Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial.

INTRODUCTION: In some European countries, discharge the day after planned cesarean section has become an accepted procedure. However, little is known about the patients' perception of early discharge. The aim of this study was to compare early discharge with standard care in relation to parental sense of security. Further, we evaluated postoperative pain, mobilization, and readmission. MATERIAL AND METHODS: We performed a randomized clinical trial including parous, singleton pregnant women with a planned cesarean section at term. The women were allocated to either discharge within 28 hours (intervention group) or after 48 hours (standard care group) following the cesarean section. Women discharged within 28 hours after cesarean section were offered a home visit by a midwife the following day. The primary outcome was the postnatal sense of security, which was reported by the woman and her partner in the "Parents' Postnatal Sense of Security" questionnaire 1 week postpartum. Secondary outcomes were pain score, use of analgesics, mobilization, readmission, and contacts with the healthcare system in the postoperative period. RESULTS: We included 143 women, of whom 72 were allocated to the intervention group and 71 were allocated to the standard care group. There were no differences in baseline characteristics. The two groups did not differ concerning the postnatal sense of security for the women (P = .98) or the postnatal sense of security for the partners (P = .38). We found no difference in pain scores, step count, use of analgesics, or number of contacts with the health-care system between the groups. CONCLUSIONS: Parental postnatal sense of security is not compromised by discharge within 28 hours followed by a home visit compared with discharge after 48 hours after planned cesarean section among parous women.

Breastfeeding: Australian Breastfeeding Association volunteers are positive deviants in Australian society.

PROBLEM: Australian breastfeeding rates are low, and strategies to increase them have been inadequate. New approaches for supporting breastfeeding are required. BACKGROUND: Preliminary data suggested that Australian Breastfeeding Association members had higher exclusive breastfeeding rates than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted project provided an opportunity to determine which practices were influencing better breastfeeding outcomes. AIMS: (1) To determine whether Australian Breastfeeding Association volunteer trainees were positive deviants regarding breastfeeding practices, (2) to explore characteristics or behaviours underpinning beneficial breastfeeding practices and (3) to identify modifiable characteristics to inform breastfeeding promotion. METHODS: A cross-sectional, one-group survey design was used. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with the Australian Breastfeeding Association (N=174), and analysed using descriptive statistics. FINDINGS: Participants in this project had higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Identified modifiable factors were knowledge and motivation to breastfeed, partner and peer support, birthing outcomes, immediate skin-to-skin contact, formula supplementation and positive attitudes to breastfeeding at work and breastfeeding in public. DISCUSSION: Participants could be defined as positive deviants with positive attitudes towards breastfeeding. The personal behaviours and practices of this group may help inform future breastfeeding interventions. CONCLUSIONS: Identifying positive deviants and supporting the broader community to adopt behaviours that explain improved breastfeeding outcomes could be powerful methods to produce change.

Factors associated with choice of antenatal, delivery and postnatal services between HIV positive and HIV negative women in Zambia.

BACKGROUND: Previous research has shown that developing countries account for the majority of maternal deaths around the world. Relatively high maternal mortality in developing countries has been linked to high HIV prevalence rates in these countries. Several studies have shown that women living with HIV are more vulnerable and are thus more likely to die during maternity than those who are not. Although there has been increased focus on this subject in contemporary research, the relationship between HIV status and maternal-care-utilization is not very well understood. It is not clear whether factors associated with professional maternal care utilization during antenatal, delivery and postnatal periods are similar for HIV positive and HIV negative women. It is also not known whether being HIV positive has an impact on the choice of care (professional care or traditional birth attendants). Thus the aim of this study is to investigate the differences in factors affecting choice of care during antenatal, delivery and postnatal periods between HIV positive and HIV negative women. We also investigate the effect of HIV positive status on choice of care. METHODS: By using the 2013-2014 Zambia Demographic Health Survey Data (ZDHS), we performed two different quantitative analyses. a) Regression analysis: to identify and compare factors associated with the likelihood of utilizing professional care during antenatal, at birth and postnatal periods between HIV positive and HIV negative women. b) Propensity score matching: to investigate the effect of being HIV positive on the choice of care (Professional care or TBAs). RESULTS: Our results show that reasons for choosing professional care during antenatal, at birth, and postnatal periods are the same for both HIV positive and HIV negative women. Further, we also showed that although the probability of utilizing professional care is slightly higher for HIV positive women, the difference is negligible. CONCLUSION: We demonstrated that in Zambia, utilization of professional care among HIV positive women is not particularly high. We also demonstrate that although institutional care is desirable and an ideal solution for HIV positive women, insisting on institutional care when the health facilities lack adequate trained personnel, drugs, and equipment is counterproductive.

