Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Treating postpartum depression with brexanolone.

The FDA has approved brexanolone specifically for treatment of adults with postpartum depression (PPD). Administered I.V., it can relieve severe signs and symptoms of PPD within days rather than weeks. This article discusses the benefits and risks of brexanolone as a treatment for PPD, including nursing considerations and patient teaching.

Antenatal and postnatal depression - Are Polish midwives really ready for them?

OBJECTIVE: Before January 2019, no established solutions regarding the screening, assessment, and treatment of patients suffering from perinatal depression existed in Poland. From 2019, a new standard of perinatal care has imposed the obligation to monitor the mental state of women during pregnancy and in the postpartum period on the healthcare providers (mainly on midwives). Thus, our study aimed to evaluate midwives' knowledge about prenatal and postnatal mental health disorders in the first six months of implementing the new standard of perinatal care in Poland. DESIGN: Polish midwives completed a survey consisting of the Test of Antenatal and Postpartum Depression Knowledge by Jones, Creedy, and Gamble (2001) and questions related to a hypothetical case study of a depressed woman named "Mary", developed by Buist and colleagues (2006). The midwives also rated their perceived knowledge and skills in assessing women' mental health condition. SETTING: The study was conducted in four Polish cities: Gdansk, Olsztyn, Szczecin, Wroclaw, and the surrounding rural areas. PARTICIPANTS: 111 Polish midwives with varied professional experience and socio-demographic characteristics participated in the study. MEASUREMENTS AND FINDINGS: Among all of their professional responsibilities, the midwives self-rated their knowledge and skills in assessing the mental state of patients as the lowest ones. A subsequent objective assessment revealed their insufficient knowledge about antenatal and postnatal depression and the ways of treatment of these disorders. KEY CONCLUSIONS: Midwives are not properly prepared for the new tasks resulting from the Polish standard of perinatal care: specifically, for the assessment of a woman's mental state. IMPLICATIONS FOR PRACTICE: Further trainings are required to ensure midwives' competency and knowledge about the assessment and dealing with mental disorders of patients who experience prenatal and postpartum depression.

Public health nurse delivered group cognitive behavioral therapy (CBT) for postpartum depression: A pilot study.

OBJECTIVES: Although postpartum depression (PPD) affects 1 in 5 women, just 15% receive treatment. Cognitive Behavioural Therapy (CBT) is a first-line treatment for PPD. The objective of this pilot study was to determine the feasibility and acceptability of public health nurse (PHN)-delivered group CBT for PPD and to determine preliminary estimates of effect. DESIGN: A pre-posttest design was used. Participants provided data before and after the CBT groups. SAMPLE: Seven women who were over the age of 18 and had given birth in the past year participated. MEASUREMENTS: Feasibility and acceptability focused on PHN training, recruitment, retention, and adherence to the intervention. Participants provided data on depression, worry, health care utilization and mother-infant relations. Women and their partners reported on infant temperament. INTERVENTION: Participants attended a 9-week CBT group delivered by two PHNs. RESULTS: The PHN training, CBT intervention and our study protocol were found to be feasible and acceptable to participants. Reductions were seen in depression and worry. The number of health care visits decreased; mother-infant relations improved. CONCLUSIONS: These findings highlight the feasibility of PHN-delivered group CBT for PPD and suggest that it could reduce the burden of PPD on women and their children.

Korean Immigrant Women's Postpartum Experiences in the United States.

