A Review of Postpartum Depression: Focused on Psychoneuroimmunological Interaction

PURPOSE: The purpose of this review was to describe a psychoneuroimmunology (PNI) framework for postpartum depression (PPD) and discuss its implications for nursing research and practice for postpartum women. METHODS: This study explored the role of hypothalamic-pituitary-adrenal (HPA) axis and inflammation as possible mediators of risk factors for PPD through literature review. RESULTS: From this PNI view, human bodies are designed to respond with the reciprocal interactions among the neuro-endocrine and immune system when they are faced with physical or psychological stressors. Chronic stress induces alterations in the function of HPA axis, and a chronic low-grade inflammatory response is associated with depression. The dysfunctions of cytokines and HPA axis have been observed during the postpartum period. Stress promotes glucocorticoid receptor resistance, which can promote inflammatory responses. This, in turn, can contribute to the pathophysiology of depression. This can especially affect populations at vulnerable time-points, such as women in the postpartum. CONCLUSION: From a PNI perspective, well-designed prospective research evaluating the role of stress and inflammation as an etiology of PPD and the effect of stress reduction is warranted to prevent PPD.

Development and Evaluation of Breastfeeding Promotion Program for Mothers with Breast Engorgement following Cesarean Birth

PURPOSE: This study was to develop a breastfeeding promotion program and to test effects of the program on levels of breast discomfort, breast size, sodium in breast milk, and type of feeding in mothers with breast engorgement following cesarean birth. METHODS: A non-synchronized non-equivalent control group pretest-posttest design was used in this study. The participants were 70 postpartum mothers who were admitted to a postpartum care center and experienced breast engorgement following cesarean birth. The planned nursing intervention was the breastfeeding promotion program consisting of breast massage and 1:1 breastfeeding education, counseling, and support focusing on individualized problem solving provided for 10 days. Fifty-three women completed the program (experimental group 26, control group, 27). Measurements were level of breast discomfort, breast size, sodium in breast milk and type of feeding at pre and posttest. RESULTS: Women who participated in the program experienced lower scores for breast discomfort, greater decrease in breast size, lower levels of sodium in breast milk, and practiced breastfeeding more than those in the control group. CONCLUSION: Results indicate that this breastfeeding promotion program is effective in reducing breast engorgement and improving breastfeeding practices, and is therefore recommended to enhance breastfeeding promotion practice in postpartum care centers.

Current Status of Women's Health Nursing Practicum and Direction

PURPOSE: This study was done to examine current status of women's health nursing practicum and identify necessary core nursing skills in this practicum area. Moreover, one syllabus and evaluation sheets for women's health nursing clinical practicum at one university were reviewed. METHODS: A survey design was used with 81 educators who were teaching maternity or women's health nursing and its practicum. RESULTS: Most clinical sites for practicum were university hospitals (43.0%), women's hospitals (32.7%), or general hospitals (17.3%); but the majority (77.8%) of educators expressed difficulty in finding appropriate practicum places. Common teaching and learning methods were clinical guides for practicum (44.6%), e-learning content (30.2%), and simulation (23.6%). Core nursing skills for this practicum included assessment of stages of labor, preparation of uterine-fetal monitoring devices and interpretation of results, monitoring uterus and fetal activity, and performing Leopold's maneuver. For postpartum care, the following were included; postpartum fundal massage, assessment of breast engorgement, fundus height, and episiotomy sites, inserting urinary catheter, and teaching the use of patient-controlled analgesia. CONCLUSION: To improve the quality of clinical practicum, development of a clear course syllabus, standardized clinical guidebook, and core nursing skills is required and should be shared with all relevant nurse educators.

Effects of Oketani Breast Massage on Breast Pain, the Breast Milk pH of Mothers, and the Sucking Speed of Neonates

PURPOSE: This study was done to test the effects of Oketani breast massage on breast pain and breast milk pH of mothers, and sucking speed of neonates. METHODS: A nonequivalent control group and a pretest-posttest design was used. Postpartum mothers complaining of breast pain were recruited at a postpartum care center. The application of Oketani breast massage by an Oketani massage therapist was the experimental treatment. The control group received the conventional massage technique from a nurse at the postpartum care centre. The collected data were analysed using a chi2-test and a t-test with the SPSS WIN 12.0 program. RESULTS: The participants were homogeneous in age, gestation period, and birth weight. Breast pain (t=8.384, p<.001) was significantly relieved, and breast milk pH (t=4.793, p<.001) was significantly increased in the experimental group compared to the control group. The sucking speed of the neonates in the experimental group was significantly increased compared to the control group (t=9.920, p<.001). CONCLUSION: These findings indicate that Oketani breast massage is effective in relieving breast pain and increasing breast milk pH as well as the sucking speed of neonates.

