RESUMO
BACKGROUND: Black and brown birthing people experience persistent disparities in adverse maternal health outcomes, partially due to inadequate perinatal care. The goal of this study is to design and evaluate a patient-centered intervention for obstetric patients with one or more cardiometabolic risk factors for severe maternal morbidity [gestational diabetes, diabetes mellitus, hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, eclampsia, or gestational hypertension), or preconception obesity (BMI > 30)] to promote postpartum visit attendance. METHODS: To address identified unmet needs for postpartum support and barriers to postpartum care, we developed 20 thematic postpartum planning modules, each with corresponding patient educational materials, community resources, care coordination protocols, and clinician support tools (decision aids, electronic medical record prompts and fields). During prenatal care encounters, a research coordinator delivers the educational content (in English or Spanish), facilitates the participant's planning and shared decision-making, provides the participant with resources, and documents decisions in the electronic medical record. We will randomize 320 eligible patients with a 1:1 ratio to the intervention or standard prenatal care and evaluate the impact on postpartum visit attendance at 4-12 weeks and secondary outcomes (postpartum mental health, perceived future maternal and cardiometabolic risk, contraceptive use, primary care use, readmission, and patient satisfaction with care). DISCUSSION: Through engagement with patients and community stakeholders, we developed a guideline-based, locally tailored intervention to address drivers of engagement with postpartum care for high-risk obstetric patients. If demonstrated to be effective, the educational materials and electronic medical record based-tool can be adapted to other settings. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov (NCT05430815) on June 23, 2022.
Assuntos
Cuidado Pré-Natal , Humanos , Feminino , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Adulto , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Complicações na Gravidez/terapia , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/organização & administração , Período Pós-Parto , Tomada de Decisão CompartilhadaAssuntos
Internato e Residência , Cuidado Pós-Natal , Atenção Primária à Saúde , Humanos , Atenção Primária à Saúde/organização & administração , Internato e Residência/organização & administração , Feminino , Cuidado Pós-Natal/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , GravidezRESUMO
BACKGROUND: The days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia. METHODS: A community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively. RESULTS: The study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization. CONCLUSION AND RECOMMENDATION: The study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia.
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Utilização de Instalações e Serviços/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Adulto , Estudos Transversais , Parto Obstétrico/psicologia , Escolaridade , Etiópia , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Parto/psicologia , Cuidado Pós-Natal/organização & administração , Gravidez , Religião , População RuralRESUMO
OBJECTIVE: The COVID-19 pandemic caused that the Health Department of the Autonomous Region of Madrid redirected the Obstetrics, Gynecology and Neonatology emergency care. On March 24th 2020, the HULP launched a program of postpartum early discharge and home visit. The objective of this work was to detect if the care strategy "Voluntary early discharge and home visit by the midwife (2nd year EIR)" applied by the HULP during the COVID-19 pandemic had any adverse effect on the woman and/or the newborn. METHODS: Cross-sectional observational descriptive study using convenience sampling among women included in the early discharge-home visit program from March 24th to May 5th 2020. 222 medical records and telephone surveys to postpartum women who complied with the inclusion criteria were analyzed. The statistical analysis was performed using SAS 9.4. RESULTS: The average of inpatient time was 25 hours and 15 minutes. 8.6% of newborns were sent back to the HULP, and 2.2% were readmitted for hyperbilirubinemia. 2.3% of parents took their infants to the Emergency Care Unit, but only 0.46% needed readmission. 0.4% of postpartum women were readmitted. At the discharge, 84.2% of newborns exclusively breastfed. After one week of the birth, 73.4% of infants were exclusively breastfeeding, 18% were mixed breastfeeding, and 8.6% were bottle feeding. 89.6% of women believed early discharge was appropriate. Home visit was described as "very satisfactory" in 83.3% of cases, and the care provided, in 88.7% of cases. CONCLUSIONS: With the early discharge-home visit program, continuity of care is provided, health problems were detected and resolved and high maternal satisfaction levels were obtained.