BACKGROUND: Postpartum depression (PPD) affects one in seven women in the United States. Korean Americans are one of the six largest Asian American (AA) subgroups, representing 9% of the AA population in the United States. Women of Asian descent have not always been represented in studies of PPD. PURPOSE: The purpose of this study was to understand postpartum experiences, perceptions of PPD, and mental health help-seeking among Korean women living in the United States. METHODS: Individual, face-to-face, semistructured interviews of Korean immigrant women, over age 18, who were able to read, write, and speak English or Korean, and who had given birth to a live infant within the past 12 months, were conducted using a qualitative exploratory design. Thematic analysis approach was used to analyze qualitative data The Edinburgh Postnatal Depression Screening Scale (EPDS) was used to assess frequency of depressive symptoms over the past week. RESULTS: Eleven women participated. Total EPDS scores ranged from 2 to 17 (mean 6.5, SD = 3.2); three women had scores indicating a high risk for developing PPD. Two overall themes, postpartum experiences and perceptions of PPD and professional help-seeking, along with several subthemes were identified. They included postpartum challenges, importance of keeping Korean postpartum traditions, desire for professional Korean postpartum care, "Sanhoo-Joeri" postpartum support and social networking, normalization of PPD symptoms, family first for health seeking attitude and behavior, and stigma attached to mental health care. CLINICAL IMPLICATIONS: Nurses working with Korean women during postpartum can provide culturally competent care by assessing postpartum care needs, respecting cultural practices, and providing resources such as Korean postpartum care centers Sanhoo-Joeriwon, which can be found in major U.S. cities with large Korean communities (e.g., Los Angeles), and in-home postpartum care providers, Sanhoo-Joerisa. Nurses should be comfortable educating women about normal signs and symptoms of PPD and those requiring immediate medical follow-up.

Estratégias de enfermagem na prevenção da depressão pós-parto / Nursing strategies for the prevention of post-birth depression / Estrategias de enfermería en la prevención de la depresión post-parto

Objetivo: identificar na literatura as estratégias utilizadas pelos(as) enfermeiros(as) na prevenção da depressão pós-parto. Método: revisão integrativa da literatura realizada nas bases de dados da Biblioteca Virtual da Saúde da Literatura Científica e Técnica da América Latina e Caribe, Base de Dados de Enfermagem Medical Literature Analysisand Retrieval System Online, por meio dos descritores depressão pós-parto and "enfermagem" e "Depression Postpartum" and "nursing". Resultados: a amostra foi constituída de nove estudos. Para a análise foi realizada a categorização dos trabalhos por similaridade de conteúdo, sendo construídas duas categorias para a análise: o acolhimento como estratégia de prevenção da depressão pósparto e o grupo de gestante como espaço de troca de experiência. Conclusão: prevenir a DPP é uma ação de fácil abordagem, com baixo custo e de viável execução na prática do enfermeiro

Objective: To identify in the literature the strategies used by the nurses in the prevention of postpartum depression. Method: Integrative literature review carried out in the databases of the Virtual Health Library of the Scientific and Technical Literature of Latin America and the Caribbean, Medical Literature Analysis and Retrieval SystemOnline Nursing Database, through the descriptors postpartum depression and "nursing" and "Depression Postpartum" and "nursing." Results: The sample consisted of nine studies. For the analysis, the categorization of the work by content similarity was performed, and two categories were constructed for the analysis: the host as a strategy to prevent postpartum depression and the pregnant group as a space for the exchange of experience. Conclusion: Preventing PPD is an easy-to-approach action, with low cost and feasible execution in the practice of nurses

Objetivo: identificar en la literatura las estrategias utilizadas por los enfermeros (as) en la prevención de la depresión posparto. Método: revisión integrativa de la literatura realizada en las bases de datos de la Biblioteca Virtual de la Salud de la Literatura Científica y Técnica de América Latina y el Caribe, Base de Datos de Enfermería, Análisis de la Revisión de la Resurrección del sistema, por medio de los descriptores depresión postparto y "enfermería" y "Depresión Postpartum" y "enfermería". Resultados: La muestra se constituyó de nueve estudios. Para el análisis se realizó la categorización de los trabajos por similitud de contenido, siendo construidas dos categorías para el análisis: la acogida como estrategia de prevención de la depresión posparto y el grupo de gestante como espacio de intercambio de experiencia. Conclusión: prevenir la DPP es una acción de fácil abordaje, con bajo costo y de viable ejecución en la práctica del enfermero

Bedside Music Therapy for Women during Antepartum and Postpartum Hospitalization.

