Validity and reliability of the Turkish version of the transition of primiparas becoming mothers scale.

BACKGROUND: The transition to motherhood is an important life event in a woman's life and represents an important developmental process that brings physical, psychological and social changes to gain a new role. However, research on the transition to motherhood in Turkish society is scarce. There is a need for a comprehensive, practical and reliable tool to evaluate the transition to motherhood in primiparous mothers. This study evaluated the reliability and validity of the Turkish version of the Transition of Primiparous Becoming Mothers Scale (TMP-S) to evaluate the transition process of primiparous mothers to motherhood. METHODS: This methodological research was carried out in obstetrics and gynecology outpatient clinics, pediatric outpatient clinics, and family health centers of a hospital in Türkiye. The sample consisted of primiparous mothers of 0 to 6- month-old babies who visited clinics and family health centers for routine postnatal examinations (n ​​= 305). After evaluating the language equivalence and content validity of the scale, test-retest reliability, internal consistency and construct validity were examined. Factor analysis, Pearson's correlation, retest reliability, and Cronbach's alpha were employed to evaluate structural validity and reliability. RESULTS: The final TPM-S had two dimensions with 25 items. Exploratory factor analysis revealed a two-factor solution, which accounted for 59.276% of the variance. Confirmatory factor analysis showed that the model fit of the two-factor model also reached a satisfactory model ft after modification. The comparative fit index was 0.894, the Tucker‒Lewis index was 0.882, and the root mean square error of approximation was 0.079. The content validity index of the scale ranged from 0.56 ~ 0.77. The Cronbach's alpha coefficient was 0.93 for the total scale, and the test-retest reliability was 0.96. CONCLUSIONS: It is a valid and reliable tool for evaluating the transition to motherhood among primiparous mothers of 0 to 6 month-old babies in Türkiye. Turkish researchers and healthcare professionals can routinely apply this measurement tool to primiparous mothers in the first six months after birth to evaluate their transition to motherhood.

Supporting the transition to parenthood: a systematic review of empirical studies on emotional and psychological interventions for first-time parents.

OBJECTIVES: The transition to parenthood can evoke a range of concerns in parents, profoundly impacting their psychological well-being. The literature regarding the transition to parenthood focuses primarily on functional aspects of parenthood, generally overlooking the psychological well-being of parents. METHOD: This comprehensive review synthesized studies describing emotional and psychological interventions during the transition to parenthood among participants between 2013 and 2022. A rigorous screening process, conducted by three of the authors, resulted in 18 studies that met the inclusion criteria. RESULTS: This report provides detailed descriptions of these studies, including their characteristics, demographics, types of interventions, and main outcomes. The majority of interventions focused on mothers and mother-infant dyads, with fewer interventions targeting couples, and none addressing fathers or father-infant dyads. CONCLUSIONS: The interventions examined were found to be effective in reducing symptoms such as depression, anxiety, and stress among mothers and had positive effects on infants' behaviors, mother-infant synchrony, and co-parenting. PRACTICE IMPLICATIONS: This review stresses the necessity of interventions targeting the transition to parenthood, especially among fathers and marginalized populations, as well as serves to identify barriers faced by vulnerable and minority populations.

Evaluation of a pregnancy programme to enhance older primiparas' physical and mental health and marital relationships after childbirth: A non-randomized clinical trial.

AIM: This study evaluated a pregnancy programme designed by us to stabilize older primiparas' physical and mental health and strengthen their marital relationships. DESIGN: A non-randomized controlled trial study of two groups; an intervention and control group. METHODS: Ultimately the scores of 15 participants assigned to an intervention group and 15 assigned to a control group were analysed. Participants responded to sociodemographic questions, the Edinburgh Postnatal Depression Scale (EPDS), a postpartum physical fatigue questionnaire, wives' satisfaction with husbands' support questionnaire and Quality Marriage Index (QMI). Data were collected during pregnancy and at one and 3 months after childbirth. RESULTS: The participating wives' EPDS scales significantly decreased after the postpartum course in the intervention group. Participating in the programme significantly raised husbands' awareness of their wives' physical burdens 1 month after childbirth. The subscale 'housework support/wives' satisfaction with husbands' support', 3 months after childbirth, did not decline. It is suggested that this programme could strengthen marital relationships because the husbands' understanding of their spouses' physical burdens after childbirth led to an improvement in the wives' satisfaction with their spouses' housework support. Participation in the pregnancy programme may strengthen the marital relationship. This study recommends appropriate nursing support for pregnant couples to improve their physical and mental health.

Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas.

BACKGROUND: Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery. Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples. AIM: To investigate the correlations among mindfulness, marital quality, anxiety, and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas. METHODS: A cross-sectional study was conducted. The self-administered questionnaire was submitted online through smartphones. The levels of mindfulness, anxiety, depression, and marital quality were respectively investigated by the mindful attention awareness scale (MAAS), the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), and the marriage perception scale (MPS) in these enrolled Han and Tujia primiparas. RESULTS: No statistical significance was observed in the prevalence of postpartum anxiety and depression, nor scores of MAAS and MPS-Total in different regions or ethnicities (P > 0.05). However, MPS-Marital interaction (P < 0.05), MPS-Family relationship (MPS-FR) (P < 0.01), and MPS-Marital conflict (MPS-MC) (P < 0.01) scores of urban primiparas were higher than those of rural primiparas. The MPS-MC score of Han primiparas was higher than that of Tujia primiparas (P < 0.05). Negative correlations were observed between MAAS and SAS (r = -0.457, P < 0.01), and MAAS and SDS (r = -0.439, P < 0.01). SAS has revealed a highly positive correlation with SDS (r = 0.720, P < 0.01) and a weak negative correlation with MPS (r = -0.200, P < 0.05). Besides, a weak negative correlation was observed between MAAS and MPS-MC (r = -0.184, P < 0.05), and a weak positive correlation was noticed between SAS and MPS-MC (r = -0.225, P < 0.01). Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety (P < 0.05, 95%CI: -0.384 to 0.033), MPS-MC and postpartum anxiety (P < 0.01, 95%CI: 0.027-0.193), MPS-FR and postpartum depression (P < 0.05, 95%CI: -0.365 to 0.031), and MPS-MC and postpartum depression (P < 0.01, 95%CI: 0.022-0.206). CONCLUSION: Mindfulness demonstrates negative correlations with marital conflict, postpartum anxiety and depression, and it may have cross-ethnic and trans-regional characteristics. Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study, it demonstrates a full mediation effect on the relationships between family relationships, marital conflict, and postpartum anxiety and depression.

Influence of the upright position delivery in the second stage of labour on delivery outcomes in primiparas / 中国实用护理杂志

Objective:To investigate the influence of the upright position delivery in the second stage of labour on delivery outcomes in primiparas, so as to provide reference for the formation of systematic delivery management strategies.Methods:This study was a cohort study, 454 primiparas who delivered in Beijing Hospital from January 2022 to December 2022 were selected. In the second stage of labour, according to the willingness of the primiparas, they were divided into the upright group(delivered in upright position, 222 cases) and the supine group(delivered in supine position, 232 cases). The duration of the second stage of labour, perineal injury, vaginal midwifery, neonatal asphyxia, and the effect of pharmacological analgesia on delivery outcomes in two groups of primiparas were observed and compared.Results:The duration of the second stage of labour was 30 (22, 50) min in the upright group, which was shorter than 48 (30, 80) min in the supine group, with statistically significant difference ( Z=-5.90, P < 0.05). The rate of lateral episiotomy was 17.6% (39/222) in the upright group, which was lower than 28.0% (65/232) in the supine group, with statistically significant difference ( χ2=7.02, P <0.05). There was no significant difference in the incidence of second degree perineal injury, vaginal midwifery, shoulder difficulty rate and neonatal asphyxia in the two groups ( P>0.05). The incidence of vaginal midwifery was 10.9% (14/129) and 2.2% (2/93) respectively in the upright group with pharmacological analgesia and non pharmacological analgesia, and the difference was statistically significant (Fisher's exact test, P<0.05). The duration of the second stage of labour was 53 (32, 85), 41 (27, 59) min in the supine group with pharmacological analgesia and non pharmacological analgesia, and the difference was statistically significant ( Z=-3.28, P<0.05). Conclusions:The adoption of upright position in the second stage of labour for primiparas can shorten the duration of the second stage, and reduce the rate of lateral episiotomy which can optimize the delivery outcome. For primiparas with pharmacological analgesia, it is recommended to use an upright position for delivery if conditions permit.

