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PubMedDate not supplied

Beliefs and practices regarding delivery and postpartum maternal morbidity in rural Bangladesh.

Most maternal deaths occur in the puerperium and most maternal morbidities probably also arise at that time. Maternal morbidities occur much more frequently than maternal deaths, but very little is known about their magnitude or causes. This study uses focus-group discussions to explore the experiences of childbirth and postpartum illness among rural Bangladeshi women. The women's beliefs about disease causation, and their use of traditional health care, are explored. The significance of the findings for the training of traditional birth attendants and for programs of postpartum care is discussed.

Adolescent↗
PubMed1988

The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction.

We investigated the value of a screening program for postpartum thyroiditis in a heterogeneous American population and used serum antithyroid antibodies to identify postpartum women at risk. Blood was drawn from 1034 consecutive women on their second postpartum day and tested for antimicrosomal and antithyroglobulin antibodies by hemagglutination. Seventy-two women (7.0%) were seropositive for antimicrosomal antibodies, but only seven (0.7%) had antithyroglobulin antibodies. There was a significant difference in the racial prevalence of antimicrosomal antibodies, with seropositivity in 52 of 588 white women (8.8%) versus nine of 367 black women (2.5%; p less than 0.001). Thirty-four of 51 (67%) antimicrosomal seropositive women followed at least 6 months post partum developed biochemical thyroid dysfunction and 20 of these patients required treatment for hypothyroidism. The mean (+/- SEM) serum thyroxine and thyrotropin levels in these patients before treatment were 3.0 +/- 0.3 micrograms/dl (normal 6.1 to 12.3 micrograms/dl) and 77 +/- 17 mU/L (normal 0.3 to 4.0 mU/L), respectively. Psychologic interviews revealed a significant increase in impaired concentration, carelessness, depression, and total complaints when patients with postpartum hypothyroidism were compared with postpartum euthyroid women. Medical evidence now suggests that postpartum thyroiditis is a common event and causes significant symptoms in women who develop hypothyroidism. Therefore, we propose that serum antimicrosomal antibody testing of postpartum women provides a feasible cost-effective screening method of identifying women likely to suffer from this disease.

Autoantibodies↗
PubMed1999

A unique drug treatment program for pregnant and postpartum substance-using women in New York City: results of a pilot project, 1990-1995.

In the 1980s, there was virtually no drug treatment for pregnant women in New York City, especially women who used crack cocaine. The purpose of the Parent and Child Enrichment (PACE) demonstration project was to assess the effectiveness of the one-stop shopping model of drug treatment for this population. Among PACE clients, 88% were primarily users of crack cocaine. The mean total length of stay was 100.0 days (median 55.5 days). Client retention 42 days after intake was 54.3%. This paper describes the essential components of this program model. "Long-stay" and "short-stay" clients were compared using urine toxicology tests and activity logs. In addition, the birth outcomes of clients were compared to two similar populations. A strong positive correlation was found between total length of stay and low rate of positive urine drug tests (UDTs). Infants of PACE long-stay clients had greater mean birth weight, less low birth weight, and less intrauterine growth retardation than the infants of the comparison groups. Fetal exposure to cocaine was decreased dramatically among women who were enrolled for 42 or more days during their pregnancy. This model of drug treatment for pregnant and postpartum women seems to improve mothers' lives, fetal drug exposure, and birth outcome significantly.

Child↗
PubMed1993

Feasibility of postpartum rapid hospital discharge: a study from a community hospital population.

We have examined the safety and efficacy of an early postpartum discharge program in 289 patients who were identified prior to delivery and counseled and educated for discharge 12 to 36 hours after delivery. A total of 55% of the study patients were able to be discharged early. There were 4.3% significant maternal problems and 3% significant neonatal problems identified in the first 72 hours after delivery by a nurse practitioner home visit. Significant maternal problems after 72 hours (10%) and neonatal problems (5%) were also found by follow-up visits. The hospital readmission rate was 1.8%. These incidences are consistent with other studies in the literature and suggest that some type of early follow-up of both the mother and infant should routinely accompany early postpartum discharge programs.

Feasibility Studies↗
PubMedDate not supplied

Health outcomes of incarcerated pregnant women and their infants in a community-based program.

An experimental, community-based, residential program, focused on health promotion, was established in 1990 for incarcerated pregnant women with short-term sentences and histories of drug abuse in a large, midwestern metropolitan area in the United States. Infants resided with mothers after birth. Prenatal care, delivery, postpartum, and family-planning services were initiated and provided by a nurse-midwifery service. Community-based health care, job training, and drug rehabilitation were provided for women during pregnancy through the fourth postpartum month. Program participants' prenatal, delivery, postpartum, and neonatal health outcomes are presented and compared with those of incarcerated women in the same state prison system who experienced usual correctional facility care and support. Program participants represented a group of obstetrically high-risk women. Health outcomes for both groups of incarcerated women and their infants were similar and more optimal than would have been expected given their preexisting health conditions and risk factors.

