a managed care health plan. The length of stay was not related to the outcomes, except that women hospitalized shorter than 48 hours had more emergency department visits than those staying 40 to 48 hours (adjusted odds ratio, 5.78; 95% confidence interval, 1.19-28.05). CONCLUSIONS: When adequate postpartum outpatient care is accessible, a moderately shorter length of postpartum stay after an uncomplicated vaginal delivery had no adverse effect on an array of outcomes. Researchers and policy makers should seek to better define the content of postpartum services necessary for achieving optimal outcomes for women and newborns; funding should be available to provide such services, regardless of the setting in which they are provided.

Adolescent↗
PubMed2005

Postpartum neurologic symptoms following single-shot spinal block for labour analgesia.

BACKGROUND: As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward. METHODS: Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) using a 27-gauge Quincke-type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms. RESULTS: Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1-3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non-postural headache and 28 (13%) of new-onset back pain. Three mothers (1%) would not want to receive a further spinal block. CONCLUSION: Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re-evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high.

Adult↗
PubMedDate not supplied

Toward improvements in parenting: a description of prenatal and postpartum classes with teaching guide.

A pilot program was developed at an urban community hospital in an attempt to enhance the educational preparation of new and expectant parents and to provide them with the opportunity to examine their values and expectations relating to parenthood. Forty-one couples attended prenatal and postpartum classes. Child development and parenting issues were the main topics of discussion. The effectiveness of the educational program and instructor performance were evaluated through questionnaires measuring parenting knowledge and emotional support. Also, a teaching guide was developed and published.

Curriculum↗
PubMed1996

Drug use among adolescent mothers: prepregnancy to 18 months postpartum.

PURPOSE: Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS: A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS: Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS: The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

Adolescent↗
PubMedDate not supplied

Successful implementation of universal woman abuse inquiry.

OBJECTIVE: This study investigated a year-long professional development strategy to improve Public Health Nurse (PHN) documented abuse inquiry among low-risk postpartum women. Strategies included workshops and small group work at regular intervals. DESIGN: A retrospective chart audit of cross-sectional data collected as part of the Healthy Babies/Healthy Children Program was conducted 1 year before and after the introduction of the Routine Universal Comprehensive Screening (RUCS) Program. SAMPLE: Charts of all postpartum women who lived in one Ontario county (Canada) and who received a PHN home visit were reviewed (pre-RUCS, n=1,151; post-RUCS, n=1,193). MEASUREMENT: Information regarding mother's age group and parity, month of PHN visit, abuse inquiry, and whether or not the woman was a single parent was abstracted. RESULTS: Originally, there was documentation of abuse inquiry on only 0.8% of low-risk postpartum client charts. Women aged <20 years and single parents were significantly (p<.001) more likely to be asked, suggesting case-finding among PHNs. Post-RUCS abuse inquiry increased to 20.5% with no demographic differences between those groups asked. CONCLUSION: Policy changes providing specific expectations and documentation cues can improve routine abuse inquiry. New policies can be effectively combined with existing programs and infrastructure, facilitating the longer term success of new initiatives.

Algorithms↗
PubMedDate not supplied

The experiences of women pediatric dental residents: a survey.

A survey of 430 female pediatric dentists in the United States determined concerns and experiences they had during their advanced training programs. The return rate was 54%. Up to 83% (24) of the women who were pregnant during their residencies asked not to be exposed to certain environmental hazards during pregnancy and the postpartum period. They requested that program directors establish policies on known environmental hazards. Eighty-eight women (41%) commented that programs should offer flexible, preestablished and preannounced maternity leave policies. Survey respondents also expressed concerns about personal safety (5%), the lack of female role models (9%), and the need for more information on business management (30%). When the women were analyzed according to age, the following were significant (P less than .05): professional acceptance was of greatest concern to women ages 41-48; pregnancy and maternity leave, and balancing career with parenthood, significantly concerned women 25-32; and women ages 33-40 said business management was the issue causing the greatest frustration as a practicing pediatric dentist. While most respondents felt that they have the same professional opportunities as men, their greatest frustrations are a lack of acceptance by the professional and lay communities and trying to balance a career and motherhood.