Development of an assessment tool for the transition of Japanese primiparas becoming mothers: Reliability and validity.

OBJECTIVE: We developed a measurement tool that may be used for Japanese primiparas to determine their progress in the transition to being a mother. DESIGN: Quantitative descriptive study. SETTING: Japan. PARTICIPANTS: A total of 86 and 395 participants were included in the pilot study and present survey, respectively. INTERVENTIONS: Drafting the scale involved creating a pool of items based on semi-structured interviews of primiparas at 1-6 months postpartum. After validating the items through researchers in the field of maternal nursing and midwifery, a web-based questionnaire was used to investigate the reliability and validity of the scale. MEASUREMENTS AND FINDINGS: In the exploratory factor analysis of the pilot study, we explained 5 subfactors and 57 items. In the present survey, upon conducting an exploratory factor analysis of 57 items and investigation of content validity, we were able to explain 5 subfactors and 30 items. The Cronbach's α coefficient for each factor was 0.871-0.648. The inter-item correlation for subfactors with α < 0.7 was r = 0.394-0.465. The confirmatory factor analysis revealed the following indices of goodness of fit of each model: comparative fit index = 0.838, goodness of fit index = 0.821, adjusted goodness of fit index = 0.789 and root mean square error of approximation = 0.07. As concurrent validity, a correlation was identified between three external criteria and the present scale. KEY CONCLUSIONS: We developed a measurement tool for Japanese primiparas to determine their progress in the transition to being a mother. IMPLICATIONS FOR PRACTICE: Through this scale, primiparas can objectively assess the transition to becoming a mother as well as developing an understanding of their state. In cases when there are similarities between results of self-evaluation and those of evaluation of others, mothers can subsequently receive various supports that can help empower them.

A nomogram model predicting the risk of postpartum stress urinary incontinence in primiparas: A multicenter study.

Stress urinary incontinence (SUI) is a common gynecological urinary system disease, and globally, 200 million or more people suffer from it. However, the existing literature mostly focuses on postpartum urinary incontinence (UI) or UI in middle-aged and elderly people, with little focus on primiparas. To analyse urinary incontinence prevalence and its risk factors in primiparas and establish a nomogram prediction model, 360 parturients were recruited from three hospitals between April and September 2021. A homemade electronic questionnaire was used to investigate the general demographic and perinatal characteristics of primiparas. The SUI was diagnosed by the physicians. Logistic regression analysis of independent risk factors for SUI and a nomogram prediction model were established. Ninety people were diagnosed as SUI. The number of pregnancies (OR = 3.322, 95% CI = 1.473-7.492), residence (OR = 5.451, 95% CI = 2.725-10.903), occupation (OR = 3.393, 95% CI = 1.144-10.064), education level (OR = 3.551, 95% CI = 1.223-10.308), delivery method (OR = 10.270, 95% CI = 4.090-25.789), and oxytocin use (OR = 2.166, 95% CI = 1.142-4.109) were independent risk factors for SUI. The C-index of the nomogram prediction model was 0.798 (95% CI = 0.749-0.846). The POPDI score, CRADI score, UDI score, and PFDI scores of women with SUI were significantly higher than those of non-SUI women, while I-QOL scores were significantly lower than those of non-SUI women. In conclusion, the prevalence of SUI among primiparas in Fuyang, China, was 25.00%, which exhibited a large impact on the quality of life of puerperae. The present study successfully established an individualized nomogram prediction model of SUI for primiparas with good discrimination and diagnostic efficiency, which was helpful for the early clinical identification of high-risk primiparas with SUI.