OBJETIVO: La pandemia por la COVID-19 motivó que la Consejería de Sanidad de la Comunidad de Madrid reorganizara la atención urgente de Obstetricia-Ginecología y Neonatología. El 24/03/2020 se inicia en el Hospital Universitario La Paz (HULP) un programa de alta precoz posparto y visita domiciliaria. El objetivo de este estudio fue detectar si la estrategia de "alta precoz voluntaria y visita domiciliaria por la residente de matrona" aplicada por el HULP durante la pandemia por la COVID-19 tuvo algún efecto adverso en puérpera y/o recién nacido (RN). METODOS: Estudio observacional descriptivo transversal, con muestreo de conveniencia en mujeres incluidas en el programa de alta precoz voluntaria-visita domiciliaria entre 24/03/2020 y 5/05/2020. Se analizaron 222 historias clínicas y cuestionarios telefónicos de puérperas que cumplieron los criterios de selección. El análisis estadístico se realizó con el programa SAS-9.4. RESULTADOS: La media de estancia hospitalaria fue de 25h 15min. Derivaron al HULP a 8,6% neonatos, ingresando un 2,2% por hiperbilirrubinemia. El 2,3% de padres con sus neonatos acudieron a urgencias, ingresando el 0,46%. El 0,4% de puérperas precisó reingreso. Al alta, el 84,2% de RN tomaban lactancia materna exclusiva (LME). A la semana, el 73,4% de RN estaban con LME, el 18% con lactancia mixta y el 8,6% con lactancia artificial. El 89,6% consideró adecuada el alta precoz. Percibieron como "muy satisfactoria" la visita domiciliaria un 83,3%, y la atención profesional recibida un 88,7%. CONCLUSIONES: Con el alta precoz-visita domiciliaria se ofrece continuidad de cuidados, detectando y resolviendo problemas, manteniendo un alto grado de satisfacción materna.
Assuntos
COVID-19 , Visita Domiciliar , Pandemias , Alta do Paciente , Cuidado Pós-Natal , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Alta do Paciente/estatística & dados numéricos , Cuidado Pós-Natal/organização & administração , Gravidez , Espanha/epidemiologia , Fatores de TempoRESUMO
BACKGROUND: Maternal complications, including psychological/mental health problems and neonatal morbidity, have commonly been observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following birth may prevent health problems from becoming chronic, with long-term effects. This is an update of a review last published in 2017. OBJECTIVES: The primary objective of this review is to assess the effects of different home-visiting schedules on maternal and newborn mortality during the early postpartum period. The review focuses on the frequency of home visits (how many home visits in total), the timing (when visits started, e.g. within 48 hours of the birth), duration (when visits ended), intensity (how many visits per week), and different types of home-visiting interventions. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (19 May 2021), and checked reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-, quasi-RCTs and studies available only as abstracts) comparing different home-visiting interventions that enrolled participants in the early postpartum period (up to 42 days after birth) were eligible for inclusion. We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period), and studies recruiting only women from specific high-risk groups (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included 16 randomised trials with data for 12,080 women. The trials were carried out in countries across the world, in both high- and low-resource settings. In low-resource settings, women receiving usual care may have received no additional postnatal care after early hospital discharge. The interventions and controls varied considerably across studies. Trials focused on three broad types of comparisons, as detailed below. In all but four of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the well-being of mothers and babies, and to provide education and support. However, some interventions had more specific aims, such as to encourage breastfeeding, or to provide practical support. For most of our outcomes, only one or two studies provided data, and results were inconsistent overall. All studies had several domains with high or unclear risk of bias. More versus fewer home visits (five studies, 2102 women) The evidence is very uncertain about whether home visits have any effect on maternal and neonatal mortality (very low-certainty evidence). Mean postnatal depression scores as measured with the Edinburgh Postnatal Depression Scale (EPDS) may be slightly higher (worse) with more home visits, though the difference in scores was not clinically meaningful (mean difference (MD) 1.02, 95% confidence interval (CI) 0.25 to 1.79; two studies, 767 women; low-certainty evidence). Two separate analyses indicated conflicting results for maternal satisfaction (both low-certainty evidence); one indicated that there may be benefit with fewer visits, though the 95% CI just crossed the line of no effect (risk ratio (RR) 0.96, 95% CI 0.90 to 1.02; two studies, 862 women). However, in another study, the additional support provided by health visitors was associated with increased mean