Effects of Breast Massage on Breast Pain, Breast-milk Sodium, and Newborn Suckling in Early Postpartum Mothers

PURPOSE: In this study the effects of breast massage on breast pain, breast-milk sodium, and newborn suckling in early postpartum mothers were investigated. METHODS: The design was a non-synchronized nonequivalent control group pretest-posttest design. Sixty postpartum mothers who were admitted to a postpartum care center and had problems with breastfeeding were recruited. Of these mothers, 44 were assigned to the intervention group and received two 30-minute breast massages within 10 days of postpartum period. The others were assigned control group and received only routine care. Breast pain was measured using a numeric pain scale and number of times newborns suckled was observed throughout breastfeeding. Breast milk was self-collected to evaluate breast-milk sodium. RESULTS: Mean age of postpartum mothers was 30 years old. Compared to the control group, women in the intervention group reported significant decreases in breast pain (p<.001), increases in number of times newborns suckled after the first and second massage (p<.001), and a decrease in breast-milk sodium after the first massage (p=.034). CONCLUSION: Breast massage may have effects on relieving breast pain, decreasing breast-milk sodium, and improving newborn suckling. Breast massage can be used to solve breast problems. Further research is needed to validate our findings.

Student Experience and Satisfaction with Clinical Nursing Practice in Women's Health Nursing / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.

Effects of Tai Chi Exercise on Cardiovascular Risk Factors and Quality of Life in Post-menopausal Women

PURPOSE: Natural menopause resulting in the decline in endogenous estrogen concentrations is responsible for an increased risk of coronary heart disease in postmenopausal women. The purpose of the study was to examine the effects of a 6-month Tai Chi exercise program on cardiovascular risk factors and quality of life in post-menopausal women. METHODS: A quasi-experimental design with pretest and posttest measures was used. The participants in the study, 29 women in the Tai Chi group and 31 in the control group, were enrolled for 6 months. RESULTS: After 6 months of Tai Chi exercise, total cholesterol (M=213 to 185), LDL-cholesterol (M=135 to 128), and their 10 yr cardiovascular disease risk (M=2.62 to 2.27) had improved significantly for the Tai Chi participants compared to the control group. Total scores for quality of life along with the sub-dimensions of health perception and mental functioning were also significantly higher in the Tai Chi participants. CONCLUSION: Tai Chi exercise favorably affected cardiovascular health and quality of life in post-menopausal women after 6 months. Additional rigorous studies are needed to examine long term effects on the prevention of cardiovascular disease in this population.

Effect of Lumbar Stabilization Exercise on Back Pain, Physical Fitness, Sleep, and Depression in Middle-Aged Women with Chronic Back Pain / 성인간호학회지

PURPOSE: The study was to examine the effect of lumbar stabilization exercise on back pain, physical fitness, sleep, and depression in middle-aged women who have chronic back pain. METHODS: With one group pre-post test design, 18 subjects who have had more than 6 months of back pain were recruited by convenience sampling in D metropolitan area. Lumbar stabilization exercise was based on Tai Chi for back pain program developed by Lam(2003). This program was mainly focusing on strengthening lumbar stabilizing muscle for one hour per session, twice a week for 20 weeks. Degree of back pain, back pain disability, sleep, and depression were measured at three time points(pretest, 12 weeks, and 20 weeks) by a structured study questionnaire. Physical fitness variables including waist flexibility, mobility, and back muscle strength were measured three times at health promotion center located in the university hospital. Data were analyzed by frequency, descriptive statistics, and repeated measures of ANOVA. RESULTS: Mean age of subjects was 52 years(SD = 6.4). Most of them(90%) had suffered from back pain more than one year and 67% was taking medicine to relieve their back pain. Results showed that back pain score and disability score were not significantly decreased after the exercise. On physical fitness variables, however, waist flexibility(F = 3.50, p = .04) and mobility(F = 3.31, p = .04) were improved after the exercise. Quality of sleep(F = 4.48, p = .03) was improved gradually and depression scores were also decreased(F = 3.12, p = .05) after the exercise. CONCLUSION: This lumbar stabilization exercise was not able to reduce chronic back pain, but could improve physical fitness and psycho-social variables for community dwelling women who have chronic back pain. Further study is needed to replicate this exercise with control group to confirm the positive effect.

Effect of Lumbar Stabilization Exercise on Back Pain, Physical Fitness, Sleep, and Depression in Middle-Aged Women with Chronic Back Pain / 성인간호학회지

PURPOSE: The study was to examine the effect of lumbar stabilization exercise on back pain, physical fitness, sleep, and depression in middle-aged women who have chronic back pain. METHODS: With one group pre-post test design, 18 subjects who have had more than 6 months of back pain were recruited by convenience sampling in D metropolitan area. Lumbar stabilization exercise was based on Tai Chi for back pain program developed by Lam(2003). This program was mainly focusing on strengthening lumbar stabilizing muscle for one hour per session, twice a week for 20 weeks. Degree of back pain, back pain disability, sleep, and depression were measured at three time points(pretest, 12 weeks, and 20 weeks) by a structured study questionnaire. Physical fitness variables including waist flexibility, mobility, and back muscle strength were measured three times at health promotion center located in the university hospital. Data were analyzed by frequency, descriptive statistics, and repeated measures of ANOVA. RESULTS: Mean age of subjects was 52 years(SD = 6.4). Most of them(90%) had suffered from back pain more than one year and 67% was taking medicine to relieve their back pain. Results showed that back pain score and disability score were not significantly decreased after the exercise. On physical fitness variables, however, waist flexibility(F = 3.50, p = .04) and mobility(F = 3.31, p = .04) were improved after the exercise. Quality of sleep(F = 4.48, p = .03) was improved gradually and depression scores were also decreased(F = 3.12, p = .05) after the exercise. CONCLUSION: This lumbar stabilization exercise was not able to reduce chronic back pain, but could improve physical fitness and psycho-social variables for community dwelling women who have chronic back pain. Further study is needed to replicate this exercise with control group to confirm the positive effect.