Transition to motherhood for Japanese primiparas from delivery to 6 months postpartum: A qualitative study.

AIM: This study investigates aspects of the socio-culturally influenced Japanese primiparas' transition to motherhood. DESIGN: A qualitative descriptive study approach with interviews of Japanese primiparas was used. METHODS: Individual interviews with 21 Japanese primiparas were conducted, with a focus on their transition to motherhood and familiarization with the maternal role. The interviews were analysed, and categories and subcategories were established. This paper was developed using the COREQ guidelines for reporting qualitative studies. RESULTS: Seven major categories with 26 subcategories were identified in the transition to motherhood. The seven categories are listed as follows: "confusion with first childcare experience," "suffering related to childcare," "clinging to the image of an ideal mother," "internal conflict while comparing oneself to other mothers," "undertaking childcare by disengaging from one's stereotype," "realization of becoming a mother" and "changing relationship with surrounding people."

Association between primiparas’ willingness of a second child and cesarean section / 上海预防医学

ObjectiveTo explore the impact of primiparas’ intention to have a second child on their delivery mode. MethodsDuring March 1st， 2019 and November 30th， 2020， the enrolled pregnant women were investigated by questionnaires at two points， first trimester pregnancy registration and post-natal visit at maternal and child healthcare community centers of Xuhui District. Logistic regression analysis was used to examine the association of willingness of a second birth and their mode of delivery. Results2 000 questionnaires were distributed and 1 664 valid questionnaires were analyzed. The overall cesarean delivery rate in nulliparous women was 40.08% （667/1 664）， with 8.95% （149/1 664） of non-medical indication cesarean delivery. Multiple Logistic regression analysis of overall delivery rate showed that age， willingness to have more children in the future， plan of vaginal delivery at first questionnaire， and complications during pregnancy were associated with overall cesarean delivery rate， and women without the willingness to have more children in the future were more likely to undergo cesarean delivery （OR=1.350， 95%CI： 1.052-1.732）. Age， whether to have a second child in the future， plan of vaginal delivery at first questionnaire， and complications during pregnancy were all factors associated with increased risks of non-medical indicated cesarean delivery， while women with no plan of a second child in the future had nearly 2 times of risk of non-medical indicated cesarean delivery （OR=1.909， 95%CI： 1.117-3.262）. ConclusionThe mode of delivery is affected by many factors， among which willingness to have more children in the future is an important factor associated with increased risks of overall cesarean delivery and non-medical indicated cesarean delivery.

Does Nubility Indicate More Than High Reproductive Value? Nubile Primiparas' Pregnancy Outcomes in Evolutionary Perspective.

The idea that human males are most strongly attracted to traits that peak in women in the nubile age group raises the question of how well women in that age group contend with the potential hazards of a first pregnancy. Using data for 1.7 million first births from 1990 U.S. natality and mortality records, we compared outcomes for women with first births (primiparas) aged 16-20 years (when first births typically occur in forager and subsistence groups) with those aged 21-25 years. The younger primiparas had a much lower risk of potentially life-threatening complications of labor and delivery and, when evolutionarily novel risk factors were controlled, fetuses which were significantly more likely to survive despite lower birth weights. Thus, nubile primiparas were more likely to have a successful reproductive outcome defined in an evolutionarily relevant way (an infant of normal birth weight and gestation, surviving to one year, and delivered without a medically necessary cesarean delivery). This suggests that prior to the widespread availability of surgical deliveries, men who mated with women in the nubile age group would have reaped the benefit of having a reproductive partner more likely to have a successful first pregnancy.