satisfaction scores (MD 14.70, 95% CI 8.43 to 20.97; one study, 280 women; low-certainty evidence). Infant healthcare utilisation may be decreased with more home visits (RR 0.48, 95% CI 0.36 to 0.64; four studies, 1365 infants) and exclusive breastfeeding at six weeks may be increased (RR 1.17, 95% CI 1.01 to 1.36; three studies, 960 women; low-certainty evidence). Serious neonatal morbidity up to six months was not reported in any trial. Different models of postnatal care (three studies, 4394 women) In a cluster-RCT comparing usual care with individualised care by midwives, extended up to three months after the birth, there may be little or no difference in neonatal mortality (RR 0.97, 95% CI 0.85 to 1.12; one study, 696 infants). The proportion of women with EPDS scores ≥ 13 at four months is probably reduced with individualised care (RR 0.68, 95% CI 0.53 to 0.86; one study, 1295 women). One study suggests there may be little to no difference between home visits and telephone screening in neonatal morbidity up to 28 days (RR 0.97, 95% CI 0.85 to 1.12; one study, 696 women). In a different study, there was no difference between breastfeeding promotion and routine visits in exclusive breastfeeding rates at six months (RR 1.47, 95% CI 0.81 to 2.69; one study, 656 women). Home versus facility-based postnatal care (eight studies, 5179 women) The evidence suggests there may be little to no difference in postnatal depression rates at 42 days postpartum and also as measured on an EPDS scale at 60 days. Maternal satisfaction with postnatal care may be better with home visits (RR 1.36, 95% CI 1.14 to 1.62; three studies, 2368 women). There may be little to no difference in infant emergency health care visits or infant hospital readmissions (RR 1.15, 95% CI 0.95 to 1.38; three studies, 3257 women) or in exclusive breastfeeding at two weeks (RR 1.05, 95% CI 0.93 to 1.18; 1 study, 513 women). AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effect of home visits on maternal and neonatal mortality. Individualised care as part of a package of home visits probably improves depression scores at four months and increasing the frequency of home visits may improve exclusive breastfeeding rates and infant healthcare utilisation. Maternal satisfaction may also be better with home visits compared to hospital check-ups. Overall, the certainty of evidence was found to be low and findings were not consistent among studies and comparisons. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
Assuntos
Visita Domiciliar , Cuidado Pós-Natal/organização & administração , Viés , Aleitamento Materno/estatística & dados numéricos , Depressão Pós-Parto/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Satisfação do Paciente , Mortalidade Perinatal , Cuidado Pós-Natal/estatística & dados numéricos , Período Pós-Parto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de TempoRESUMO
BACKGROUND: Postnatal care (PNC) is important for preventing morbidity and mortality in mothers and newborns. Even though its importance is highlighted, PNC received less attention than antenatal care. This study determines the level of PNC coverage and its determinants in Srilanka. METHODS: This is a secondary analysis of the 2016 Demographic and Health Survey. Receiving full postnatal care (FPNC) was defined with a set of indicators to detect adequate care for mother and newborn. Demographic and socio-economic associated factors for receiving FPNC were identified using binary and multiple logistic regression. Variables that had marginal relationship with receiving FPNC which p-value less than or equal to 0.2 at binary analysis were selected and included in the multiple logistic regression models. We used manual backward stepwise regression to identify variables which had independent association with receiving FPNC on the basis of adjusted odds ratios (AOR), with 95% confidence interval (CI) and p-value less than 0.05. All analyses were performed in SPSS 25. RESULTS: Of the 8313 women with a live birth in the last 5 years, more than 98% had received postnatal care at facility at least 24 h. More than three-fourth of mothers (n = 5104) received the FPNC according to WHO guideline. Four factors were positively associated with receiving FPNC: mothers received antenatal home visits by Public health midwife (AOR = 1.98, 95% CI 1.65-2.39), mothers who got information about antenatal complications and places to go at antenatal clinics (AOR = 1.56, 95% CI 1.27-1.92), been Sinhala (AOR = 1.89, 95% CI 1.35-2.66) and having own mobile phone (AOR = 1.19, 95% CI 1.02-1.38). Mothers who are residing in rural area (AOR = 0.697 95% CI = 0.52-0.93] compared to those who reside in urban areas and maternal age between 20 and 34 years [AOR = 0.72, 95% CI 0.54-0.97] compared to maternal age less than 20 years were detected as negatively associated. CONCLUSION: Receiving FPNC in Srilanka is high. However, inequity remains to be a challenge. Socio-demographic factors are associated with FPNC coverage. Strategies that aim to improve postnatal care should target improvement of non-health factors as well.
