Parents' Experiences with Postpartum Support Groups using Videoconferencing: Perceptions of Safety in the Virtual Space.

PURPOSE: To explore new parents' experiences with web-based videoconferencing as a mechanism of offering postpartum virtual support groups. STUDY DESIGN AND METHODS: Virtual support sessions and individual interviews were conducted to explore participants' experiences with virtual postpartum groups. RESULTS: Thirty-seven parents participated in seven virtual support sessions and 19 participated in individual interviews. Participant narratives centered on perceptions of safety when engaging in virtual support groups. Tools within the virtual space (camera; mute) created a relational paradox which provided safeguards but also hindered the building of trust. Participants described negotiating the fear of harm and judgment within virtual spaces alongside feelings of security in connecting from the safety of their homes. CLINICAL IMPLICATIONS: The virtual environment provides a forum for new parents to access information and support and an avenue for engagement with maternal child nurses and care providers. Awareness of how parents perceive safety in the virtual environment is an important part of facilitating and structuring parent groups on videoconferencing platforms. Nurses should be familiar with videoconferencing technology and be able to guide parents. Experience facilitating virtual groups to ensure safety and security while providing needed support is a valuable nursing skill.

Exploring the Meaning of Sexuality, the Body, and Identity After Birth Using Feminist Poststructuralism.

OBJECTIVE: To explore how sexual health in the postpartum period is influenced by and negotiated through relations of power. DESIGN: Discourse analysis informed by feminist poststructuralism. SETTING: Telephone interviews conducted in Nova Scotia, Canada. PARTICIPANTS: Eleven women who gave birth in the last 1 to 6 months and lived in Nova Scotia. METHODS: We recruited participants through social media and invited them to share their experiences after birth through individual interviews. Using Baxter's approach to discourse analysis, we focused on identifying how participants created meaning within their experiences. RESULTS: We identified two main themes: Negotiating Change and Renegotiating Identity. Participants defined their bodies in new ways that could be sexual and/or nonsexual and created new meaning(s) of their identities as mothers and as sexual beings after birth. CONCLUSION: The meaning of the body and identity are intricately connected and significantly affect how sexual health is experienced by women during the first 6 months after birth. As such, it is critical that care providers prioritize, acknowledge, and validate how women in the postpartum period choose to define their sexuality, identity, and bodies to ensure the provision of person-centered care.

Examining How Postpartum Videoconferencing Support Sessions Can Facilitate Connections between Parents: A Poststructural and Sociomaterial Analysis.

Postpartum support for new parents can normalize experiences, increase confidence, and lead to positive health outcomes. While in-person gatherings may be the preferred choice, not all parents can or want to join parenting groups in person. Online asynchronous chat spaces for parents have increased over the past 10 years, especially during the COVID pandemic, when "online" became the norm. However, synchronous postpartum support groups have not been as accessible. The purpose of our study was to examine how parents experienced postpartum videoconferencing support sessions. Seven one-hour videoconferencing sessions were conducted with 4-8 parents in each group (n = 37). Nineteen parents from these groups then participated in semi-structured interviews. Feminist poststructuralism and sociomaterialism were used to guide the research process and analysis. Parents used their agency to actively think about and interact using visual (camera) and audio (microphone) technologies to navigate socially constructed online discourses. Although videoconferencing fostered supportive connections and parents felt less alone and more confident, the participants also expressed a lack of opportunities for individual conversations. Nurses should be aware of the emerging opportunities that connecting online may present. This study was not registered.

'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health.

There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.

"There's an Etiquette to Zoom That's Not Really Present In-Person": A Qualitative Study Showing How the Mute Button Shapes Virtual Postpartum Support for New Parents.

