Current concepts in postpartum anemia management.

PURPOSE OF REVIEW: Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. RECENT FINDINGS: Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age. SUMMARY: Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.

Acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders: A protocol of randomized controlled trial.

BACKGROUND: Female pelvic floor dysfunction is one of the common chronic diseases affecting women's physical and mental health. Pregnancy and delivery are one of the main causes. Pelvic floor rehabilitation is a common method for the treatment of postpartum pelvic floor dysfunction, but it has some defects. Acupoint injection has advantages in the treatment of postpartum pelvic floor dysfunction, but there is a lack of standard clinical research to verify it. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders. METHODS: This is a prospective randomized controlled trial to study the efficacy and safety of acupoints injection combined with pelvic floor rehabilitation. And it is approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly divided into observation group (acupoint injection combined with pelvic floor rehabilitation group) or control group (pelvic floor rehabilitation group alone). The patients were followed up for 8 weeks after 12 weeks of treatment. The observation indexes included: pelvic organ prolapse degree, pelvic floor muscle strength, urinary incontinence score, adverse reactions, among others. Data were analyzed using the statistical software package SPSS version 18.0. CONCLUSIONS: This study will evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor dysfunction, and provide reliable reference for the clinical application of this project. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/VC65Z.

Moxibustion therapy for treating patients with postpartum urinary retention: A protocol for systematic review and meta-analysis.

BACKGROUND: Postpartum urinary retention (PUR) is one of the most common complications after parturition which affect women's recovery after childbirth. Many clinical trials have shown that moxibustion, a traditional Chinese medicine therapy, is effective in treating PUR. But its effectiveness has not been evaluated scientifically and systematically. Therefore, this review aims to evaluate the safety and effectiveness of moxibustion therapy in treating patients with PUR. METHODS: We will search the following electronic databases, regardless of publication status and languages, from their respective inception dates to February 2021: the Cochrane Central Register of Controlled Trails, Pubmed, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan-Fang Database. Clinical randomized controlled trials (RCTs) related to moxibustion therapy for treating PUR will be included. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. For data synthesis, we will select either the fixed-effects or random-effects model according to heterogeneity assessment. Cure rates and postvoid residual volume (PVRV) will be the primary outcomes. The total effective rate and first urination time will be the second outcomes. Review Manager Software (RevMan) V.5.3 will be used if it is appropriate for meta-analysis. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence interval (CI) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CI for continuous data. TRIAL REGISTRATION NUMBER: INPLASY 202140037.

Prevalence and Treatment of Postpartum Stress Urinary Incontinence: A Systematic Review.

OBJECTIVES: Many women present for treatment of stress urinary incontinence (SUI) after childbirth. This systematic review describes the efficacy of treatment options for SUI initiated during the 12 months after delivery. METHODS: We conducted a systematic review to identify studies comparing treatment options for SUI initiated in the 12 months after parturition. We searched MEDLINE from inception to February 2019, using Medical Subject Heading terms related to pregnancy and urinary incontinence. Preintervention and postintervention populations were compared using analysis of variance with Fisher least significant difference method used to determine efficacy between groups. Grades for Recommendation, Assessment, Development and Evaluation system was used to categorize quality of evidence as high, moderate, low, or very low. RESULTS: We double screened 4548 abstracts, identifying 98 articles for full-text review. Seven studies met the eligibility criteria and were included. Compared with a control group, the 4 interventions identified outperformed the control group (P < 0.001) using Fisher (with effect sizes noted): (1) supervised pelvic floor physical therapy (0.76), (2) electrical stimulation (0.77), (3) home physical therapy (PT) (0.44), and (4) surgery (not applicable). Based on Grades for Recommendation, Assessment, Development and Evaluation assessment, there was moderate evidence to support PT and electrical stimulation, with insufficient evidence for surgery. There were no significant differences in parity, age, or body mass index via analysis of variance. The overall strength of evidence is poor for the treatment of postpartum SUI; more data are needed to fully evaluate other treatment options. CONCLUSIONS: All identified interventions demonstrated greater improvement for postpartum SUI over no treatment. Supervised PT ± electrostimulation was the most effective nonsurgical intervention.

Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain. METHODS: A search strategy was developed. Interventions were those manual or other nonpharmacologic therapies commonly used by chiropractors (not requiring additional certifications). The outcomes were self-reported changes in pain or disability self-reported outcomes. We used the Scottish Intercollegiate Guideline Network checklists. Strength of the evidence (excluding cohort studies) was determined using an adapted version of the US Preventive Services Task Force criteria as described in the UK report. RESULTS: Of the 1611 published articles, 16 were included. These were 5 SRs, 10 randomized controlled trials (RCTs), and 1 cohort study. Postpartum LBP (1 RCT): moderate, favorable strength for spinal manipulation therapy/mobilization. Postpartum PGP (4 RCTs): moderate, unclear strength for exercise; and inconclusive, unclear strength for patient education. Postpartum LBP or PGP (3 SRs and 4 RCTs): inconclusive, unclear strength for exercise, self-management, and physiotherapy; while osteopathic manipulative therapy was inconclusive, favorable. CONCLUSION: No treatment option was identified as having sufficient evidence to make a clear recommendation. This SR identified a scarcity of literature regarding chiropractic care and back pain for postpartum women, as well as inconsistency among the terms LBP, PGP, and combination pain.

Bear bile use at the intersection of maternal health in Cambodia.

BACKGROUND: The consumption of bear gallbladders and bear bile in Southeast Asia is a persistent threat to bear populations. As part of a larger effort to understand the characteristics of bear part consumption in Cambodia, we uncovered a consumer base of women seeking treatment for post-partum and uterine ailments. METHODS: To better understand this aspect of consumption, we interviewed 122 women in seven different provinces in Cambodia, probing into the motivations and influences for using bear bile, as well as what types of ailments Cambodian women use it for. RESULTS: We found that it is generally used by young or expecting mothers, and for such issues as post-partum "fatigue" (toas in Khmer), which could encompass post-partum depression. A desire to be supported by kin networks seems to facilitate the continued use of bear gallbladder and bile for these purposes. CONCLUSIONS: We suggest that efforts to reduce consumption should focus on encouraging older kin to change their means of support to Western/biomedical and by extension non-wildlife alternatives.

Physiotherapists' and midwives' views of increased inter recti abdominis distance and its management in women after childbirth.

BACKGROUND: Physiotherapists and midwives in primary healthcare often encounter women with an increased separation between the two rectus abdominis muscle bellies after pregnancy, a so-called increased inter recti distance (IRD). There are few studies on the contribution of increased IRD to the explanation of post-partum health complaints, and very little guidance in the literature for health professionals on the management of increased IRD. The aim of this study was to describe how physiotherapists and midwives in primary healthcare perceive the phenomenon of increased IRD and its management in women after childbirth. METHODS: A purposeful sampling approach was used to select physiotherapists and midwives working in primary healthcare in three large county council healthcare organisations in Sweden having experience of encountering women with increased IRD after pregnancy. Sixteen physiotherapists and midwives participated in focus group discussions. Four focus groups with four participants in each were undertaken. A semi-structured topic guide was used to explore responses to the research questions and the discussions were analysed using qualitative content analysis. RESULTS: We identified an overarching theme: Ambivalence towards the phenomenon increased IRD and frustration over insufficient professional knowledge. The theme included three categories: Uncertainty concerning the significance of increased IRD as a causal factor for functional problems; perceived insufficient professional knowledge base for the management of increased IRD; and lack of inter-professional collaboration and teamwork in the management of patients with increased IRD. Due to sparse and somewhat contradictory research findings and absence of clinical guidelines, the health professionals lacked basic preconditions for applying an evidence-based practice concerning increased IRD. They obtained their information about increased IRD from the media and fitness coaches, and hence were somewhat unsure about what to believe regarding the phenomenon. CONCLUSIONS: There was no consensus among the health professionals on how to best approach increased IRD in the clinical setting. Our findings stress the importance of more research to increase the professional knowledge base among physiotherapists and midwives. The findings highlight the urgent need for policies and clinical guidelines advising health professionals in the management of increased IRD and for facilitating inter-professional collaboration and teamwork.

Adding Chiropractic Treatment to Individual Rehabilitation for Persistent Pelvic Girdle Pain 3 to 6 Months After Delivery: A Pilot Randomized Trial.