As vivências da maternidade e a concepção da interação mãe-bebê: interfaces entre as mães primíparas adultas e adolescentes / The motherhood experiences and the conception of mother-baby interaction: interfaces between primiparous adult mothers and adolescents / Las experiencias de la maternidad y el diseño de la interacción madre-hijo: interfaces entre las madres de adultos por primera vez y adolescentes

Objective: The study's purpose has been to further understand the interfaces of the experiences related to the first experience of both adolescent and adult mothers, then seeking to identify the creation of the mother-baby interaction. Methods: It is a descriptive-exploratory study with a qualitative approach, which counted with the participation of eleven primiparous mothers, from the Chapecó city, Santa Catarina State. Data collection was carried out through semi-structured questions, and the participants were identified by butterfly names. Data were analyzed using the Content Analysis. Results: The findings have shown profound changes in the way of life of the primiparous mothers, such as: physical changes, image concerns, greater responsibility, sadness, joy, fear, distancing from friends, sudden changes in lifestyle; and, for the adolescent mothers were found school abandonment and difficulties with child care. Conclusion: Bearing in mind the implications of motherhood, some adolescent mothers feel unprepared for maternity, because they are too young, although they believe that there is no differentiation between their feelings and those of an adult and primiparous mother

Objetivo: Compreender as interfaces das vivências relacionadas à primeira experiência de mães adolescentes e adultas, buscando identificar a construção da interação mãe-bebê. Método: Estudo exploratório, descritivo, qualitativo, com participação de onze mães primíparas, do município de Chapecó/ SC. Para a coleta de dados foi utilizado questões semiestruturadas e as participantes foram identificadas pelo nome de borboletas. Os dados foram analisados através da Análise de Conteúdo. Resultados: Mudanças profundas na forma de viver das mães primíparas, como: alterações físicas, preocupações com a imagem, maior responsabilidade, tristeza, alegria, medo, distanciamento de amigos, brusca alteração no modelo de vida, e para a adolescente mãe, também o abandono escolar e dificuldades com o cuidado da criança. Conclusão: No que tange às implicações da maternidade, algumas mães adolescentes sentem-se despreparadas para desempenhar a maternidade, por terem pouca idade, porém, acreditam não haver diferenciação entre seus sentimentos com os de uma mãe adulta e primípara

Objetivo: Comprender las interfaces de las vivencias relacionadas con la primera experiencia de madres adolescentes y adultas, buscando identificar la construcción de la interacción madre-bebé. Método: estudio exploratorio, descriptivo, cualitativo, con participación de once madres primíparas, del municipio de Chapecó SC. Para la recolección de datos se utilizaron cuestiones semiestructuradas y las participantes fueron identificadas por el nombre de mariposas. Los datos se analizaron a través del análisis de contenido. Resultados: cambios profundos en la forma de vivir de las madres primíparas, como: alteraciones físicas, preocupaciones con la imagen, mayor responsabilidad, tristeza, alegría, miedo, distanciamiento de amigos, brusca alteración en el modelo de vida, y para la adolescente madre, El abandono escolar y las dificultades con el cuidado del niño. Conclusión: En lo que se refiere a las implicaciones de la maternidad, algunas madres adolescentes se sienten despreparadas para desempeñar la maternidad, por tener poca edad, sin embargo, creen no haber diferenciación entre sus sentimientos con los de una madre adulta y primípara

Barriers to Postpartum Glucose Intolerance Screening in an Italian Population.

Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015⁻2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6⁻12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.

Counseling Women on Smoking Relapse Prevention During Postpartum.

Many women who quit smoking after learning they are pregnant revert back to smoking after birth of their baby. The high rate of recidivism suggests that women need education about risk of relapse and effective strategies to remain smoke free even before they are discharged from the hospital. Despite evidence that smoking cessation and relapse prevention counseling is effective during early postpartum, many nurses do not provide their patients with this important information, perhaps because they feel inadequately prepared to do so. Helping Women Stop Smoking in Pregnancy and Beyond is an education program designed to help perinatal nurses inform women of negative risks of smoking and offer women strategies to avoid the high probability of resuming smoking after birth. It includes evidence-based interventions that can be used by nurses to provide effective smoking relapse prevention counseling to women during postpartum.

