[Postpartum blues - a Czech adaptation of the Maternity Blues Questionnaire]. / Poporodní blues - ceská adaptace dotazníku "Maternity Blues Questionnaire".

OBJECTIVE: To validate the Kennerley and Gaths Maternity Blues Questionnaire (MBQ) for the Czech postpartum population, to present the psychometric properties of the Czech version of that screening method, and to assess its predictive power for the risk of postpartum depression. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Arts and Philosophy, Charles University, Prague. METHODS: The Czech version of the MBQ was validated on a sample of 1093 women. The data were collected from October 2013 to September 2014 at all maternity hospitals in Vysocina region. The MBQ was administered on a one-time basis during womens postpartal stay at maternity hospital. After six weeks post partum, a screening for postpartum depression was performed using the Edinburgh Postnatal Depression Scale (EPDS). The cut-off point was set at 10/11 for MBQ and 12/13 for EPDS as such were the respective levels achieved by the 90th percentile in the MBQ and EPDS scores. The sociodemografic data were collected at the time of completing the MBQ. A logistic regression was performed to identify the predictors of severe blues. Cronbachs alpha was calculated to assess the internal consistency of the MBQ as a whole and its component scales. In order to assess the validity of the MBQ, a logistic regression was used to analyze the association between the MBQ and EPDS scores. The norms for the Czech version of MBQ are presented as percentiles. RESULTS: The MBQ scores showed a gradual rise over the days following the delivery (day 0 to day 4). The percentage of women with severe blues (MBQ score > 10) increased from 7.3% to 14.55% between day 0 and day 4. The most frequent feelings and mood states experienced by women in the first postpartum days included tiredness (61%), decreased self-confidence (30%), over-sensitivity (26%) and tension (19%), while 6,5% of women felt low spirited and 7% felt depressed. The women suffering from severe blues reported most frequently the same states of mood as did the women in the whole sample, but the rates of those states were higher: 83% for tiredness, 81% for decreased self-confidence, 79% for over-sensitivity, 71% for tension, while 46% of women with severe blues felt low spirited and 51% felt depressed. The significant risk factors for severe blues included parity (multipara, OR = 0.42; p < 0,001), mode of delivery (reference category unassisted vaginal delivery: emergency sectio caesarea, OR = 2.188, p = 0.004; planned sectio caesarea, OR = 1.843, p = 0.03; assisted vaginal delivery, OR = 6.136; p < 0.001), and previous depression (OR = 4.71, p = 0.003). Cronbachs alpha of the individual scales ranged from 0.34 to 0.76, Cronbachs alpha for the MBQ as a whole was 0.88. The severe blues were found to be a predictive factor for postpartum depression as assessed with EPDS (OR = 5.90; p < 0.001). CONCLUSION: With its high reliability and validity, the MBQ appears to be a useful tool for clinical practice and research. The MBQ can be used to identify the women with severe blues and with an increased risk of postpartum depression.

[Satisfaction with perinatal care in Vysocina region in the period between October 2013 and September 2014]. / Spokojenost zen s perinatální pécí v Kraji Vysocina za období ríjen 2013 az zárí 2014.

OBJECTIVE: To assess women's satisfaction with perinatal care provided in maternity hospitals in Vysocina region, to identify the areas with high satisfaction scores as well as those requiring improvement, and to describe the factors influencing women's satisfaction, i. e. dissatisfaction with the care provided during labor and birth and the early postpartal period. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philo-sophy, Charles University, Prague. METHODS: The satisfaction survey was conducted in all maternity hospitals in Vysocina region (Jihlava, Havlíckuv Brod, Trebíc, Pelhrimov, Nové mesto na Morave) during the period between October 2013 and September 2014. All women who had given birth in those hospitals during the period were approached and asked to participate in this survey. The women evaluated the perinatal care not before 58 days after birth, so that the evaluation of perinatal care did not take place directly during their stay at maternity hospital. In total, 1366 women took part in the study. The original Czech questionnaire KLI-P was used for the data collection. The KLI-P measures psychosocial climate of maternity hospitals on the following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. The satisfaction rates with component dimensions of intrapartal and postpartal care at the maternity hospitals in Vysocina region were compared to the satisfaction rates for the Czech Republic as a whole as obtained in our previous study. We used the Kruskal-Wallis test for this comparison. The ordinal logistical regression (cumulative logit model) was used to identify predictors of women's satisfaction with intrapartum and postpartum care in Vysocina region. RESULTS: The women who delivered at maternity hospitals in Vysocina region were significantly more satisfied with all dimensions of care received both at delivery (DU) and after-birth unit (ABU) as compared to the average parturient's satisfaction in the Czech Republic as specified in our previous study. The best rated scale at DU in Vysocina region was Physical comfort and services (93% vs. 85% for the whole country; P < 0,0001), while the worst evaluation score received the scale Control and involvement in decision-making (75% vs. 58% for the whole country; P < 0,0001). At ABU, the best rated scale was Control and involvement in decision-making (95% vs. 89% for the whole country; P < 0,0001), while the lowest evaluation score was found for the scale Physical comfort and services (85% vs. 76% for the whole Republic; P < 0,0001). The women perceived generally the caregivers as helpful and kind but they often missed sufficient emotional support. They considered the information received easy to understand, but they would welcome more information in general. Among the most important determinants of parturients satisfaction with care at DU were kind and helpful attitude of midwives (P < 0,0001), confidence in physicians (P < 0,0001), sufficient provision of information (P = 0,0016), pleasant appearance of the delivery room (P = 0,0010), kind and helpful attitude of physicians (P = 0,018). Among the most important determinants of satisfaction with care at ABU were sufficient provision of information (P = 0,0007), equipment of the room (P = 0,0014), informations regarding the care for the newborn (P = 0,0013), emotional support (P = 0,0039) and confidence in staff employed in newborn care (P = 0,025). CONCLUSION: Satisfaction with care received at maternity hospitals in Vysocina region was rated very high. However, despite its high quality, the perinatal care in Vysocina region suffers from several shortcomings. Regarding the significance of the individual determinants of parturient's satisfaction, improving the quality of care requires first of all better provision of information both during the labor and postpartal period. It would be beneficial to provide the health care professionals with the opportunities of attending a training in breastfeeding support and communication and of taking part in clinical supervision.