Adult↗
PubMed2002

Introducing domestic violence assessment in a postpartum clinical setting.

OBJECTIVES: Attempts to introduce assessment for exposure to domestic violence in health care settings have met with limited success, in spite of widespread knowledge of the prevalence of spousal abuse and its implications for women's health. We assessed the utility of Rogers' model of institutional change for the implementation of a universal screening program for domestic violence in postpartum clinical settings. METHODS: We adapted Rogers' innovation-diffusion model to develop and implement a protocol for domestic violence assessment among 300 nurses working in two hospitals that together provide obstetrical care to the City of Vancouver, British Columbia, Canada. Our education sessions introduced new knowledge and addressed attitudes and beliefs. They were followed by "hands-on" demonstration and supervision of assessments. Our "Let's Talk" visual aids program added visibility to our initiative and provided cues as to how to undertake screening and response. Screening rates were monitored along with a process evaluation based on anecdotal reporting by nursing staff. RESULTS: Following the initiation of educational sessions and supervision of assessment, the screening rate was 42%. Within 6 months, the screening rate had climbed to 60% and was sustained at that level. Major barriers to screening include difficulty in finding the opportunity to screen in privacy and overcoming language barriers. CONCLUSIONS: Application of Rogers' principles of diffusion of innovation in the implementation of a universal program for a domestic violence in two obstetrical care settings resulted in a screening rate of 60% which has been sustained for the first 18 months of the program.

British Columbia↗
PubMedDate not supplied

Being born in Manitoba: a look at perinatal health issues.

OBJECTIVE: The Manitoba Centre for Health Policy was commissioned by Manitoba's provincial health department to examine the health of newborns born 1994 through 1998, using three indicators: preterm birth (< 37 weeks gestation), birthweight, and type of infant feeding. METHODS: Data were derived from the Population Health Research Data Repository and the National Longitudinal Survey of Children and Youth 1996. Variation by 12 Regional Health Authorities (RHAs) and by 12 Winnipeg Community Areas (CAs) was examined, as well as associations with the population's health and socioeconomic well-being. RESULTS: Manitoba's preterm birth rate was 6.7% of live births, from 5.3% to 7.4% by RHA, and 5.7% to 8.0% by Winnipeg CA. Manitoba's low birthweight rate (< 2500 g) was 5.3%, from 2.7% to 5.7% by RHA, and 4.4% to 7.2% by Winnipeg CA. The lower the income, the greater the likelihood of low birthweight (p < 0.05). Manitoba's breastfeeding initiation rate was 78%, from 64% to 87% by RHA, and 66% to 90% by Winnipeg CA. The lower the income and the poorer the health status of the population, the lower the breastfeeding rate (p < 0.001). Of those initiating breastfeeding, 42% breastfed for at least six months. CONCLUSION: Factors affecting child health in Manitoba could be addressed through systematic programs both during pregnancy and during the postpartum period, including support for nutritional counselling, promotion of breastfeeding, smoking cessation programs, and social policy decisions designed to overcome disparities within low-income groups and populations with poorer health status.

Birth Rate↗
PubMed1996

Evaluation in the Substance Abuse and Mental Health Services Administration.

The evaluation policy of the Substance Abuse and Mental Health Services Administration (SAMHSA) is described in this article. Three studies are presented that exemplify SAMHSA's evaluations. These include evaluations of a program to prevent substance abuse among pregnant and postpartum women and their infants; a Job Corps treatment enrichment program; and the McKinney program for homeless persons with severe mental illnesses. Each of these evaluations demonstrated the effectiveness of the programs in reducing substance abuse or homelessness and in improving the health and well-being of the consumers served. SAMHSA will use the results of these and similar evaluations to guide policy and program development. Through its evaluations, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. By using its evaluation results to guide policy and program development, SAMHSA aims to improve the quality of the public system of substance abuse and mental health services.

