Music therapy intervention in cardiac autonomic modulation, anxiety, and depression in mothers of preterms: randomized controlled trial.

BACKGROUND: Mothers of preterm infants often have symptoms of anxiety and depression, recognized as risk factors for the development of cardiovascular diseases and associated with low rates of heart rate variability (HRV). This study aimed to evaluate the influence of music therapy intervention on the autonomic control of heart rate, anxiety, and depression in mothers. METHODS: Prospective randomized clinical trial including 21 mothers of preterms admitted to the Neonatal Intensive Care Unit of a tertiary hospital, recruited from August 2015 to September 2017, and divided into control group (CG; n = 11) and music therapy group (MTG; n = 10). Participants underwent anxiety and depression evaluation, as well as measurements of the intervals between consecutive heartbeats or RR intervals for the analysis of HRV at the first and the last weeks of hospitalization of their preterms. Music therapy sessions lasting 30-45 min were individually delivered weekly using receptive techniques. The mean and standard deviation of variables were obtained and the normality of data was analyzed using the Kolmogorov-Smirnov test. The paired sample t-test or Wilcoxon test were employed to calculate the differences between variables before and after music therapy intervention. The correlations anxiety versus heart variables and depression versus heart variables were established using Spearman correlation test. Fisher's exact test was used to verify the differences between categorical variables. A significance level of p < 0.05 was established. Statistical analysis were performed using the Statistical Package for the Social Sciences, version 20. RESULTS: Participants in MTG had an average of seven sessions of music therapy, and showed improvement in anxiety and depression scores and autonomic indexes of the time domain (p < 0.05). Significant correlations were found between depression and parasympathetic modulation using linear (r = - 0.687; p = 0.028) and nonlinear analyses (r = - 0.689; p = 0.027) in MTG. CONCLUSION: Music therapy had a significant and positive impact on anxiety and depression, acting on prevention of cardiovascular diseases, major threats to modern society. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (no. RBR-3x7gz8 ). Retrospectively registered on November 17, 2017.

Twin parenthood: the midwife's role--a randomised controlled trial.

OBJECTIVE: To determine whether a midwife-led intervention improved preparation for twin parenting and maternal psychosocial outcome. DESIGN: Randomised controlled trial. SETTING: Two maternity units in North East England. POPULATION: A cohort of 162 women with uncomplicated twin pregnancy. METHODS: Self-completion questionnaire at multiple time points. MAIN OUTCOME MEASURES: The primary outcome was probable postnatal depression (measured with the Edinburgh Postnatal Depression Scale, EPDS) 26 weeks after delivery. Secondary outcomes included preparation for parenting, maternal anxiety, parenting stress, and maternal wellbeing. RESULTS: The mean maternal EPDS scores at 26 weeks after delivery were 5.4 (SD 4.5) in the twin intervention (TI) group and 6.9 (SD 5.5) in the twin control (TC) group, and the mean difference between the groups was 1.5 (95% confidence interval, 95% CI, -0.2 to 3.3). The relative risk (RR) of having probable depression in the TI group compared with the TC group at 26 weeks was 0.48 (95% CI 0.19-1.20) for mothers and 0.84 (95% CI 0.42-1.70) for fathers. There were no statistically significant differences in maternal anxiety or parenting stress. TI mothers reported increased maternal wellbeing, reaction to motherhood, family support, mood, and greater self-confidence 26 weeks after delivery, and felt more prepared for parenting. CONCLUSION: As a result of the limited sample size, the study was unable to detect a difference in maternal depression using the maternal EPDS mean score. The antenatal preparation for parenting programme did not improve postnatal maternal anxiety or parenting stress; however, it did improve postnatal maternal wellbeing, mood, self-confidence, reaction to motherhood, and better prepared mothers to parent twin infants. Midwives have a key role in preparing mothers to parent twins.

Migration and maternity: insights of context, health policy, and research evidence on experiences and outcomes from a three country preliminary study across Germany, Canada, and the United kingdom.

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.

A systematic review of systematic reviews of interventions to improve maternal mental health and well-being.