Virtual spaces that allow parents in the postpartum period to connect, support each other, and exchange information have been increasing in popularity. With the COVID-19 pandemic, many parents had to rely on virtual platforms as a primary means to connect with others and attend to their postpartum health. This study explored virtual postpartum support sessions through the web-based videoconferencing software, Zoom. Guided by feminist poststructuralism and sociomaterialism, we held seven virtual support sessions for parents caring for a baby 0-12 months in age, in Canada, and interviewed 19 participants about their experiences in the sessions. Our methodological approach allowed us to analyze discourses of (1) parenthood, (2) material realities of virtual environments, and (3) support and information on this virtual platform. The purpose of this research was to understand how technology influences postpartum support and learning through online videoconferencing for parents. Our findings document an overarching discourse of Zoom etiquette by which muting was a discursive practice that all participants used. The consistent use of the mute button while not talking structured conversation in virtual postpartum sessions and resulted in three themes: (1) minimizing disruptions; (2) taking turns; and (3) staying on task. The norm of using the mute button changed how parents received and gave support and information. Based on findings and broader literature, we discuss considerations for facilitation of virtual postpartum support sessions.

Mothers' Access to Social and Health Care Systems Support during Their Infants' First Year during the COVID-19 Pandemic: A Qualitative Feminist Poststructural Study.

Social support and health services are crucial for mothers and families during their infants' first year. The aim of this study was to explore the effect of self-isolation imposed by the COVID-19 pandemic on mothers' access to social and health care systems support during their infants' first year. We utilized a qualitative design using feminist poststructuralism and discourse analysis. Self-identifying mothers (n = 68) of infants aged 0 to 12 months during the COVID-19 pandemic in Nova Scotia, Canada completed an online qualitative survey. We identified three themes: (1) COVID-19 and the Social Construction of Isolation, (2) Feeling Forgotten and Dumped: Perpetuating the Invisibility of Mothering, and (3) Navigating and Negotiating Conflicting Information. Participants emphasized a need for support and the associated lack of support resulting from mandatory isolation during the COVID-19 pandemic. They did not see remote communication as equivalent to in-person connection. Participants described the need to navigate alone without adequate access to in-person postpartum and infant services. Participants identified conflicting information related to COVID-19 as a challenge. Social interactions and interactions with health care providers are crucial to the health and experiences of mothers and their infants during the first year after birth and must be sustained during times of isolation.

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review.

OBJECTIVE: The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). INTRODUCTION: Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period. INCLUSION CRITERIA: This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to the available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants. METHODS: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by 2 reviewers using a study-specific data extraction form. All conflicts were resolved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively. RESULTS: A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,760,731 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week had the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8 and 28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2 and 7 (48.1%), and diarrhea between days 8 and 28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%). CONCLUSION: Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.

Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review.

OBJECTIVE: The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period. INTRODUCTION: Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally. INCLUSION CRITERIA: This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2-7, and days 8-42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women). METHODS: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively. RESULTS: A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2-7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%). CONCLUSION: Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020187341.

Mothers' Experiences with Child Protection Services: Using Qualitative Feminist Poststructuralism.

BACKGROUND: The postpartum period is often portrayed as a blissful, calm and loving time when mothers, partners and family members bond with their newborn babies. However, this time may be experienced quite differently when mothers are monitored by Child Protection Services. Having a baby under these circumstances can be very difficult and traumatizing. While all new parents require support and information to help them through the transition to parenthood and address physical and psycho-social changes, mothers who are involved with Child Protection Services require more specialized support as they encounter higher incidences of postpartum stressors and higher rates of poverty, mental illness and substance abuse. The impact of support for mothers involved with Child Protection Services is not well-understood from the perspective of mothers. AIM: The aim of the study was to understand how new mothers in Nova Scotia prioritized their postpartum needs and where they went to obtain information and support. METHODS: Feminist poststructuralism was the methodology used to understand how the experiences of five mothers who accessed a family resource center and had been involved with Child Protection Services in Nova Scotia Canada had been personally, socially and institutionally constructed. RESULTS: Themes include: (1) We are Mothers, (2) Being Red Flagged, (3) Lack of Trust, (4) Us Against Them and (5) Searching for Supportive Relationships. CONCLUSION: Personal stories from all participants demonstrated how they experienced stigma and stereotypes from healthcare workers and were often not recognized as mothers. They also struggled to find information, supports and services to help them keep or regain their babies.

