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PubMed1999

A postpartum self-medication program: effect on narcotic use.

Our objective was to determine the impact of a self-medication program on postpartum narcotic use. We retrospectively studied narcotic use in patients who underwent vaginal delivery before and after implementation of a self-medication program in April 1997. Narcotic use was compared between patients who delivered in January 1997 (n = 263) and those who delivered in January 1998 (n = 254). Oral narcotic use was also analyzed with respect to type of vaginal delivery (spontaneous vs. operative), extent of episiotomy or laceration, and use of epidural analgesia during labor. Narcotic use was significantly reduced (p < 0.001) in postpartum patients who participated in the self-medication program. The reduction was consistent despite the type of vaginal delivery or use of epidural analgesia during labor. A more extensive episiotomy or laceration at delivery (fourth-degree episiotomy or vaginal sulcus tear) was associated with an increase in narcotic use, although there was still a statistically significant decrease in use in patients in the self-medication program. A significant reduction in postpartum narcotic use may be achieved through implementation of a self-medication program. As a result, substantial benefits are potentially gained by both the patients and the nursing staff.

Administration, Oral↗
PubMed1980

Elements and outcomes of a postpartum support group program.

Questionnaires were sent to 90 women who had participated in a lay postpartum support group program to determine (a) the characteristics of the women who used this form of support, (b) the needs met by the group, (c) the types of discussions most meaningful to group members, and (d) the factors that influenced the group's effectiveness in providing support. Sixty-six questionnaires were returned. The respondents were older, better educated, and more affluent than a random sample of childbearing women. They joined the group primarily to meet other women going through the same experience with whom they could share ideas and feelings. The most meaningful discussions for these women focused on personal issues rather than infant-related issues. The presence of babies at group meetings adversely affected the regularity of attendance. Women who worked outside the home were significantly more likely to continue meeting with the group for over a year. Only 7 women thought the group would have been better for them if their husbands had been present.

Adaptation, Psychological↗
PubMed2002

Is postpartum contraceptive advice given antenatally of value?

In response to the concept that a good postpartum program should begin prenatally, this study was designed to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of contraceptive usage, and pregnancy rates during the first year after childbirth. Over 500 women attending antenatal clinics in each of three centers (Edinburgh, Scotland; Shanghai, People's Republic of China; Cape Town, South Africa) were randomized to receive expert contraceptive advice (participants, n = 771) or the standard advice routinely given in that setting (controls, n = 866). Follow-up was by postal or interviewer-administered questionnaires at 16 and 52 weeks after childbirth. There were no significant differences in the prevalence of contraceptive use at one year (over 79% in all centers) between participants and controls. In Edinburgh, participants were more likely to undergo sterilization (p < 0.01) than controls, otherwise there were no differences among Edinburgh, Shanghai, or Cape Town in either the methods of contraception chosen or in the methods used over time. Contraceptive counseling delivered antenatally appeared to have no impact on the pregnancy rate during the first year after childbirth. In Shanghai, over 11% of women in both groups underwent termination of pregnancy in the year of follow-up. In conclusion, although women in all centers said they found the opportunity to discuss contraception antenatally was useful, it had very little effect on contraceptive use or on subsequent pregnancy rates.

Adult↗
PubMed1999

Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project.

Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.

Adult↗
PubMedDate not supplied

Hawaiian-style "talkstory": psychosocial assessment and intervention during and after pregnancy.

Standard health care services generally limit the psychosocial assessment and management provided for women during and after pregnancy. Recommendations for improving prenatal care include the need for evaluating different approaches for addressing culturally sensitive care. In an innovative prenatal and postpartum program developed by public health nurses in Hawaii, the use of local "talkstory" has been integrated successfully as a caregiving strategy for participating women from Asian and Pacific Islander ethnic groups. This article describes the use of talkstory for delivering psychosocial care and its application in the design of health care services for pregnant women in the general population.

Asian↗
PubMed1984

Cost-effectiveness of antepartum prevention of Rh immunization.

While antepartum prophylaxis of Rh immunization is much more costly and the postpartum program is much more cost-effective, the question is whether the antepartum program is sufficiently cost-effective to warrant its use. How, in any given region, should the issue be tackled? This article addresses that question.

Antibody Formation↗
PubMed1976

[Desire for children and the practice of family planning].

Of 1647 women in confinement (mean age 26years) and 185 students nurses (mean age 18 years), the majority wanted two children. 8% of the women in confinement and 2% of the student nurses had received no previous family planning information, whereas 38% of the women in confinement and 81% of the student nurses had practiced contraceptive methods with a Pearl-index of 3 or less (oral contraceptives, basal-temperature-method). 31% of the women in confinement had already had unplanned pregnancies (mean: 1.4 pregnancy per woman). The last pregnancy was not planned in 27% and in these 4 out of 5 pregnancies were caused by incorrect application of the contraceptive method. Faulty practices and unsatisfactory results, in spite of the availability of secure contraceptive methods, emphasize the necessity of intensifying family planning. Because programmes including personal counsel have yielded better results, these should be favoured and include a clinical post partum programme. The latter was considered necessary by 95% of the women attending such a programme in our hospital.