OBJECTIVE: The purpose of this study was to investigate the feasibility of conducting a study examining the influence of individualized rehabilitation and chiropractic treatment, compared with individualized rehabilitation alone, in women with persistent dominating 1-sided pelvic girdle pain (PGP) 3 to 6 months after delivery. METHODS: Women were recruited from an outpatient clinic at Stavanger University Hospital, Norway and in a private chiropractic clinic in Stavanger. Those with persistent, dominating 1-sided PGP were included in this pilot study. Those who met inclusion criteria were randomized into 2 groups, one group received individualized rehabilitation and chiropractic treatment and the other group women received individualized rehabilitation alone. Treatment was measured for 20 weeks. RESULTS: Of 330 consenting women who were recruited who reported pelvic pain during pregnancy, 68 reported PGP or low back pain, and 63 consented to fill in a questionnaire. Forty-seven women underwent a clinical examination 3 to 6 months after delivery. During the examination, the women were diagnosed into subgroups for PGP. After exclusion of the women with low back pain only, a total of 13 women were diagnosed with dominating 1-sided PGP and thus included in this study. Six were randomized to the individualized rehabilitation and chiropractic treatment group and 5 to the individualized rehabilitation alone group. After 20 weeks of intervention, both groups reported improvement in disability and pain, but not in general health status. No serious or long-lasting adverse events were registered after treatment or training. CONCLUSION: We found that a study of this nature is feasible. However, the conditions of patient recruitment need to be considered carefully. We learned that a trial to investigate the effect of chiropractic treatment for PGP pain should include all subgroups of PGP to reach an acceptable sample size.

Health professionals' views on maternity care for women with physical disabilities: a qualitative study.

BACKGROUND: During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS: The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS: Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION: The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.

Controversies in the management of vesicovaginal fistula.

Achieving 100% closure and continence rate in the management of vesicovaginal fistulas remains a challenge. There is still debate about several aspects of the care including the following.

Effect of LED therapy for the treatment nipple fissures: Study protocol for a randomized controlled trial.

INTRODUCTION: Poor positioning of the child in relation to the breast and improper suckling are the main causes of nipple fissure. Treatment options for nipple fissures include drug therapy with antifungal and antibiotics, topical applications of lanolin, glycerin gel, creams and lotions, the milk itself, hot compresses, and silicone nipple shields. Studies involving light-emitting diode (LED) therapy have demonstrated anti-inflammatory properties, the enhancement of the wound repair process, and the control of pain. As it does not cause discomfort, is relatively inexpensive and may impede the discontinuation of breastfeeding, phototherapy could be a viable option for the treatment of nipple fissures. AIM: The principal objective of the proposed study is to evaluate the effectiveness of LED therapy for the treatment of nipple fissures in postpartum mothers. MATERIALS AND METHODS: One hundred patients treated with a medical diagnosis of bilateral nipple trauma classified as nipple fissures or cracks will participate in the study, randomized into 2 groups: The control group will receive orientation regarding breast care and adequate breastfeeding techniques. The experimental group will receive the same orientation and phototherapy sessions using a device developed especially for the treatment of nipple trauma. Both groups will be followed up for 6 consecutive weeks.

[Spirituality and health: problems during pregnancy and postpartum and their consequences in women and children's life trajectories (Salta, Argentina)]. / Espiritualidad y salud: problemas de salud durante el embarazo y el puerperio y sus consecuencias en las trayectorias de mujeres y niños (Salta, Argentina).

This article addresses the relationship between health and spirituality through the analysis of narratives of illnesses that occur during pregnancy and postpartum and that affect women and children in rural communities of Molinos (Calchaquí Valleys, Salta). It is based on research carried out from 2009-2017, in which 33 semi-structured interviews were conducted with women caring for children under six years of age. We focused on the way in which the interviewed women presented the sequence of events surrounding the emergence of illnesses affecting their own health and that of their children, in which organic, emotional and spiritual aspects interact in both the etiology of the illness and its treatment. We analyze as an example susto [fright] and its variations, as well as recaida [relapse] and matriz [womb]. The meanings attributed to these illnesses stress the spiritual dimension involved that justifies the use of traditional medicine resources. Our approach seeks to go beyond a taxonomic and essentialist perspective to focus on aspects involved in the process of the experience of illness.