Relatório de estágio em Enfermagem de Saúde Materna e Obstetrícia: Impacto da transição para a parentalidade: perceção das primíparas / Internship report in Maternal Health and Obstetrics Nursing: Impact of the transition to parenthood: perception of primiparous women

Problemática: O nascimento do primeiro filho provoca transformações notórias em toda a dinâmica familiar, sendo um período desafiador e stressante para os pais, que são expostos a inúmeras mudanças, nomeadamente conjugal, familiar e social (Carvalho, 2020). Objetivos: Conhecer a perceção das mães primíparas sobre o impacto da transição para a parentalidade na relação conjugal. Metodologia: Estudo nível I do tipo exploratório-descritivo, amostra do tipo não probabilística, em bola de neve, constituída por 53 mães que experienciaram pela primeira vez o nascimento do filho. O estudo teve parecer favorável pela Comissão de Ética da Unidade Investigação em Ciências da Saúde: Enfermagem, da Escola Superior de Enfermagem de Coimbra. Em todo o estudo foi garantida a confidencialidade das participantes, pelo anonimato da identidade e dos dados obtidos, onde ao submeterem o questionário, através do Google forms, assumiam a participação no estudo de forma esclarecida e consentida. O questionário foi dividido em três grupos de questões, nomeadamente dados sociodemográficos, dados obstétricos e questões de resposta aberta, que foram analisadas de acordo com Análise de Conteúdo de Bardin (2011). Resultados: Da análise dos resultados emergiram quatro categorias principais: Redefinição de papéis; Alteração da conjugalidade; Alteração na vivência da sexualidade; Necessidade de apoio à dinâmica familiar. Esta transição, como descrito pelas primíparas e apoiado pela evidencia científica leva a uma reorganização de papéis e reestruturação de competências pessoais e sociais. Foi possível compreender os sentimentos e preocupações das primíparas e a forma como esta mudança de papel e de competências influencia na relação com o companheiro. Neste contexto, concluiu-se que o nascimento do primeiro filho, está relacionado com esta nova readaptação papéis de esposa e de esposo ao papel de pai e de mãe. Foi também possível realçar a importância e a necessidade de intervenção do EESMO no período pré e pós-parto.

The effect of continuous midwifery services on the delivery mode, labor progress, and nursing satisfaction of primiparas during natural deliveries.

OBJECTIVE: To analyze the effect of continuous midwifery services on the delivery mode, labor progress, and primiparas' nursing satisfaction levels during natural deliveries. METHODS: 340 primiparas admitted to our hospital from January 2017 to June 2020 were recruited as the study cohort and randomized into a continuous midwifery group and a traditional midwifery group, with 170 patients in each group. They underwent traditional midwifery nursing services and continuous midwifery services, respectively. The two groups' delivery modes, labor progress, analgesic methods, perinatal Self-Rating Anxiety Scale (SAS) scores, postpartum hemorrhage amounts, Apgar scores, and nursing satisfaction levels were compared. RESULTS: The natural delivery rate in the continuous midwifery group was higher than it was in the traditional midwifery group (P<0.05). The maternal non-drug analgesia rate in the continuous midwifery group was higher than it was in the traditional midwifery group (P<0.05). The duration of the first stage in the continuous midwifery group was shorter than it was in the traditional midwifery group (P<0.05). The comparisons made during the second and third stages in the two groups showed no statistical differences (P>0.05). The SAS scores in the continuous midwifery group were significantly better than the SAS scores in the traditional midwifery group at the time of waiting for delivery and at one day after delivery (P<0.01). The postpartum hemorrhage amounts in the continuous midwifery group were lower than they were in the traditional midwifery group (P<0.01). The neonatal Apgar scores and maternal nursing satisfaction levels in the continuous midwifery group were better than they were in the traditional midwifery group (P<0.01). CONCLUSION: Continuous delivery services for primiparas during natural delivery can significantly increase the natural delivery rate, reduce the use of analgesics, shorten the delivery times, alleviate the delivery-related anxiety levels in the primiparas, reduce postpartum hemorrhages, effectively improve the delivery outcomes, improve the quality of the newborns, and improve the primiparas' nursing satisfaction levels, so it is worthy of clinical promotion and application.

Urinary parabens, bisphenol A and triclosan in primiparas from Shenzhen, China: Implications for exposure and health risks.