Mental Health & Parental Concerns during COVID-19: The Experiences of New Mothers Amidst Social Isolation.

BACKGROUND: The COVID-19 pandemic has resulted in an unprecedented situation for new parents, with public health orders greatly affecting daily life as well as various aspects of parenting and new parent wellbeing. OBJECTIVES: To understand the impact of the COVID-19 pandemic on mothers/parents across Nova Scotia who are caring for a child 0-12 months of age. DESIGN: This study utilized an online qualitative survey to collect data. Feminist poststructuralism and discourse analysis guided the analysis and discussion. SETTING: Nova Scotia, Canada PARTICIPANTS: : 68 participants were recruited from across the province of Nova Scotia. FINDINGS: Mental health and socialization were both major concerns for new mothers/parents, as many expressed feelings of worry, anxiety, loneliness, isolation, and stress. KEY CONCLUSIONS: Online support was sought by many new mothers/parents as a way of supporting their own mental health. Some found ways to make it meaningful for them, while others believed that it could not replace or offer the same benefits as in-person interaction and support. IMPLICATIONS FOR PRACTICE: Informal and formal support systems are both essential for new mothers. As public health systems and health care services learn to adapt to COVID-19, further research is required to examine how health services may best meet the needs of new mothers/parents.

Transitions in Atrial Fibrillation Care: A Systematic Review.

BACKGROUND: Patients with atrial fibrillation (AF) commonly transition between care settings and providers. These transitions are often points in the health care system where errors and clinical deterioration can occur. Anticoagulation interruption or discontinuation and sub-optimal follow-up post-emergency department (ED) discharge are considered major transitional issues. OBJECTIVE: The purpose of this study was to synthesise the evidence examining the impact of transitional care interventions on patient, provider, and health care utilisation outcomes. METHODS: This systematic mixed studies review examined citations from four databases Medline, CINAHL, EMBASE, and Cochrane Central Controlled Register of Trials (CENTRAL) using relevant search terms. Fourteen (14) moderate to high quality articles were selected. RESULTS: The available evidence reporting impacts of transitional interventions on health care utilisation, provider, and patient outcomes in AF patients is mixed and of variable quality. The stronger evidence revealed improvements in patient outcomes including knowledge, quality of life, and medication adherence and increased provider anticoagulant prescriptions resulting from transitional interventions. Hospital admissions and ED visits were not significantly affected by any interventions. CONCLUSIONS: Apps and educational toolkits improved patient knowledge. Pathways increased patient quality of life and provider prescription rates. There is a need for more research to determine the AF transition interventions which maximise patient, provider and health care outcomes.

Blessings and Curses: Exploring the Experiences of New Mothers during the COVID-19 Pandemic.

The aim of this study was to explore the postpartum experiences of new parents during the COVID-19 pandemic. The postpartum period can be a time of significant transition, both positive and negative, for parents as they navigate new relationships with their babies and shifts in family dynamics. Physical distancing requirements mandated by public health orders during the COVID-19 pandemic had the potential to create even more stress for parents with a newborn. Examining personal experiences would provide health care professionals with information to help guide support during significant isolation. Feminist poststructuralism guided the qualitative research process. Sixty-eight new mothers completed an open-ended on-line survey. Responses were analyzed using discourse analysis to examine the beliefs, values, and practices of the participants relating to their family experiences during the pandemic period. It was found that pandemic isolation was a time of complexity with both 'blessings and curses'. Participants reported that it was a time for family bonding and enjoyment of being a new parent without the usual expectations. It was also a time of missed opportunities as they were not able to share milestones and memories with extended family. Caring for a newborn during the COVID-19 pandemic where complex contradictions were constructed by competing social discourses created difficult dichotomies for families. In acknowledging the complex experiences of mothers during COVID-19 isolation, nurses and midwives can come to understand and help new parents to focus on the blessings of this time while acknowledging the curses.