Este trabajo aborda la relación entre salud y espiritualidad a través del análisis de la narrativa de padecimientos que ocurren durante el embarazo y el puerperio y afectan a mujeres y niños en comunidades rurales de Molinos (Valles Calchaquíes, Salta). Se basa en una investigación desarrollada entre 2009 y 2017, en el marco de la cual se realizaron 33 entrevistas semiestructuradas a mujeres cuidadoras de niños menores de seis años, y en la que se focalizó en el modo en que las entrevistadas presentaban las secuencias de eventos que rodeaban la emergencia de problemas de salud propios y de sus hijos, en las que se conjugan aspectos orgánicos, emocionales y espirituales tanto en su etiología como en su terapéutica. Tomamos como ejemplos de análisis el susto y sus variantes, la recaída y la matriz. Los sentidos otorgados a estos padecimientos ponen de relieve la dimensión espiritual que justifica la apelación a recursos médicos tradicionales. Nuestro enfoque busca trascender la perspectiva taxonómica y esencialista para dar cuenta de los aspectos procesuales involucrados en la experiencia de enfermar.

Pregnant and Postpartum Women With Bipolar Disorder: Taking the Care to Where They Are.

Up to 20% of women who screen positive for depression in the perinatal period in primary care and obstetric settings may have bipolar disorder, but little is known about best practices for this population. This column describes clinical programs that support identification and management of depression and bipolar disorder among women in non-mental health settings. The programs use diverse management strategies, including referral to specialty mental health, collaborative care, and consultation and care coordination. Most mental health programs based in primary care and obstetric settings are designed for depression treatment. Assessment and treatment strategies need to be refined to ensure that women with bipolar disorder receive appropriate care.

Espiritualidad y salud: problemas de salud durante el embarazo y el puerperio y sus consecuencias en las trayectorias de mujeres y niños (Salta, Argentina) / Spirituality and health: problems during pregnancy and postpartum and their consequences in women and children's life trajectories (Salta, Argentina)

RESUMEN Este trabajo aborda la relación entre salud y espiritualidad a través del análisis de la narrativa de padecimientos que ocurren durante el embarazo y el puerperio y afectan a mujeres y niños en comunidades rurales de Molinos (Valles Calchaquíes, Salta). Se basa en una investigación desarrollada entre 2009 y 2017, en el marco de la cual se realizaron 33 entrevistas semiestructuradas a mujeres cuidadoras de niños menores de seis años, y en la que se focalizó en el modo en que las entrevistadas presentaban las secuencias de eventos que rodeaban la emergencia de problemas de salud propios y de sus hijos, en las que se conjugan aspectos orgánicos, emocionales y espirituales tanto en su etiología como en su terapéutica. Tomamos como ejemplos de análisis el susto y sus variantes, la recaída y la matriz. Los sentidos otorgados a estos padecimientos ponen de relieve la dimensión espiritual que justifica la apelación a recursos médicos tradicionales. Nuestro enfoque busca trascender la perspectiva taxonómica y esencialista para dar cuenta de los aspectos procesuales involucrados en la experiencia de enfermar.

ABSTRACT This article addresses the relationship between health and spirituality through the analysis of narratives of illnesses that occur during pregnancy and postpartum and that affect women and children in rural communities of Molinos (Calchaquí Valleys, Salta). It is based on research carried out from 2009-2017, in which 33 semi-structured interviews were conducted with women caring for children under six years of age. We focused on the way in which the interviewed women presented the sequence of events surrounding the emergence of illnesses affecting their own health and that of their children, in which organic, emotional and spiritual aspects interact in both the etiology of the illness and its treatment. We analyze as an example susto [fright] and its variations, as well as recaida [relapse] and matriz [womb]. The meanings attributed to these illnesses stress the spiritual dimension involved that justifies the use of traditional medicine resources. Our approach seeks to go beyond a taxonomic and essentialist perspective to focus on aspects involved in the process of the experience of illness.

Acupuncture for the treatment of post-partum urinary retention.