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Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Adulto , Fatores Etários , Criança , Pré-Escolar , Pai/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Cuidado Pós-Natal/organização & administração , Gravidez , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Sri Lanka , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
This guideline covers the routine postnatal care that women and their babies should receive in the first 8 weeks after the birth. It includes the organisation and delivery of postnatal care, identifying and managing common and serious health problems in women and their babies, how to help parents form strong relationships with their babies, and baby feeding. The recommendations on emotional attachment and baby feeding also cover the antenatal period. The guideline uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but are pregnant or have given birth. Similarly, where the term 'parents' is used, this should be taken to include anyone who has main responsibility for caring for a baby. The Royal College of Obstetricians and Gynaecologists has produced guidance on COVID-19 and postnatal care for all midwifery and obstetric services.
Assuntos
Humanos , Feminino , Recém-Nascido , Cuidado Pós-Natal/organização & administração , Aleitamento Materno/métodos , Período Pós-Parto/fisiologia , Serviços de Saúde Materno-Infantil/organização & administraçãoRESUMO
BACKGROUND: Hospital-based kangaroo mother care can help reduce preventable newborn deaths and has been recommended by the World Health Organization in the care of low birthweight babies weighing 2000 g or less. However, implementation has been limited. The objective of this review is to understand the barriers and facilitators of kangaroo mother care implementation in health facilities in sub-Saharan Africa, where there are the highest rates of neonatal mortality in the world. METHODS: A systematic search was performed on MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, African Journals Online, African Index Medicus as well as the references of relevant articles. Inclusion criteria included primary research, facility-based kangaroo mother care in sub-Saharan Africa. Studies were assessed by the Critical Appraisal Skills Programme Qualitative Checklist and the National Institutes of Health quality assessment tools and underwent narrative synthesis. RESULTS: Thirty studies were included in the review. This review examined barriers and facilitators to kangaroo mother care practice at health systems level, health worker experiences and perspectives of mothers and their families. Strong local leadership was essential to overcome barriers of inadequate space, limited budget for supplies, inadequate staffing, lack of guidelines and policies and insufficient supportive supervision. Workload burdens, knowledge gaps and staff attitudes were highlighted as challenges at health workers' level, which could be supported by sharing of best practices and success stories. Support for mothers and their families was also identified as a gap. CONCLUSION: Building momentum for kangaroo mother care in health facilities in sub-Saharan Africa continues to be a challenge. Strengthening health systems and communication, prioritizing preterm infant care in public health strategies and supporting health workers and mothers and their families as partners in care are important to scale up. This will support sustainable kangaroo mother care implementation as well as strengthen quality of newborn care overall. PROSPERO registration: CRD42020166742.
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Barreiras de Comunicação , Método Canguru , Cuidado Pós-Natal , África Subsaariana , Necessidades e Demandas de Serviços de Saúde , Humanos , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Método Canguru/métodos , Método Canguru/psicologia , Cuidado Pós-Natal/organização & administração , Cuidado Pós-Natal/normasRESUMO
BACKGROUND: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. METHOD: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. RESULTS: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16-112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. CONCLUSIONS: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.