The usage of parabens, bisphenol A and triclosan in diverse consumer products is in widespread. Nevertheless, there are limited data concerning exposure to these chemicals in human being, especially in primiparas. Biomonitoring of chemicals in primiparas is useful for the estimation of chemical exposure risks for both primiparas and their offspring. This study aims to investigate urinary levels of parabens, bisphenol A and triclosan of 84 primiparas from Shenzhen, China and to evaluate their potential health risks. Methyl, ethyl, and n-propyl parabens bisphenol A and triclosan exhibited high detection rates (DRs) (> 97%) in urine samples, suggesting that primiparas are exposed to them widely. The median concentrations of methyl, ethyl, and n-propyl parabens, bispenol A and triclosan in urine were 2.14, 4.10, 0.46, 1.30 and 3.00 µg/L, respectively. Ethyl paraben was the predominant paraben accounting for nearly half of Σ3parabens (The sum concentrations of methyl, ethyl, n-propyl parabens). Positive associations with significance (p < 0.05) were found between the usage of plastic containers and urinary concentrations of ethyl paraben or BPA, indicating plastic containers might be an important factor influencing primipara exposure to these two chemicals. Urinary concentrations of methyl paraben were positively associated (p < 0.05) with the time of computer use by participant, suggesting that indoor dust might constitute an important source of parabens. The estimated daily intakes of parabens, bisphenol A and triclosan contrasted with the acceptable daily intakes in a comparatively low level. The hazard quotients (HQs) of these chemicals were all less than 1, suggesting no health risks for primiparas from South China. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-020-00599-1.

Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum.

INTRODUCTION AND HYPOTHESIS: To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum, comparing vaginal and cesarean delivery. METHODS: Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother. RESULTS: The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI < 25, obesity was a predictor for urinary incontinence after vaginal delivery (OR 1.94; 95% CI 1.20-3.14). Birthweight > 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05-2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30-3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section. CONCLUSIONS: Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.

Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness and feasibility of simulation-based childbirth education (SBCE) on reducing fear of childbirth (FOC) of Chinese primiparas. METHODS: A total of 56 primiparas completed the trial including 26 in the intervention group and 30 in the control group. The intervention group received four sessions of SBCE while the control group received routine prenatal care. Chinese versions of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and Childbirth Self-Efficacy Inventory (CBSEI) were used to evaluate FOC and childbirth self-efficacy. Birth outcomes including delivery method, labor duration and Apgar scores were collected. RESULTS: Scores on the WDEQ-A of the intervention group were statistically lower than those of the control group (P < 0.05). The CBSEI scores of the intervention group were significantly higher than those of the control group (P < 0.05). The cesarean birth rate of the intervention group was lower than that of the control group (34.61% vs 46.67%, P > 0.05). CONCLUSION: Simulation-based childbirth education alleviates FOC, increases childbirth self-efficacy and improves birth outcomes, providing a new perspective to alleviate FOC of primiparas in the future. PRACTICE IMPLICATIONS: Simulation-based childbirth education is an effective and feasible method to educate women about childbirth. Its integration into routine prenatal care of Chinese primiparas should be encouraged to reduce FOC.

Effects of lateral episiotomy on the emergence of urinary incontinence during the first postpartum year in primiparas: prospective cohort study.

AIM OF THE STUDY: Lateral episiotomy is a widely used procedure, although it is rarely mentioned in the literature and its effects on the pelvic floor are largely unexplored. The purpose of this study is to evaluate the impact of lateral episiotomy on the incidence of urinary incontinence (UI) after vaginal delivery in primiparas. MATERIAL AND METHODS: The study design is a prospective cohort study. The primiparas were divided into two groups. The first group consisted of women who gave birth with lateral episiotomy, while the second group included women who gave birth with an intact perineum or with perineal tears of first and second degree. Assessments of UI were performed at 5 and 8 months after childbirth using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) questionnaire followed by the stress test. RESULTS: The results revealed no significant differences (p > 0.05) in emergence of stress urinary incontinence (SUI) between the groups at the two time points. There were no statistically significant differences in overall rate of UI, urge urinary incontinence (UUI), or mixed urinary incontinence according to the ICIQ-SF questionnaire. The overall incontinence rate on the first examination was 24% in the episiotomy group and 36% in the perineal laceration group, although the difference was not statistically significant (p = 0.064). On the second examination, rates were similar and without a statistically significant difference. CONCLUSIONS: Lateral episiotomy has a neutral effect on the onset of UI in primiparous women in the first year after delivery.