STUDY OBJECTIVES: The aims of the present study were to evaluate acupuncture as an alternative treatment to an indwelling catheter for women with postpartum urinary retention, and to evaluate the accuracy of sonographic estimation of bladder volume by portable bedside equipment in women postpartum. STUDY BACKGROUND: Post-partum urinary retention is a common obstetric complication. The accepted method for diagnosing post void residual bladder volume is by ultrasound or catheterization. However, the accuracy of bedside sonographic evaluation of bladder volume in women postpartum is controversial due to anatomical and technical issues. The traditional treatment of urinary retention is catheterization for variable lengths of time. Acupuncture, while an accepted treatment method for urinary retention in traditional societies in the Far East, has not been proven scientifically to resolve the problem. Therefore, the aims of our study were to evaluate acupuncture as an alternative treatment to catheterization for urinary retention, and to evaluate the accuracy of sonographic estimation of bladder volume by portable bedside ultrasound in women postpartum. MATERIALS AND METHODS: The study was a prospective randomized case-controlled trial conducted in 55 women post-partum with urinary retention. All patients underwent a pre and post treatment sonographic evaluation of bladder volume. Women with urinary retention were given the choice of treatment by acupuncture or catheterization. Acupuncture was performed by an experienced acupuncturist licensed in Traditional Chinese Medicine and point selection was based on Meridian theory and clinical experience. RESULTS: In the acupuncture group, 23 women (92%) achieved spontaneous micturition within one hour following treatment. Bedside sonographic evaluation of bladder volume showed excellent correlation to actual volume as measured by catheterization (r2 = 0.988). CONCLUSION: Acupuncture proved to be an excellent alternative to catheterization in treatment of women with postpartum urinary retention.

The fourth trimester: a critical transition period with unmet maternal health needs.

After childbirth, most American women are not scheduled for follow-up care for 6 weeks, and this visit is poorly attended. Many new mothers feel unprepared for the common health issues they encounter and are uncertain of whom to contact. To improve care, the 4th Trimester Project is bringing together mothers, health care providers, and other stakeholders to explore what families need most from birth to 12 weeks postpartum. Eighty-seven individuals convened in March 2016 in Chapel Hill, NC. Four major topic areas emerged: (1) the intense focus on women's health prenatally is unbalanced by infrequent and late postpartum care; (2) medical practice guidelines often do not align with women's experiences and constraints; (3) validation of women as experts of their infants and elevating their strengths as mothers is necessary to achieve health goals; and (4) mothers need comprehensive care, which is difficult to provide because of numerous system constraints. Considerations for improving postpartum services include enabling more convenient care for families that is holistic, culturally appropriate, conversation based, and equitable. Maternal health issues in the fourth trimester intersect and can compound one another. Enhanced collaboration among health care providers may improve the focus of clinical interactions to address the interrelated health issues most important to women.

Tratamiento ambulatorio en una paciente con psicosis puerperal / Ambulatory treatment in a patient with postpartum psychosis

Se presenta el caso clínico de una puérpera que a los 37 días del parto acudió de forma espontánea a la consulta de Ginecología en el Policlínico Docente Municipal de Santiago de Cuba, refiriendo que sentía mucho miedo y sensación de frío intenso en la cabeza, además de no poder dormir bien. El diagnóstico presuntivo fue psicosis puerperal, que se confirmó en la interconsulta con el Departamento de Psicología. La paciente fue tratada con terapia floral y antipsicóticos de manera ambulatoria, y mantuvo seguimiento médico hasta que se le dio el alta. Como factores de riesgo se identificaron la edad mayor de 30 años, y los antecedentes personal y familiar de abandono de la pareja y enfermedad psiquiátrica, respectivamente(AU)

The case report of a newly-delivered woman that went spontaneously to the Gynecology Service in the Teaching Municipal Polyclinic in Santiago de Cuba 37 days after the childbirth is presented, referring that she felt a lot of fear and sensation of intense cold in the head, besides that she could not sleep well. The presumptive diagnosis was postpartum psychosis that was confirmed in the Department of Psychology consultation. The patient was treated with floral therapy and antipsychotics in an ambulatory way, and she maintained follow up until she was discharged. Age over 30 years, and the personal and family history of marital break-up and psychiatric disease respectively were identified as risk factors(AU)

Efficacy of Osteopathic Manipulative Treatment for Management of Postpartum Pain.