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Acreditação/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde/organização & administração , Bem-Estar do Lactente/estatística & dados numéricos , Valores Sociais , Acreditação/economia , Austrália , Aleitamento Materno/economia , Feminino , Promoção da Saúde/economia , Hospitais/estatística & dados numéricos , Humanos , Bem-Estar do Lactente/economia , Recém-Nascido , Política Organizacional , Cuidado Pós-Natal/organização & administração , Gravidez , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
BACKGROUND: Supporting women to continue breastfeeding is a global challenge. The Milky Way Program is an effective face to face intervention to increase breastfeeding rates up to six months postpartum. The sustainability and access to the Milky Way Program could be enhanced by transforming it into a mobile application allowing women to access relevant information from their own place at a convenient time. AIM: To explore the process of transforming the Milky Way Program into an acceptable and usable mobile health application. METHOD: Stakeholders including multidisciplinary researchers and end-users designed the application based on the Milky Way Program by using Persuasive System Design principles. A mixed-method approach was used in the development and evaluation process. Seven women were recruited through convenience sampling to pilot test the application. The women's feedback was collected through an online survey six weeks after birth and individual interviews at four months postpartum. FINDINGS: Women in the pilot study reported that the breastfeeding application was well designed, easy to use, interactive, reassuring and evidence-based with credible sources of information. CONCLUSION: The Persuasive System Design model combined with end-user engagement can feasibly inform the development of an acceptable and usable mobile health application for breastfeeding based on a proven clinical intervention. Further rigorous testing is required to evaluate the effectiveness of the application on breastfeeding initiation and duration.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Educação em Saúde/métodos , Cuidado do Lactente/métodos , Aplicativos Móveis , Mães/psicologia , Cuidado Pós-Natal/organização & administração , Adulto , Aleitamento Materno/psicologia , Feminino , Humanos , Recém-Nascido , Projetos Piloto , Período Pós-Parto , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Many factors influence women's use of alcohol and other drugs while pregnant and postpartum. Substance use impacts the maternal-child relationship during the critical neonatal period. The first days and months of human development lay the foundation for health and well-being across the lifespan, making this period an important window of opportunity to interrupt the transmission of trauma and stress to the next generation. Pregnant and postpartum women with a history of substance use require specialized support services. METHODS: The Team for Infants Exposed to Substance abuse (TIES) Program provides a holistic, multi-disciplinary, community-based model to address the complex needs of families with young children affected by maternal substance use. RESULTS: A multi-year implementation study of the model yielded results that indicate the effectiveness of this home-based family support intervention. The model focuses on reducing maternal alcohol and other drug use, increasing positive parenting, promoting child and maternal health, and improving family income and family housing. A key component of the model is establishing a mutual, trusting relationship between the home visiting specialists and the family. Foundational to the TIES model is a family-centered, culturally competent, trauma-informed approach that includes formal interagency community partnerships DISCUSSION: This article describes elements of the model that lead to high retention and completion rates and family goal attainment for this unique population.
Assuntos
Visita Domiciliar/estatística & dados numéricos , Relações Mãe-Filho , Poder Familiar/psicologia , Cuidado Pós-Natal/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Criança , Aconselhamento , Feminino , Humanos , Lactente , Masculino , Saúde Materna , Cuidado Pós-Natal/organização & administração , Gravidez , Avaliação de Programas e Projetos de Saúde , Apoio Social , Adulto JovemAssuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/epidemiologia , Vigilância em Saúde Pública/métodos , Maternidades/organização & administração , Brasil/epidemiologiaAssuntos
COVID-19 , Controle de Doenças Transmissíveis/métodos , Cuidado Pós-Natal , Atenção Primária à Saúde , Saúde da Mulher/normas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Recém-Nascido , Masculino , Inovação Organizacional , Distanciamento Físico , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/organização & administração , Cuidado Pós-Natal/normas , Cuidado Pós-Natal/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , SARS-CoV-2 , Medicina Estatal/normas , Telemedicina , Reino UnidoRESUMO