Exploring postpartum sexual health: A feminist poststructural analysis.

Postpartum sexual health has historically been viewed and discussed in specific ways, often dominated by biomedical discourse. There is a need to expand understandings of sexual health for postpartum women in the context of interdisciplinary health care. Research surrounding postpartum sexual health is largely focused on physical measures, such as vaginal lubrication or initiation of intercourse, without accounting for the diverse and subjective ways that sexuality and sexual health are experienced during the postpartum period. This critical analysis uses feminist post-structuralism to critique and analyze current health research and practice surrounding postpartum sexual health. Agency, subjectivity, gender and sex considerations, relations of power, and discourse are essential to understanding postpartum sexual health in a more holistic, woman-centered way. This includes awareness of dominant discourses that have shaped how health researchers, practitioners, postpartum women, and health institutions care for, support, and promote postpartum sexual health. There is a need to move beyond physically focused, reductionist, heteronormative understandings of sexual health to better promote overall postpartum health and wellbeing.

Let's talk about sex: A feminist poststructural approach to addressing sexual health in the healthcare setting.

AIMS AND OBJECTIVES: To explore the use of feminist poststructuralism (FPS) as a way to critique, understand and improve sexual health care and policy in healthcare settings. BACKGROUND: Sexual health is an important aspect of health; however, in healthcare settings, it often goes unaddressed by both healthcare providers and patients due to stigma, taboo, fear of embarrassment or uncertainty. Lack of attention to sexual health has been stated as a legitimate concern for patients across the lifespan; there remain gaps in implementing sexual health care discussions into practice in healthcare settings. DESIGN: A critical analysis will be presented to explore sexual health care and attitudes in the healthcare setting from patient and nursing perspectives using FPS. METHODS: Feminist poststructuralism is used to examine the meaning of experience that is personally, socially and institutionally constructed through relations of power. FPS will also be applied to understand how sexual health discourses are negotiated in healthcare settings. SQUIRE guidelines were used in the preparation of this paper (See Appendix S1). RELEVANCE TO CLINICAL PRACTICE: The application of a feminist poststructural lens to sexual health care in healthcare settings may be used by healthcare professionals to understand, question and challenge how social and institutional beliefs, values and practices surrounding sexual health, inclusive of a patient's sexual pleasure or sexual activity, are experienced by healthcare professionals and patients. This theoretical and methodological approach could lead to identifying possibilities for change in healthcare settings that are inclusive and supportive of sexual health care.

Hypertension prevalence and risk factors in rural and urban Zambian adults in western province: a cross-sectional study.

INTRODUCTION: Hypertension is a longstanding problem in Zambia, yet little is known about its prevalence and risk factors, particularly in rural and urban settings. Identifying geographical variations in hypertension is important to enhance the health of adult Zambians regardless of where they live. Therefore, the purpose of this study was to compare the prevalence of hypertension and related risk factors between rural (n = 130) and urban (n = 131) communities in Western Province, Zambia. METHODS: This cross-sectional study included urban and rural adult Zambians attending health checks who completed a modified World Health Organization (WHO) survey, and had blood pressure and anthropometric measurements completed. Descriptive statistics were used to summarize demographic and risk factor variables. Chi-square tests of association were used to analyze relationships between categorical variables, t-tests to analyze relationships between continuous variables and logistic regression to examine associations of hypertension with selected risk factors. RESULTS: The prevalence of hypertension in rural Zambians was double (46.9%) that of urban Zambians (22.9%). Increasing age, not engaging in walking/biking, and alcohol intake within the last 30 days were associated with an increased likelihood of hypertension in rural Zambians while eating vegetables more days during the week was associated with a decreased likelihood of hypertension in rural Zambians. Body Mass Index (BMI) was significantly associated with an increased likelihood of hypertension in urban Zambians. CONCLUSION: Modifiable risk factors (such as BMI, dietary intake, and physical activity) are associated with hypertension prevalence in this population, indicating opportunities for screening and other prevention measures.