OBJECTIVE: to identify non-invasive interventions in the perinatal period that could enable midwives to offer effective support to women within the area of maternal mental health and well-being. METHODS: a total of 9 databases were searched: MEDLINE, PubMed, EBSCO (CINAHL/British Nursing Index), MIDIRS Online Database, Web of Science, The Cochrane library, CRD (NHS EED/DARE/HTA), Joanne Briggs Institute and EconLit. A systematic search strategy was formulated using key MeSH terms and related text words for midwifery, study aim, study design and mental health. Inclusion criteria were articles published from 1999 onwards, English language publications and articles originating from economically developed countries, indicated by membership of the Organisation for Economic Co-operation and Development (OECD). Data were independently extracted using a data collection form, which recorded data on the number of papers reviewed, time frame of the review, objectives, key findings and recommendations. Summary data tables were set up outlining key data for each study and findings were organised into related groups. The methodological quality of the reviews was assessed based on predefined quality assessment criteria for reviews. FINDINGS: 32 reviews were identified as examining interventions that could be used or co-ordinated by midwives in relation to some aspect of maternal mental health and well-being from the antenatal to the postnatal period and met the inclusion criteria. The review highlighted that based on current systematic review evidence it would be premature to consider introducing any of the identified interventions into midwifery training or practice. However there were a number of examples of possible interventions worthy of further research including midwifery led models of care in the prevention of postpartum depression, psychological and psychosocial interventions for treating postpartum depression and facilitation/co-ordination of parent-training programmes. No reviews were identified that supported a specific midwifery role in maternal mental health and well-being in pregnancy, and yet, this is the point of most intensive contact. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This systematic review of systematic reviews provides a valuable overview of the current strengths and gaps in relation to maternal mental health interventions in the perinatal period. While there was little evidence identified to inform the current role of midwives in maternal mental health, the review provides the opportunity to reflect on what is achievable by midwives now and in the future and the need for high quality randomised controlled trials to inform a strategic approach to promoting maternal mental health in midwifery.

Cambodian migrant women's postpartum experiences in Victoria, Australia.

OBJECTIVE: to explore the postpartum experiences of Cambodian born migrant women who gave birth for the first time in Victoria, Australia between 2000 and 2010. DESIGN: an ethnographic study with 35 women using semi-structured and unstructured interviews and participant observation; this paper draws on interviews with 20 women who fit the criteria of first time mothers who gave birth in an Australian public hospital. SETTING: the City of Greater Dandenong, Victoria Australia. PARTICIPANTS: twenty Cambodian born migrant women aged 23-30 years who gave birth for the first time in a public hospital in Victoria, Australia. FINDINGS: after one or two home visits by midwives in the first 10 day postpartum women did not see a health professional until 4-6 weeks postpartum when they presented to the MCH centre. Women were home alone, experienced loneliness and anxiety and struggled with breast feeding and infant care while they attempted to follow traditional Khmer postpartum practices. IMPLICATIONS FOR PRACTICE: results of this study indicate that Cambodian migrant women who are first time mothers in a new country with no female kin support in the postpartum period experience significant emotional stress, loneliness and social isolation and are at risk of developing postnatal depression. These women would benefit from the introduction of a midwife-led model of care, from antenatal through to postpartum, where midwives provide high-intensity home visits, supported by interpreters, and when required refer women to professionals and community services such as Healthy Mothers Healthy Babies (Victoria Department of Health, 2011) for up to 6 weeks postpartum.

Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study.

OBJECTIVE: to explore the experiences and perceptions of parenthood and maternal health care among Latin American women living in Spain. DESIGN: an exploratory qualitative research using focus groups and thematic analysis of the discussion. SETTING AND PARTICIPANTS: three focus groups with 26 women from Bolivia and Ecuador and three focus groups with 24 midwives were performed in three towns in the Valencian Community receiving a large influx of immigrants. FINDINGS: the women interpreted motherhood as the role through which they achieve fulfilment and assumed that they were the ones who could best take care of their children. They perceived that men usually make decisions about sex and pregnancy and recognised a poor or inadequate use of contraceptive methods in planning their pregnancies. Women reported that it was not necessary to go as soon and as frequently for health examinations during pregnancy as the midwives suggested. The main barriers identified to health-care services were linked to insecure or illegal employment status, inflexible appointment timetables for prenatal checkups and sometimes to ignorance about how public services worked. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: empowering immigrant women is essential to having a long-term positive effect on their reproductive health. Antenatal care providers should be trained to build maternity care that is culturally sensitive and responds better to the health needs of different pregnant women and their newborns.

Maternal psychosocial determinants of fetal and infant health and the National Children's Study.

The purpose of this article is to inform perinatal nurses about the longitudinal National Children's Study (NCS), which was mandated by Congress. The NCS was designed to follow infants from before birth to age 21, and researchers propose to study 100,000 children. This complex and extensive study will provide especially relevant information to perinatal nurses in practice, teaching, and research.

Perinatal quality of life: is it important for childbearing women?

Acknowledgement of and support for women's psychological and social health and wellbeing across the childbearing spectrum is a core aspect of contemporary maternity care provision. These broader definitions of health and wellbeing have stimulated a growing interest in and acknowledgement of the concept of quality of life as important in pregnant and postnatal women. Accruing evidence would suggest that a number of aspects of the childbearing experience, linked to physiological change, physical demand, clinical events, outcomes and complications and emotional transition across the perinatal period, are relevant to a woman's perceived quality of life. In addition, those perceptions of quality of life may have further implications for both physical and psychological wellbeing. It could be argued that accurate assessment of quality of life, however, requires reliable tools that have been either designed for or validated in childbearing populations. This paper briefly presents some of the issues related to quality of life in pregnancy and the postnatal periods and discusses some of the available measures to assess quality of life in childbearing women.

Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals.

BACKGROUND: The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual's decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine. DISCUSSION: Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. "Good" mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children's needs before their own - they should not allow toxins to enter the body. On the other hand, "responsible" women take and act on medical advice - they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies. SUMMARY: The increased complexity involved when one body's actions impact the body of another - as in the pregnant and lactating body - has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.

Predictors of breastfeeding cessation among HIV-infected women in Dar es Salaam, Tanzania.

This paper examines predictors of breastfeeding cessation among a cohort of human immunodeficiency virus (HIV)-infected women. This was a prospective follow-up study of HIV-infected women who participated in a randomized micronutrient supplementation trial conducted in Dar es Salaam, Tanzania. 795 HIV-infected Tanzanian women with singleton newborns were utilized from the cohort for this analysis. The proportion of women breastfeeding declined from 95% at 12 months to 11% at 24 months. The multivariate analysis showed breastfeeding cessation was significantly associated with increasing calendar year of delivery from 1995 to 1997 [risk ratio (RR), 1.36; 95% confidence interval (CI) 1.13-1.63], having a new pregnancy (RR 1.33; 95% CI 1.10-1.61), overweight [body mass index (BMI) ≥25 kg m(-2) ; RR 1.37; 95% CI 1.07-1.75], underweight (BMI <18.5kg m(-2) ; RR 1.29; 95% CI 1.00-1.65), introduction of cow's milk at infant's age of 4 months (RR 1.30; 95% CI 1.04-1.63). Material and social support was associated with decreased likelihood of cessation (RR 0.83; 95% CI 0.68-1.02). Demographic, health and nutritional factors among women and infants are associated with decisions by HIV-infected women to cease breastfeeding. The impact of breastfeeding counselling programs for HIV-infected African women should consider individual maternal, social and health contexts.

Fatty acid status and maternal mental health.

Maternal mental health (MMH) problems are a major public health concern with adverse consequences for women, their offspring and families. Intake of long-chain polyunsaturated fatty acids, especially the n-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid, which are found predominantly in cold water fish, has been associated with a range of mental health outcomes and may improve MMH. The demands for these fatty acids are increased during pregnancy and lactation, and may influence MMH as they are integral parts of cell membranes especially in the brain and play a role in physiological processes such as membrane fluidity and neurotransmitter function. Observational studies and intervention trials that have examined the role of fatty acids and MMH disorders especially post-partum depression (PPD) were identified using Pubmed and have been reviewed. Only three well-designed large prospective studies were identified; these studies examined the relationship between dietary intakes of n-3 fatty acids and fish during pregnancy, and found limited evidence of an association with PPD. Several intervention trials (n=8) have been done but generally suffer from small sample size and vary in terms of the study subject characteristics and timing, duration and dosage of the intervention. The results are mixed, but one recently completed large trial found no evidence of benefit among women who received DHA during pregnancy. Few studies have been conducted in developing countries, and gaps remain on the influence of other nutrient deficiencies, genetic polymorphisms that influence n-3 fatty acid synthesis and total fatty acid intake.

Effects of unplanned pregnancy on maternal health in Turkey.

OBJECTIVE: to investigate the effects of unplanned pregnancy on maternal health in Turkey. DESIGN: a case-control study. SETTING: a government hospital in Aydin, Turkey. PARTICIPANTS: 314 women in the early postpartum period, selected with a non-probability method. FINDINGS: significantly more women with unplanned pregnancy had physical problems (76.4% vs. 63.7%; p<0.01) and lower haemoglobin levels (11.26±1.27g/dl vs. 11.62±1.27g/dl; p<0.01) compared with women with planned pregnancy. Also, significantly more women with unplanned pregnancy had lower scores for adaptive behaviour in pregnancy (14.78±3.08 vs. 19.19±3.11; p<0.001), felt negative feelings during labour (mean scores on Labour Agentry Scale: 81.03±19.07 vs. 98.64±16.94; p<0.001), felt more severe pain during labour (mean rank: 173.21 vs. 141.79, p<0.001), and were at high risk of depression in the early postpartum period (mean scores on Edinburgh Postpartum Depression Scale: 14.86±6.08 vs. 7.28±4.85; p<0.001) compared with women with planned pregnancy. KEY CONCLUSIONS: unplanned pregnancy has a negative impact on the development of positive behaviour concerning self-care, physical well-being, labour experience, pain in labour and psychological status in the early postpartum period. IMPLICATIONS FOR PRACTICE: midwives and nurses should identify women with unplanned pregnancy at an early stage, and try to decrease the negative effects of unplanned pregnancy on maternal health and to improve prenatal, perinatal and postnatal care.