BACKGROUND: The recent use of antenatal care (ANC) has steadily improved in low- and middle-income countries (LMIC), but postnatal care (PNC) has been widely underutilized. Most maternal and newborn deaths occur during the critical postnatal period, but PNC does not receive adequate attention or support, particularly in Sub-Saharan Africa. In Ghana, the majority of mothers attend four ANC assessments, but far fewer receive the four recommended PNC visits. This study sought to understand perceptions toward PNC counselling administered prior to discharge among both mothers and healthcare providers in the Greater Accra Region of Ghana. METHODS: Facility assessments were conducted among 13 health facilities to determine the number and type of deliveries, staffing, timing of discharge following delivery and the PNC schedule. Structured interviews were conducted for 172 mothers over four-months in facilities, which included one regional hospital, four district hospitals, and eight sub-district level hospitals. Additionally, healthcare providers from 12 of the 13 facilities were interviewed. Data were analyzed with Chi-square or students t-test, as appropriate, with p < 0.05 considered statistically significant. RESULTS: Ninety-nine percent of mothers received PNC instructions prior to hospital discharge, the majority of which were given in a group format. Mothers in the regional hospital were significantly more likely to have been informed about maternal danger signs but were less likely to know the PNC schedule than were mothers in district and sub-district facilities. No mother recalled more than four maternal or five newborn danger signs. Thirty-eight percent of facilities did not have PNC guidelines. Most patient and providers reported positive attitudes toward the level of PNC education, however, knowledge was inconsistent regarding the number and timing of PNC visits as well as other critical information. Only 23% of patients reported having a contact number to call for concerns. CONCLUSIONS: Despite overall positive feelings toward PNC among Ghanaian mothers and providers, there are significant gaps in PNC education that must be addressed in order to recognize problems and to prevent serious complications. Improvements in pre-discharge PNC counseling should be provided in Ghana to give mothers and babies a better chance at survival in the critical postnatal period.
Assuntos
Educação em Saúde/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pós-Natal/organização & administração , Adulto , Aconselhamento/organização & administração , Aconselhamento/estatística & dados numéricos , Feminino , Gana , Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Maternidades/organização & administração , Humanos , Lactente , Morte do Lactente/prevenção & controle , Morte Materna/prevenção & controle , Mães/psicologia , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Cuidado Pós-Natal/estatística & dados numéricos , Adulto JovemRESUMO
Breastfeeding has health benefits for both infants and mothers and is recommended by numerous health and medical organizations*, (1). The birth hospitalization is a critical period for establishing breastfeeding; however, some hospital practices, particularly related to mother-newborn contact, have given rise to concern about the potential for mother-to-newborn transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2). CDC conducted a COVID-19 survey (July 15-August 20, 2020) among 1,344 hospitals that completed the 2018 Maternity Practices in Infant Nutrition and Care (mPINC) survey to assess current practices and breastfeeding support while in the hospital. Among mothers with suspected or confirmed COVID-19, 14.0% of hospitals discouraged and 6.5% prohibited skin-to-skin care; 37.8% discouraged and 5.3% prohibited rooming-in; 20.1% discouraged direct breastfeeding but allowed it if the mother chose; and 12.7% did not support direct breastfeeding, but encouraged feeding of expressed breast milk. In response to the pandemic, 17.9% of hospitals reported reduced in-person lactation support, and 72.9% reported discharging mothers and their newborns <48 hours after birth. Some of the infection prevention and control (IPC) practices that hospitals were implementing conflicted with evidence-based care to support breastfeeding. Mothers who are separated from their newborn or not feeding directly at the breast might need additional postdischarge breastfeeding support. In addition, the American Academy of Pediatrics (AAP) recommends that newborns discharged before 48 hours receive prompt follow-up with a pediatric health care provider.