Mothers Value and Utilize Early Outpatient Education on Breast Massage and Hand Expression in Their Self-Management of Engorgement.

BACKGROUND: Breast engorgement is a major cause of pain and weaning in the early postpartum period. While protocols reinforce the need for anticipatory engorgement advice and continued outpatient health professional breastfeeding support, there remains limited information on the efficacy of focused postdischarge engorgement education. This study sought to explore if outpatient postpartum engorgement education changed mothers' home management and if mothers found instruction on specific massage and hand expression techniques helpful. MATERIALS AND METHODS: This was a prospective descriptive cohort study. Subjects received engorgement-specific postpartum support from a healthcare professional at the posthospital discharge (PD) newborn visit. Email surveys at 1, 2, and 12 weeks postpartum collected data on engorgement home management, clinical course, and postpartum education. RESULTS: After the office visit, mothers changed their engorgement home management. Significantly more mothers utilized massage toward the axillae (25% versus 1%, p ≤ 0.001), reverse pressure softening (18% versus 3%, p = 0.001), and feeding more frequently (32% versus 16%, p = 0.04). Sixty-one percent would not have used massage and hand expression before education in the office. At 12 weeks, 96% of women reported massage and hand expression instruction as helpful. Mothers reported engorgement peaked at a median of 5 days postpartum, corresponding well to the office visit at a median of 4 days postpartum. CONCLUSIONS: Maternal engorgement symptoms are commonly present at the PD newborn visit. Education on engorgement, massage, and hand expression at this visit significantly changes home management strategies. Mothers find massage and hand expression instruction helpful.

[Barriers and facilitators for physical activity during pregnancy and postpartum in women living in poverty of Mexico]. / Barreras y facilitadores para actividad física durante el embarazo y posparto en mujeres pobres de México.

OBJECTIVE: To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico. MATERIALS AND METHODS: A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation). RESULTS: The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002). CONCLUSION: There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

Barreras y facilitadores para actividad física durante el embarazo y posparto en mujeres pobres de México / Barriers and facilitators for physical activity during pregnancy and postpartum in women living in poverty of Mexico

Objetivo. Explorar percepciones de proveedores de salud y beneficiarías del Programa Oportunidades sobre la práctica de actividad física durante el embarazo y posparto, e identificar características de la consejería sobre el tema en el primer nivel de atención en salud. Material y métodos. Estudio de métodos mixtos que forma parte de una intervención en nutrición del Programa Oportunidades. La información cualitativa se colectó por entrevista (50 mujeres; 34 proveedores de salud) y se obtuvo información cuantitativa a partir de un cuestionario (n=88 mujeres; n=64 proveedores; n=111 observaciones de consulta). Resultados. Se documentaron barreras a) individuales: falta de tiempo y de apoyo social; b) socioculturales: prejuicios de pares y familiares, y falta de instructores, y c) ambientales: falta de espacios físicos seguros y apropiados. 38% de las mujeres reporta haber recibido consejería sobre el tema versus 63.4% de proveedores que reportan haberla dado (p=0.002). Conclusiones. Urgen capacitación a proveedores y promoción de la actividad física que eliminen los prejuicios asociados al tema durante el embarazo y posparto.

Objective.To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico. Materials and methods. A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation). Results. The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002). Conclusion. There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

Fertility desires and intentions among HIV-positive women during the post-natal period in Uganda.

This study describes the fertility intentions and discusses the potential reproductive health needs of post-natal HIV-infected Ugandan women. HIV-infected mothers attending post-natal services in Kampala, Uganda participated in this cross-sectional study using structured interviewer administered questionnaires. Descriptive statistics and logistic regression models were used to identify predictors of desire for more children. Among 403 participants, 35% desired more children. Of these, 25% wanted another child within 2 years and 75% within 3 years or more. In multivariable analyses, believing that one's partners wanted more children (OR = 2.44; 95% CI = 1.30, 4.59) was associated with the desire for future children while having more living children was negatively associated with the desire for future children (OR = 0.08; 95% CI = 0.02, 0.39). A minority of women desired future pregnancies, and most wanted to delay pregnancy for 3 years. These women are in need of family planning (FP) methods to meet stated desires to delay or end future pregnancies. Perceived partner desire for children also impacts on women's fertility intentions, highlighting the importance of engaging men during the post-natal period.67-77)

Fathers' experiences of supporting breastfeeding: challenges for breastfeeding promotion and education.

Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother-infant dyad and to recognise their importance in promoting and enabling breastfeeding.

Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action.

Three important infant feeding support problems are addressed: (1) mothers who use formula milk can feel undersupported and judged; (2) mothers can feel underprepared for problems with breastfeeding; and (3) many mothers who might benefit from breastfeeding support do not access help. Theory of constraints (TOC) is used to examine these problems in relation to ante-natal education and post-natal support. TOC suggests that long-standing unresolved problems or 'undesirable effects' in any system (in this case a system to provide education and support) are caused by conflicts, or dilemmas, within the system, which might not be explicitly acknowledged. Potential solutions are missed by failure to question assumptions which, when interrogated, often turn out to be invalid. Three core dilemmas relating to the three problems are identified, articulated and explored using TOC methodology. These are whether to: (1) promote feeding choice or to promote breastfeeding; (2) present breastfeeding positively, as straightforward and rewarding, or focus on preparing mothers for problems; and (3) offer support proactively or ensure that mothers themselves initiate requests for support. Assumptions are identified and interrogated, leading to clarified priorities for action relating to each problem. These are (1) shift the focus from initial decision-making towards support for mothers throughout their feeding journeys, enabling and protecting decisions to breastfeed as one aspect of ongoing support; (2) to promote the concept of an early-weeks investment and adjustment period during which breastfeeding is established; and (3) to develop more proactive mother-centred models of support for all forms of infant feeding.

Identification of mothers at risk for postpartum depression by hospital-based perinatal nurses.

In the western world, most women deliver their infants in a hospital setting. The purposes of this article are to provide guidelines and suggest best practices related to hospital-based care for postpartum depression by perinatal nurses; with this information, policies, procedures, and educational programs can be implemented to improve nursing care of new mothers. Hospital-based perinatal nurses need to "launch" new mothers from the hospital into the community so that the new mothers are prepared for self-monitoring for symptoms of depression, and know what steps to take if they do experience depressive symptoms.

Significado de la experiencia, para la madre adolescente de la hospitalización del recién nacido en la unidad neonatal. Hospital Engativá, 2012 / Meaning of the experience, for the adolescent mother of the hospitalization of the newborn in the neonatal unit. Engativa Hospital, 2012

Según el objetivo de la investigación que fue describir el significado de la experiencia para la madre adolescente de la hospitalización del recién nacido, en la unidad de cuidado neonatal, en un grupo de madres adolescentes del hospital Engativá de Bogotá; se realizó un estudio de tipo cualitativo, aplicando la etnoenfermería. Se tuvo en cuenta la información que aportaron ocho (8) informantes claves, madres adolescentes entre los 15 y 18 años, también la de seis (6) informantes generales, enfermeras profesionales. La recolección y análisis de los datos se llevó a cabo desde diciembre de 2011 hasta Julio de 2012. Los resultados proponen 11 patrones, 54 códigos y 4 temas. Conclusión: El significado de la experiencia para la madre adolescente de la hospitalización del recién nacido se evidencia en los temas propuestos, en los que se describen la universalidad y diversidad, cuando el investigador vuelve a la literatura con respecto a la experiencia de las madres en edad adulta y que justifica un cuidado específico a la adolescente que tiene su hijo hospitalizado.

As the aim of the research was to describe the meaning of the experience for the teen mother of newborn hospitalization in neonatal care unit in a group of adolescent mothers Engativá Bogota hospital, a study of type qualitative ethnonursing applying. It took into account the information provided eight (8) key informants, teenage mothers between 15 and 18, also of six (6) general informants, professional nurses. The collection and analysis of data was carried out from December 2011 to July 2012. The results suggest patterns 11, 54 and 4 subjects codes. Conclusion: The meaning of the experience for the teen mother of newborn hospitalization evidenced by the topics proposed, which describes the universality and diversity, when the researcher returns to the literature on the experience of mothers in adulthood and justifying specific care to the adolescent with his hospitalized son.

Postpartum depression among rural women from developed and developing countries: a systematic review.