Applicability and Program Effects of Tai Chi Exercise in Outpatients with Coronary Artery Disease / 성인간호학회지

PURPOSE: The study aimed to apply Tai Chi exercise to patients with coronary artery disease for 6 months, and to examine changes on body composition, physical strength, and cardiovascular risks. METHODS: Applying a quasi experimental design with a nonequivalent control group, 90 subjects with cardiovascular disease were recruited at C university hospital. For 6 months, 44 subjects performed Tai Chi exercise once a week and daily home exercise, while 46 subjects did not. Body composition was assessed by body mass index, % body fat, and waist-hip ratio; physical strength by balance, mobility, flexibility, grip strength, and back muscle strength; and cardiovascular risk checklist for fixed and modifiable risk factors. Data were analyzed by SPSS/WIN program with ANCOVA to consider group differences at the pretest. RESULTS: The subjects were 66 years old in average. In 6 months, Tai Chi group improved significantly in balance, mobility, and flexibility with decreased modifiable cardiovascular risks after adjusting for the pretest scores. CONCLUSION: Tai Chi exercise was safely applicable to individuals with coronary artery disease, and effective in some measures of physical strength and modifiable cardiovascular risks. It could be an alternative exercise for outpatient cardiac rehabilitation program in this population.

Effects of an Abdominal Obesity Management Program on Body Composition and Physiological Indicators in Women with Abdominal Obesity / 여성건강간호학회지

The purpose of this study was to examine the effects of an abdominal obesity management program on a woman's body composition and physiological indicators. A sample of 20 women who were 33 to 62 years old with abdominal obesity (greater than 80cm of waist circumference) participated in the program for 12 weeks. The program consisted of aerobic dance and yoga for one hour, twice a week. Their body composition was measured with BMI, body fat %, waist circumference, and waist/hip ratio. The physiological indicators were measured by systolic blood pressure, blood glucose, total cholesterol, and triglycerides before and after the program. The results showed that waist circumference, waist/hip ratio, and fasting blood glucose decreased significantly after the program. However, BMI, systolic blood pressure, and blood lipids did not change. An abdominal obesity management program with aerobic dance and yoga is partially effective in decreasing abdominal obesity. Further studies are required to replicate the study with a control group using an experimental design.

Pilot Study for Perceived Effectiveness of Music Therapy for Pain and Music Preference in Women following Gynecological Surgery in a Local Area / 여성건강간호학회지

PURPOSE: The purposes of this pilot study were to describe the perceived effectiveness of music therapy for pain control and to identify music preference for postoperative pain and anxiety control in Korean women who had a gynecological surgery. SAMPLE: A convenience sample of 52 women was recruited from a gynecological unit at P University hospital and they were interviewed to assess their perception of music therapy and music preference using a structured study questionnaire. RESULTS: Fifty-six percent of women reported that music therapy would be effective and 96% perceived it would be effective if combined with analgesics. The best music chosen for relieving postoperative pain and anxiety were Korean old pop and ballad song/music followed by Korean religious music, American pop songs, piano music, Korean classic songs, and Orchestra music. CONCLUSION: There was a cultural difference in music preference for the relief of post-operative pain in this sample. Therefore, effects of music for postoperative pain control need to be determined after considering musical preferences of postoperative women in Korea.

Canonical Correlation between Korean Traditional Postpartum Care Performance and Postpartum Health Status / 간호학회지

PURPOSE: The purpose of this longitudinal study was to examine the relationship between postpartum care performance and postpartum health status. SAMPLE: The study subjects were 82 mothers who delivered full-term infants at 3 hospitals at P city. Data were collected for their health status at the postpartum unit and the sample was followed up to 6 weeks postpartum to collect postpartum care performance and health status. RESULTS: Mothers rated postpartum care performance as moderate to high and especially rated the maternal role attainment the highest. Mothers experienced 4 physical symptoms and moderate levels of fatigue. In addition, they experienced moderate levels of positive affect and low levels of negative affect at both times. Canonical correlation revealed that postpartum care performance was related to postpartum health status with 2 significant canonical variables. The first variate indicated that mothers who performed hospitality, physical and emotional recovery, self-caring, and role attainment well showed higher positive affects, lower negative affects, fewer physical symptoms, and lower levels of fatigue. The second variate showed that the greater the performance of caring and physical and emotional recovery, the fewer physical symptoms and lower levels of fatigue. CONCLUSION: Although Korean traditional postpartum care performance was related to postpartum health status, the further study is needed to identify the causal relationship between them. Nurses need to integrate the perspective of westernized postpartum care and Korean traditional views of postpartum approach to maintain and promote women's health better.