Assuntos
Aleitamento Materno , Infecções por Coronavirus/prevenção & controle , Hospitais/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal/organização & administração , COVID-19 , Infecções por Coronavirus/epidemiologia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Recém-Nascido , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Less than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been in progress since 2015 resulting in escalated method uptake in implementing hospitals. This study investigates failure rate, complications, and risk factors for one-year continuation of TCu380A IUD when used for immediate postpartum contraception under the initiative in Tanzania. METHODOLOGY: A prospective cohort study of women who had TCu380A insertion within 48 h of delivery in 6 hospitals in Tanzania between 1st December 2017 and 18th April 2018 was conducted. Face to face post insertion interviews were made with 1114 clients before discharge and later through phone calls up to the beginning of 13th month postpartum. Postpartum Intrauterine Device (PPIUD) continuation status, complications, duration of time they stayed with the IUD and the currently used method if PPIUD was discontinued were enquired. The outcome variable was PPIUD continuation at one year of IUD insertion. Data were analyzed using Statistical Product and Service Solutions software (SPSS) for Windows version 20 (IBM SPSS Statistics, Chicago, IL, USA). RESULTS: In total 511(45.8%)clients had consented and availed to complete the one-year follow-up. Out of these, 440 still had IUD, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7th week and 6 months of insertion. One-year method expulsion rate was 2.1%. There was one reported pregnancy that gives a method failure rate of about 2 per 1000. The independent risk factors in favor of method continuation at one year were absence of medical or social problem, being a youth (16-24 years), and delivery by Cesarean section. CONCLUSIONS: The continuation rate when CuT380A is used for immediate postpartum contraception is high, with low complication and failure rates. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.
Assuntos
Anticoncepção/métodos , Serviços de Planejamento Familiar/organização & administração , Dispositivos Intrauterinos de Cobre , Dispositivos Intrauterinos/efeitos adversos , Cuidado Pós-Natal/organização & administração , Adolescente , Adulto , Cesárea , Estudos de Coortes , Feminino , Humanos , Doença Inflamatória Pélvica/etiologia , Período Pós-Parto , Gravidez , Estudos Prospectivos , Tanzânia/epidemiologia , Hemorragia Uterina/etiologia , Perfuração Uterina/etiologiaRESUMO
Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.
Assuntos
Canal Anal/lesões , Lacerações/terapia , Obstetrícia , Distúrbios do Assoalho Pélvico/terapia , Modalidades de Fisioterapia , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Parto Obstétrico/efeitos adversos , Dispareunia/terapia , Incontinência Fecal/terapia , Feminino , Humanos , Lacerações/etiologia , Equipe de Assistência ao Paciente , Diafragma da Pelve/lesões , Distúrbios do Assoalho Pélvico/etiologia , Prolapso de Órgão Pélvico/terapia , Dor Pélvica/terapia , Períneo/lesões , Período Periparto , Gravidez , Encaminhamento e Consulta , Incontinência Urinária/terapiaAssuntos
Infecções por Coronavirus , Enfermagem Baseada em Evidências , Enfermagem Neonatal , Pandemias , Pneumonia Viral , Cuidado Pós-Natal , American Nurses' Association , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Enfermagem Baseada em Evidências/métodos , Enfermagem Baseada em Evidências/tendências , Feminino , Humanos , Recém-Nascido , Controle de Infecções/organização & administração , Enfermagem Neonatal/organização & administração , Enfermagem Neonatal/normas , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/organização & administração , Cuidado Pós-Natal/tendências , SARS-CoV-2 , Estados UnidosRESUMO
The COVID-19 pandemic has posed challenges for medical education and patient care, which were felt acutely in obstetrics due to the essential nature of pregnancy care. The mobilization of health professions students to participate in obstetric service-learning projects has allowed for continued learning and professional identify formation while also providing a motivated, available, and skilled volunteer cohort to staff important projects for obstetric patients.
Assuntos
COVID-19 , Atenção à Saúde/organização & administração , Obstetrícia/organização & administração , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Estudantes de Ciências da Saúde , Voluntários , Estágio Clínico , Feminino , Humanos , Cidade de Nova Iorque , Portais do Paciente , Equipamento de Proteção Individual/provisão & distribuição , Gravidez , SARS-CoV-2 , Estudantes de Medicina , Estudantes de Enfermagem , Estudantes de Saúde Pública , Telemedicina/organização & administração , TelefoneRESUMO
BACKGROUND: Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn't adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. METHODS: We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system's readiness and families' willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. RESULTS: Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents' resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. CONCLUSIONS: We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.