PURPOSE: Postpartum depression (PPD) is a significant public health problem, with significant consequences for the mother, infant, and family. Available research has not adequately examined the potential impact of sociodemographic characteristics, such as place of residence, on risk for PPD. Therefore, this systematic review and meta-analysis examines the prevalence of and risk factors for PPD in rural communities within developed and developing countries, and where possible, compares rates to those among urban women. METHODS: Five databases were searched, from start dates through early May 2010, using key words relevant to PPD and rural residence. Peer-reviewed articles were eligible if a standardized assessment of depression was administered to rural mothers within the first year postpartum. Data on PPD were extracted from 19 articles, of which 17 provided data for meta-analyses. FINDINGS: The overall prevalence of PPD among rural women was 27.0% (95% CI, 18.8%-37.2%). Prevalence was somewhat higher among women in developing countries (31.3%; 95% CI, 21.3%-43.5%) than among women in developed countries (21.5%; 95% CI, 10.9%-38.0%), although there was significant heterogeneity among both groups of studies. Comparisons between rural and urban women yielded conflicting results. Although established PPD risk factors were associated with depression in rural women, additional risk factors were reported for rural women from developing countries, such as having 2 or more young children. CONCLUSIONS: Longitudinal studies with clearly defined "rural" and "comparison" groups are needed to determine whether rural residence is associated with increased risk for PPD. The results can inform prevention and treatment programs tailored to serve rural women.

Maternal child home visiting program improves nursing practice for screening of woman abuse.

OBJECTIVE: This study investigated changes in public health nurse practices and the incidence of abuse inquiry and disclosure. DESIGN AND SAMPLE: A retrospective record review of cross-sectional data was collected before and after implementation of the Routine Universal Comprehensive Screening (RUCS) protocol within a maternal child home visiting program. Records of postpartum women receiving a universal home visit within 48 hr of discharge from the hospital were reviewed (pre-RUCS, n=459; post-RUCS, n=485). Also reviewed were the records of women receiving a family assessment for at risk home visiting (pre-RUCS, n=79; post-RUCS, n=66). MEASURES: The variables collected consisted of abuse inquiry, abuse disclosure, and the alone status. RESULTS: Documentation of women's alone status significantly improved for both types of home visits: the 48-hr home visits ( p<.001) and the at risk home visits ( p<.01). Disclosures of abuse significantly increased in both types of home visits ( p<.01). Ensuring privacy by not asking abuse questions if women were not alone during a visit significantly improved ( p<.001). CONCLUSIONS: Implementing a protocol to screen for woman abuse into an existing maternal child home visiting program demonstrated improved practices related to the safety and privacy of women, and an increase in abuse disclosures.

South Australian rural women's views of their pregnancy, birthing and postnatal care.

INTRODUCTION: This study considered the views and experiences of 85 rural women, most of whom gave birth in two regional South Australian hospitals. METHOD: This descriptive survey used a validated questionnaire, modified for use in rural South Australia, which included open-ended questions to invite further comment. Women were invited to participate while in hospital after giving birth and those who agreed (n = 136) were mailed a questionnaire 6-8 weeks after the birth. Data were collected on demographic and other information including: age, smoking status, model of antenatal and birth care, birth method, women's views of their care in pregnancy, labour and after the birth, breastfeeding uptake and continuance rates, and prevalence of possible depression after birth using the Edinburgh Postnatal Depression Scale. Non-identifiable data were described using descriptive statistics and analysed using t-tests, 2 x 2 contingency tables and relative risks, as appropriate. Where available, comparisons were made with other rural and South Australian data. Qualitative data were themed by consensus. RESULTS: Eighty-five women (63%) returned a completed questionnaire. Rates of spontaneous vaginal birth were significantly lower in the study than for 5257 South Australian rural residents who gave birth in 2006 (n = 38, 45% vs 3057, 58%). While caesarean rates overall were similar, elective caesarean rates were higher (25% vs 15%), while fewer study women smoked throughout pregnancy (9% vs 24%). Overall, women in the study rated their care as 'very good' for antenatal care(59%), for labour and birth care (73%) and postnatal care (53%). More women stayed in hospital for 5 days or more than South Australian women overall (53% vs 40%). Open-ended comments confirmed reasons that were related to their choice. Breastfeeding was commenced by 95% of the women and 69% were breastfeeding at 6 weeks. CONCLUSIONS: The findings confirm Victorian rural women's ratings, and further highlight that in the postnatal period women often feel left to manage on their own, and are less than happy with their care.