Adult↗
PubMed1985

Grand multiparity: benefits of a referral program for hospital delivery and postpartum tubal ligation.

The maternal death rate is high in grand multiparas giving birth in remote villages in Milne Bay Province, Papua New Guinea. Such women are often reluctant to go to hospital for delivery. However, many of them have accepted the idea of going to hospital to await delivery and postpartum tubal ligation. We discuss the results and benefits of this program. 43% of grand multiparas suffered one or more complications during their hospitalization; 77% were sterilized. Considerable morbidity and mortality can be prevented by an active program for hospital management of grand multiparas. Costs of such early referral are at least partially offset by decreasing costs for late emergency transfer of obstetric disasters. 47% of emergency air charters for obstetric complications were for grand multiparas. Numbers of such emergency transfers have decreased as increasing numbers of grand multiparas have been referred early for delivery and tubal ligation.

Emergencies↗
PubMed2000

Consented testing of newborns and childbearing women for human immunodeficiency virus through a newborn metabolic screening program.

OBJECTIVE: In this program a postpartum woman could consent to receive her newborn's human immunodeficiency virus test result from the New York State Newborn Screening Program. STUDY DESIGN: By state regulation each postpartum woman was counseled and offered her newborn's human immunodeficiency virus test result. With the mother's consent, newborn human immunodeficiency virus antibody test results from the Newborn Screening Program were sent to the baby's pediatrician; otherwise, test results were blinded. Data were analyzed for births from August 1, 1996, to January 31, 1997. RESULTS: Overall, 92.5% of women offered newborn human immunodeficiency virus testing consented to receive the result. Among 444 human immunodeficiency virus-positive women offered newborn testing, consented testing resulted in a 21.4% increase in knowledge of human immunodeficiency virus status from 72.3% (n = 321) at delivery to 93.7% (n = 416) after newborn testing; 6.3% (n = 28) of human immunodeficiency virus-positive women delivered of infants who did not consent apparently remained unaware of their human immunodeficiency virus status. CONCLUSION: Combined prenatal and consented newborn testing identified 94% of human immunodeficiency virus-positive mothers and exposed newborns, allowing early entry into care. Such testing may provide an opportunity for women not previously tested for the human immunodeficiency virus to learn their status but is not a substitute for universal prenatal human immunodeficiency virus counseling and consented human immunodeficiency virus testing.

Adult↗
PubMedDate not supplied

Mother-infant interactions in postpartum depression: an early intervention program.

This paper examines the role of postnatal intervention in the prevention of the negative consequences of postpartum depression on developing mother-infant relationships. It is argued that, once difficulties in these interactions have been identified, direct attempts to modify the interactions must occur within a framework that includes maternal, paternal, partnership/marital and social variables. An intervention program that may be instituted by nurses is described. The Baby Happiness, Understanding, Giving and Sharing (HUGS) Programme is an attempt to integrate direct intervention in mother-infant interactions into a systemic framework which takes into account contextual variables such as cognitive style and social support.

Cognition↗
PubMed1987

Infant safety seat use. Reaching the hard to reach.

We crafted an interactive video infant safety seat (ISS) education program for presentation to postpartum mothers. This program was designed to reach all socioeconomic groups with the message that consistent, correct ISS use is important. The program was further designed to be physically portable, versatile, and affordable and to narrow previously observed differences in correct ISS use between groups of high and low socioeconomic status exposed to the same educational message. Observed ISS use at an examination after four months confirmed the utility of this program in meeting the experimental goals. While also reaching other program goals, the interactive video program (64.6% correct use) was found to be at least as effective as a control education program (63.9% correct use).

Health Promotion↗
PubMed1982

A maternal and child health program to prepare and support parents in the postpartum.

The Maternal and Child Health Program Kit has been developed to prepare and support parents in the postpartum. The kit responds to four objectives: to help families to get to know their babies; develop feelings of competence; set realistic expectations for the postpartum; and to identify and use supports and resources. In developing the kit, two target groups have been identified--the primary group, the parents; the transmitter group, the educators. The kit includes question booklets at the bedside that encourage mothers to ask questions; resource cards for health professionals that facilitate consistency in information giving; information sheets to provide concise information on topics that cover detailed information or emotional areas; four slide-tape shows on breastfeeding and a coloring book for siblings. The Maternal and Child Health Program Kit is currently being evaluated.

Breast Feeding↗
PubMed1991

The management of intrauterine devices following uterine perforation.

The generally accepted indications for removal of an intra-abdominal intrauterine device (IUD) are: a) a closed variety of IUD, b) medicated IUDs with copper or hormone release, and c) a medico-legal or psychological problem. A perforated IUD can be left in the peritoneal cavity if it is made of non-irritating plastic. The copper IUD causes adhesions, but these lead to few cases of serious complications. The reason for removal of the IUD stems only from the fear of adhesion formation. Our experience, supported by the literature, leads us to believe that this indication should no longer be accepted.

Female↗