Psychosocial factors affecting pregnancy reactions of primipara in Mianyang / 四川精神卫生

ObjectiveTo explore the psychosocial factors affecting pregnancy reactions of primipara， so as to alleviate pregnancy reactions in early pregnancy stage. MethodsBasic information scale， Symptom Checklist 90 （SCL-90）， Pregnancy Pressure Scale （PPS） and Pregnancy-unique Quantification of Emesis and Nausea （PUQE） were used to assess the primiparas in a hospital from April to June 2020， thereafter， multiple linear regression was used to screen the main psychosocial factors affecting pregnancy reaction. ResultsA total of 100 pregnant women completed the survey， and the scores of PUQE， PPS and SCL-90 were （4.39±1.14）， （10.89±6.94） and （112.75±22.27）， respectively. Analysis showed that the pregnancy reactions were mild in 93 cases （93%）， moderate in 6 cases （6%） and severe in 1 case （1%）. One-way ANOVA results showed that there was no significant difference in PUQE score among primipara of different age， working status， education levels and average annual family incomes （F=0.57， 0.07， 0.89， 0.51， P>0.05）. Multifactorial regression analysis showed that pregnancy stress， SCL-90 score， obsessive-compulsive symptoms， depression levels， hostility， paranoia and others had statistical significance （P<0.05 or 0.01）. ConclusionThe main psychosocial factors influencing pregnancy reaction are the pregnancy stress and psychosomatic symptoms including obsessive-compulsive symptoms， depression levels， paranoia， hostility， sleep status， diet and others.

Influence of group health care model during pregnancy on midwifery based primipara′s self-efficacy and quality of life / 中华健康管理学杂志

Objective:To explore the influence of a midwife-led group health care model on primiparas′ self-efficacy and quality of life.Methods:The study included 200 primiparas who registered with the obstetrics department of our hospital between January and December 2019. The puerperas were divided into two groups with 100 cases each according to the random number table method. The control group received routine health care during pregnancy. The T-test and χ 2 test were used, while the observation group received midwifery-led group health care during pregnancy. The scores of maternal role adaptability, self-efficacy, weight control, delivery mode, breastfeeding, mental state, and quality of life was compared between the two groups. Results:After nursing, the mother′s role adaptability (63.14±9.38) and self-efficacy (34.16±2.89) scores in the observation group were higher than those in the control group (52.89±8.41 and 31.28±2.43, respectively) ( t=8.136, 7.627, P<0.05). The weight gain of the observation group in the third trimester [(3.68±1.22) kg] was less than that of the control group [(5.49±1.76) kg] ( t=8.452, P<0.05). The vaginal natural delivery rate of the observation group was 91% higher than the 71% of the control group (χ2=12.966, P<0.05), the cesarean section rate of the observation group was 9% lower than the 29% of the control group (χ2=12.966, P<0.05), and the exclusive breastfeeding rate in the observation group was higher than that in the control group ( χ2 =6.258, P<0.05). After nursing, the SAS (40.74±4.93) and SDS scores (42.16±5.07) of the observation group were lower than those of the control group (47.10±5.27 and 48.59±5.42, respectively) ( t=8.813, 8.664, P<0.05), and the four-dimension quality of life scores of the observation group were higher than those of the control group ( t=7.293, 7.406, 7.357, 8.767, P<0.05). Conclusion:A midwife-led group pregnancy care model can effectively enhance the self-efficacy of primiparas and improve their quality of life.

Relationships Among Factors Related to Childbirth and Breastfeeding Outcomes in Primiparous Women.