Adolescent↗
PubMed2001

The impact on clients of a community-based infant mortality reduction program: the National Healthy Start Program Survey of Postpartum Women.

OBJECTIVES: This study assessed the effect of the national Healthy Start Program on its clients. METHODS: We used a cross-sectional survey of a sample from Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) rosters of women less than 6 months postpartum who were residents of Healthy Start Program areas. RESULTS: Healthy Start clients revealed higher sociodemographic risk, but not behavioral risk, for adverse pregnancy outcome than other area residents. They did not differ from other residents in receipt of services except for a greater likelihood of receiving case management, using birth control at the time of the interview, and rating their prenatal care more highly. CONCLUSIONS: The Healthy Start Program succeeded in enrolling women at high risk. It had little effect on the immediately concluded pregnancy, but it might influence future outcomes.

Adolescent↗
PubMed2001

Better care and better teaching. New model of postpartum care for early discharge programs.

PROBLEM BEING ADDRESSED: Rapid postpartum discharge has reduced opportunities to detect early newborn or parenting problems and to teach neonatal assessment and maternal postpartum care to medical trainees. OBJECTIVE OF PROGRAM: Development of a program to not only ensure adequate care of mothers and newborns after early hospital discharge, but also to teach outpatient assessment skills to family medicine residents. MAIN COMPONENTS OF PROGRAM: In an urban, secondary care, university-affiliated teaching hospital predominantly training family medicine residents, an interdisciplinary committee created and supervised a neonatal and maternal postpartum assessment program. Newborn infants and their mothers are seen by a family physician, a family medicine resident, and a nurse within 48 hours of discharge, after which care is assumed in the community by the child's primary care physician. An assessment protocol developed by the interdisciplinary group promotes standardized mother and child care and a structured learning experience for trainees. CONCLUSION: Rapid follow up of early discharged infants and their mothers can be facilitated by a program of standardized assessment by a roster of pooled, interacting family physicians and nurses. When this assessment occurs in a teaching milieu, a comprehensive learning experience can be combined with defined objectives that emphasize and encourage newborn and maternal assessment for ambulatory patients.

Family Practice↗
PubMed1999

Postpartum follow-up care in a hospital-based clinic: an update on an expanded program.

The Postpartum Care Center, an outpatient, in-hospital follow-up clinic began in 1991 in response to shortening maternity stays and the resulting need to provide follow-up care to mothers, infants, and families. This innovative model of postpartum follow-up care is cost effective and allows one nurse to see two to three times as many families in a clinic day as could be seen at home. Support services including the laboratory, pharmacy, social service, and anesthesia service are in close proximity to the clinic.

Adult↗
PubMed1996

Controversial issues surrounding early postpartum discharge.

Throughout the world, early postpartum discharge programs are emerging as one strategy for reducing health care costs and, in some areas, relieving the shortage of hospital beds. This article summarizes the research findings to date regarding programs of early postpartum discharge. Additionally, findings from recently completed work on a program of early discharge for high-risk childbearing families is discussed.

Breast Feeding↗
PubMed1982

A prenatal and postpartum safety education program: influence on parental use of infant car restraints.

The effects of pre- and/or postnatal infant car safety education were examined. Educational approaches included demonstrations and talks on automobile crash statistics in the prenatal course; and a car safety film on the hospital television, a pamphlet given to each mother, and instructions to nurses to encourage parents' purchase and use of car restraints in the postpartum period. Although differences were not statistically significant, the reported and actual use of infant restraints on the trip home was highest in the pre- plus postnatal education group. Counseling in any period was associated with higher restraint use than on counseling. The pediatrician's role in effecting positive behavioral changes in this and other areas is emphasized.

Accident Prevention↗
PubMed1995

Postpartum care center: follow-up care in a hospital-based clinic.

Because of ever-decreasing lengths of maternity stays and the emphasis on reducing health-care costs, there is a need for innovative, low-cost postpartum follow-up programs. The Postpartum Care Center, begun in 1991, is a model program that provides early postpartum assessment and support to mothers, infants, and their families for one third the cost of a home visit. This article reviews program development, description of services, and program outcomes.

Adolescent↗
PubMedDate not supplied

An early postpartum hospital discharge program: implementation and evaluation.

The philosophy of the FBC strengthens the concept of childbirth as a normal physiologic process. Couples are guaranteed a high level of quality nursing and medical care. Simultaneously, provisions are made to enhance the family's assertiveness in obtaining a satisfying experience in the hospital that extends to the home environment. With careful planning and decision making throughout the pregnancy, early discharge becomes a satisfying and safe alternative for families and provides a means to decrease the ever rising cost of health care.

Chicago↗