Adolescent↗
PubMed1995

Improving postpartum marital relationships.

The effects of a traditional prenatal education program focused on maternal and infant physical health education were compared with effects of an innovative prenatal program designed to decrease the potentially negative effects of childbirth on the quality of marital relationships. 53 couples participated in the traditional approach and 63 in the innovative program: all expected a first child. Analysis of variance of their scores on the Sexual Relationship Scale and also on the Abbreviated Marital Adjustment Scale administered two months postpartum (controlled for their scores on the 2 scales before the prenatal education program) showed a significant difference between the two groups of parents only with respect to sexual relationship: the couples graduating from the innovative program were more satisfied with sexual aspects of their marriage postpartum.

Adult↗
PubMed1996

A study of the lactational amenorrhoea method of family planning in New Zealand women.

AIM: To evaluate the acceptance and efficacy of the lactational amenorrhoea method of family planning in breastfeeding clients attending clinics of the NZ Association of Natural Family Planning. METHODS: Mothers who were fully breastfeeding their babies, were amenorrhoeic and were early postpartum were offered for the purpose of family planning either lactational amenorrhoea method or the usual fertility awareness charting method. The clients who chose lactational amenorrhoea method were contacted at monthly intervals to check if they continued to meet the lactational amenorrhoea method criteria of fully breastfeeding and amenorrhoea. The fertility awareness group followed the normal practice of clinic visits for instruction until they became autonomous users. The status of both groups were assessed at 6 months postpartum when lactational amenorrhoea method users were advised to adopt another family planning method. RESULTS: Of 149 breastfeeding clients, 110 met the lactational amenorrhoea method criteria. Seventy chose lactational amenorrhoea method, the majority (56.7%) because of its simplicity. Thirty (48.6%) of initial lactational amenorrhoea method users were able to use the method for the full 6 months postpartum period. None of the women conceived while using lactational amenorrhoea method. CONCLUSION: For mothers who choose to fully breastfeed and who maintain a state of amenorrhoea lactational amenorrhoea method is an effective means of avoiding pregnancy during the first 6 months postpartum.

Adult↗
PubMed1995

Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study.

BACKGROUND AND PURPOSE: This descriptive cohort study investigated a physical therapy program of pelvic-floor neuromuscular electrostimulation (NMES) combined with exercises, with the aim of developing a simple, inexpensive, and conservative treatment for postpartum genuine stress incontinence (GSI). SUBJECTS: Eight female subjects with urodynamically established GSI persisting more than 3 months after delivery participated in the study. The subjects ranged in age from 24 to 37 years (X = 32, SD = 4.2). METHODS: This was a descriptive multiple-subject cohort study. Each subject received a total of nine treatment sessions during 3 consecutive weeks, consisting of two 15-minute sessions of NMES followed by a 15-minute pelvic-floor muscle exercise program. Patients also practiced daily pelvic-floor exercises during the 3-week treatment period. The treatment intervention was measured using three separate variables. Maximum muscle contractions (pretraining, during training, and post-training) were measured indirectly as pressure, using perineometry. Urine loss pretraining and posttraining was measured by means of a Pad test. Self-reported frequency of incontinence was recorded daily throughout the period of the study, using a diary. Data were analyzed using a one-way repeated-measures analysis of variance (ANOVA), a Wilcoxon signed-ranks test, and a Friedman two-way ANOVA by ranks. RESULTS: The results indicated that maximum pressure generated by pelvic-floor contractions was greater and both the quantity of urine loss and the frequency of incontinence were lower following the implementation of the physical therapy program. Five subjects became continent, and three others improved. A follow-up survey 1 year later confirmed the consistency of these results. CONCLUSION AND DISCUSSION: The results suggest that the proposed physical therapy program may influence postpartum GSI. Further studies are needed to validate this simple, inexpensive, and conservative physical therapy protocol. [Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Pelvic-floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study.

Adult↗