CONTEXT: Pain is one of the most common postpartum complaints by women in the United States, and the pain varies in its location. Research on intervention strategies for postpartum pain has focused primarily on the lower back, but pain management for other types of postpartum pain remains unclear. OBJECTIVE: To investigate the effects of osteopathic manipulative treatment (OMT) on postpartum pain; the location, quality, and timing of pain; and the difference in pain between vaginal and cesarean delivery. METHODS: Postpartum patients who reported having pain were recruited at St Barnabas Hospital in Bronx, New York. The short-form McGill Pain Questionnaire was administered along with a screening questionnaire. Second- or third-year residents in neuromusculoskeletal medicine and osteopathic manipulative medicine examined patients and then diagnosed and managed somatic dysfunction with OMT for approximately 25 minutes. The short-form McGill Pain Questionnaire was again administered after OMT. Paired t tests and McNemar tests were used to analyze changes before and after OMT for continuous and categorical variables, respectively. Differences in visual analog scale (VAS) pain scores between patients who had vaginal vs cesarean delivery were tested using analysis of variance, and group differences in pain location were tested using a Pearson χ2 test. RESULTS: A total of 59 patients were included in the study. The mean VAS score for pain was 5.0 before OMT and 2.9 after OMT (P<.001). The VAS scores before OMT significantly differed between patients who had a vaginal delivery and those who had a cesarean delivery (P<.001), but the mean decrease in VAS score was similar in both groups. Decreases in low back pain (34 [57.6%] before and 16 [27.1%] after OMT), abdominal pain (32 [54.2%] before and 22 [37.3%] after OMT), and vaginal pain (11 [18.6%] before and 5 [8.5%] after OMT) were reported after OMT (P<.05). CONCLUSION: Preliminary results demonstrate that OMT is efficacious for postpartum pain management. The lack of a control group precludes the ability to make causal claims. Future studies are needed to solidify OMT efficacy and generalizability.

[Effects of Auricular Acupressure on Improving the Sleep Quality of Puerperae].

BACKGROUND: Puerperae exhibit generally poor sleep quality. Previous studies have shown auricular acupressure as effective in improving the sleep problems of nurses, college students, and elderly indigenous Taiwanese women. However, no study has yet examined the effectiveness of auricular acupressure in improving the sleep quality of postpartum women. PURPOSE: To explore the efficacy of auricular acupressure (AA) on puerperae who were affected by sleep disturbance. METHODS: A prospective quasi-experimental design was used and 60 puerperae with insomnia who scored at least 5 on the Chinese of version of the Pittsburgh Sleep Quality Index (CPSQI) were recruited at one postpartum centre (a "doing-the-month" care centre) in northern Taiwan. The experimental group (n=30) received pasted auricular magnetic beads and acupressure on the Shenmen, Xin, and Shen points. The control group (n=30) received general nursing directions about insomnia only. All participants were assessed using the CPSQI prior to the intervention and on the 21st post-intervention day. The intervention effects were analysed using the Generalized Estimating Equation (GEE). RESULTS: After three weeks of the AA intervention, the mean global PSQI score had decreased significantly more in the experimental group than in the control group (p<.05). Furthermore, experimental-group participants reported better sleep quality (p<.05), longer total sleep time (p<.001) and lower sleep disturbance (p<.05) than their control-group peers. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The present pilot study found complementary AA to be an effective intervention for treating puerperae with insomnia. This non-pharmacological and nonintrusive intervention for improving sleep disturbance in puerperae promotes the quality of sleep.

Effect of auricular acupressure for postpartum insomnia: an uncontrolled clinical trial.

AIMS AND OBJECTIVES: This study examined the effects of auricular acupressure therapy on women with postpartum insomnia. BACKGROUND: Postpartum women generally have poor sleep quality because of frequent night-time breastfeeding during the first month after giving birth. DESIGN: A one-group pretest/post-test quasi-experiment was conducted. METHODS: A convenience sampling method was used to recruit participants at a postpartum centre (doing-the-month centre) in Northern Taiwan, from January 2014-July 2014. Thirty women with postpartum insomnia received auricular acupressure therapy on one auricular point (Shenmen point pressing) four times a day for 14 days. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality before and after the 14-day treatment. RESULTS: After the 14-day auricular acupressure treatment, the Pittsburgh Sleep Quality Index total scores of the women decreased from 8·7 (pretest) to 5·57 (post-test, 36% reduction). Scores on the subscales of the Pittsburgh Sleep Quality Index, including sleep quality, sleep latency, sleep duration and sleep disturbance, also statistically improved (p < 0·05). CONCLUSIONS: Hormone changes and frequent breastfeeding were identified as characteristics that may exacerbate poor sleep quality of postpartum women, for whom the auricular acupressure intervention may effectively improve sleep quality. RELEVANCE TO CLINICAL PRACTICE: Auricular acupressure can be an alternative complementary therapy to aid postpartum women with insomnia in improving sleep quality.