Postpartum depression in Asian cultures: a literature review.

OBJECTIVES: Postpartum depression (PPD), a major health concern, produces insidious effects on new mothers, their infant, and family. This literature review aims to explore risk factors for postpartum depression among women in Asian cultures, which has not been fully elaborated. DATA SOURCES: A literature search was undertaken by using various electronic research databases. Studies were eligible for this review if they (a) examined risk factors for PPD, (b) were conducted in Asian countries using quantitative or qualitative methodologies, and (c) were published in English in peer-reviewed journals between 1998 and 2008. A total of 64 studies from 17 countries were reviewed, summarised, and synthesised. RESULTS: The prevalence of postpartum depression in Asian countries ranged from 3.5% to 63.3% where Malaysia and Pakistan had the lowest and highest, respectively. Risk factors for postpartum depression were clustered into five major groups: biological/physical (e.g., riboflavin consumption), psychological (e.g., antenatal depression), obstetric/paediatric (e.g., unwanted pregnancy), socio-demographic (e.g., poverty), and cultural factors (e.g., preference of infants' gender). Traditional postpartum rituals were not found to provide substantial psychological benefits for the new mothers. CONCLUSIONS: This review informs a current state of knowledge regarding risk factors for postpartum depression and has implications for clinical practice. Health care professionals should be aware that the phenomenon is as prevalent in Asian cultures as in European cultures. Women should be screened for potential risk factors and depressive symptoms during pregnancy and postpartum periods so that appropriate interventions, if needed, can be initiated in a timely fashion.

The effect of health and nutrition education intervention on women's postpartum beliefs and practices: a randomized controlled trial.

BACKGROUND: 'Sitting month' is the Chinese tradition for postpartum customs. Available studies indicate that some of the traditional postpartum practices are potentially harmful for women's health. However, no intervention study aiming at postpartum practices has been performed. In this paper we evaluated the effect of a health and nutrition education intervention, which focused on improving postpartum dietary quality and optimal health behaviors. METHODS: The study design was a randomized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004. A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited. Women randomized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits. Control group women received usual health care during pregnancy and postpartum period. Women were followed up until 42 days postpartum. Outcome measures were nutrition and health knowledge, dietary behavior, health behavior and health problems during the postpartum period. RESULTS: Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits, vegetables, soybean and soybean products as well as nutrition and health knowledge than those in the control groups. Significantly more women in the intervention groups give up the traditional behavior taboos. The incidence of constipation, leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups. CONCLUSION: The study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practices and decrease the prevalence of postpartum health problems. The intervention has potential for adaptation and development to large-scale implementation. TRIAL REGISTRATION NUMBER: klACTRN12607000549426.

Recasting Hope: a process of adaptation following fetal anomaly diagnosis.

Recent decades have seen ultrasound revolutionise the management of pregnancy and its possible complications. However, somewhat less consideration has been given to the psychosocial consequences of mass screening resulting in fetal anomaly detection in low-risk populations, particularly in contexts where termination of pregnancy services are not readily accessible. A grounded theory study was conducted exploring forty-one women's experiences of ultrasound diagnosis of fetal abnormality up to and beyond the birth in the Republic of Ireland. Thirty-one women chose to continue the pregnancy and ten women accessed termination of pregnancy services outside the state. Data were collected using repeated in-depth individual interviews pre- and post-birth and analysed using the constant comparative method. Recasting Hope, the process of adaptation following diagnosis is represented temporally as four phases: 'Assume Normal', 'Shock', 'Gaining Meaning' and 'Rebuilding'. Some mothers expressed a sense of incredulity when informed of the anomaly and the 'Assume Normal' phase provides an improved understanding as to why women remain unprepared for an adverse diagnosis. Transition to phase 2, 'Shock,' is characterised by receiving the diagnosis and makes explicit women's initial reactions. Once the diagnosis is confirmed, a process of 'Gaining Meaning' commences, whereby an attempt to make sense of this ostensibly negative event begins. 'Rebuilding', the final stage in the process, is concerned with the extent to which women recover from the loss and resolve the inconsistency between their experience and their previous expectations of pregnancy in particular and beliefs in the world in general. This theory contributes to the theoretical field of thanatology as applied to the process of grieving associated with the loss of an ideal child. The framework of Recasting Hope is intended for use as a tool to assist health professionals through offering simple yet effective interventions grounded in women's experiences of this event.