OBJECTIVES: To explore the relationships among potentially modifiable factors related to childbirth and effective breastfeeding initiation at approximately 36 hours after birth and duration and exclusivity at hospital discharge, 2 weeks, 2 months, and 6 months after birth in primiparous women and to explore whether modifiable and nonmodifiable secondary factors and covariates influenced the relationships among factors related to childbirth and these breastfeeding outcomes. DESIGN: A prospective, longitudinal, cohort study. SETTING: The postpartum units of two general hospitals in eastern Canada. PARTICIPANTS: Ninety-seven mother-infant dyads. METHODS: We recorded demographic, childbirth, obstetric history, and breastfeeding data through chart review. A breastfeeding observation was completed at approximately 36 hours after birth by unit nurses. Participants maintained breastfeeding logs in hospital and for 6 months after birth and completed three self-report questionnaires before discharge. We analyzed outcomes using backward stepwise linear and logistic regression. RESULTS: One childbirth factor, labor induced with oxytocin, was negatively associated with effective initiation of breastfeeding, and none was related to breastfeeding duration and exclusivity at any time point. Maternal weight; professional support; and newborn's gestational age at birth, 5-minute Apgar score, weight loss, LATCH score, and active feeds (newborn actively suckled at the breast) were significantly associated with breastfeeding outcomes. CONCLUSION: Induction of labor with oxytocin should be used judiciously; when used, nurses must be hypervigilant to assess the mother-infant dyad for breastfeeding issues and to intervene to prevent or remediate them.

Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: A randomized controlled trial.

BACKGROUND: Stress urinary incontinence is a distressing and burdensome condition affecting approximately one third of pregnant women and pelvic floor muscle training is recommended as the first-line treatment. Convenient and cost-effective regimen of pelvic floor muscle training is required to facilitate the treatment of stress urinary incontinence and improve the adherence to treatment in pregnant women. OBJECTIVE: To determine the effectiveness of app-based audio guidance pelvic floor muscle training on the treatment of stress urinary incontinence in primiparas. DESIGN: The study was a two-arm, parallel, randomized controlled clinical trial. SETTING: The study was conducted in the obstetric clinic of a tertiary maternity hospital in Hangzhou, China. PARTICIPANTS: A total of 108 eligible primiparas were enrolled from January to April 2018. METHODS: Participants were randomly allocated (1:1) to the audio group or the control group. Primary outcomes included severity of stress urinary incontinence and adherence to pelvic floor muscle training assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the Broome Pelvic Muscle Self-Efficacy Scale, respectively. Secondary outcomes included pelvic floor muscle strength, bladder neck mobility and sexual function measured by vaginal palpation and pelvic floor muscle surface electromyography, perineal ultrasound and Female Sexual Function Index, respectively. Data analysis followed the intention-to-treat principle. Generalized estimation equation model, t-test and chi-square test were used to examine intervention effect on primary outcomes and secondary outcomes, respectively. RESULTS: Participants showed significant improvement in symptom severity across the study, which was most significant at 6 weeks postpartum (ß = -4.245, p < 0.001). No significant difference was found in symptom severity between groups (ß = -0.344, p = 0.168). The interaction effect between intervention and time on adherence was significant. Compared with the control group, greater self-efficacy was shown in the audio group at 6 weeks (ß = 4.425, p = 0.009), 3 months (ß = 3.204, p < 0.001) and 6 months (ß = 4.457, p < 0.001) postpartum. Participants in the audio group indicated less bladder neck descent (16.5 vs. 19.5, p = 0.020) at 6 weeks postpartum, better pelvic floor muscle strength (12.5% vs. 34.0%, p = 0.012; 4.2% vs. 18.0%, p = 0.030) and sexual function (22.2 vs. 17.3, p = 0.007) at 6 months postpartum. CONCLUSIONS: The app-based audio guidance pelvic floor muscle training was more effective and much easier to comply for treatment of stress urinary incontinence in primiparas than the conventional home-based pelvic floor muscle training.