PURPOSE: Stress and anxiety are prevalent during pregnancy and postpartum with adverse effects on mothers and newborns, yet women's psychological and emotional needs are often given a lower priority than their physical wellbeing. The purpose of this study was to assess feasibility of implementing a bedside music therapy intervention to alleviate stress and anxiety, provide emotional support, and facilitate mother-baby bonding for women during antepartum and postpartum hospitalization at a large urban medical center. STUDY DESIGN AND METHODS: Over 15 months, women on three units who were hospitalized during antepartum or postpartum were referred for music therapy and received a single bedside session from a credentialed music therapist (MT-BC), including tailored interventions and education in relaxation techniques. A retrospective analysis of postintervention feedback questionnaires and process notes was conducted to assess participant receptivity and satisfaction, and the feasibility of implementing the program on the units. RESULTS: Music therapy was provided to 223 postpartum and 97 antepartum patients. The program was found to be feasible and well received, including high satisfaction, positive effects on participants' relaxation and sense of connection with their baby, and enthusiastic reception from providers and staff. Qualitative feedback revealed salient themes including the effect of the intervention on mothers' mental, emotional and physical states, and the soothing effect of music on their newborns. CLINICAL IMPLICATIONS: Hospitals are in a unique position to provide support services and self-care education for women during their antepartum and postpartum hospitalization. Music therapy can be integrated successfully into inpatient care as a nurturing and patient-centered form of psychosocial support.

Technology-assisted nursing for postpartum support: A randomized controlled trial.

AIM: To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. BACKGROUND: Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk. DESIGN: Randomized controlled trial (RCT) with three conditions. METHODS: Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured. RESULTS: Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF. CONCLUSION: The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness. IMPACT: Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02843022.

Postpartum depression symptoms among Syrian refugee women living in Jordan.

Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.

Health visitors' perceptions on their role to assess and manage postpartum depression cases in the community.

The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence-based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important.

Postnatal psychosocial assessment and clinical decision-making, a descriptive study.

AIMS AND OBJECTIVES: To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment. BACKGROUND: Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making. DESIGN: A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment. METHODS: This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment. RESULTS: The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information. CONCLUSION: The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring.

Integrating Optimal Screening, Intervention, and Referral for Postpartum Depression in Adolescents.

According to the World Health Organization, 10% to 13% of postpartum women develop a mental disorder, mainly depression. This number is higher in developing countries. This percentage increases in adolescents and symptoms in adolescents tend to be overlooked. These disorders can be treated successfully if detected early, which will in turn prevent more severe symptoms from developing. This article provides evidence-based clinical best practices for the assessment and early recognition of postpartum depression, specifically in adolescents. In addition, suggestions for integration into practice and recommendations for interprofessional collaboration are discussed.

Thought stopping and supportive therapy can reduce postpartum blues and anxiety parents of premature babies

Objective: The parents of premature baby tend to be at risk undergoing postpartum blues and anxiety. It is due to many problems faced by postpartum mother of premature baby. This research is aim to identifying influence of thought stopping and supportive therapy of postpartum blues and anxiety parents of premature babies. Method: This is quantitative with quasi-experiment with control group pretest-posttest design and consecutive sampling method. Sample in this research are 62 postpartum mothers of premature babies in perinatal NICU (neonatal intensive care unit). Results: The results show that there is significant decrease of postpartum blues and anxiety (p value = 0.000) in the group that was treated by using nursing intervention, thought stopping and supportive therapy and greater significant decrease than the group that was only treated by nursing intervention. Conclusions: Thought stopping and supportive therapy are able to decrease postpartum blues and anxiety parents of premature babies

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There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care.

AIMS AND OBJECTIVES: To explore public health nurses' engagement, competence and education needs in relation to perinatal mental health care in Ireland. BACKGROUND: It is estimated that 15%-25% of women will experience a mental health problem during or postpregnancy, either as a new problem or a reoccurrence of a pre-existing problem. Public health nurses, or their equivalent, are ideally positioned to support women's mental health and improve health outcomes for the woman and baby, yet little is known about their role and engagement with mental health issues, other than with postnatal depression. The objectives of the study were to identify public health nurses' knowledge, skills and current practices in perinatal mental health and establish their education needs. DESIGN: The research used a descriptive design. METHOD: A total of 186 public health nurses completed an anonymous, online survey, designed by the research team. RESULTS: While public health nurses are positive about their role in supporting women's mental health, they lack the knowledge and skills to address all aspects of mental health, including opening a discussion with women on more sensitive or complex issues, such as trauma and psychosis and providing information to women. Those who received education reported statistically significant higher knowledge and confidence scores than those without. CONCLUSION: Public health nurses lack the knowledge and skills required to provide comprehensive perinatal mental health care to women. Future education programmes need to move beyond postnatal depression and address the range of mental health problems that may impact on women in the perinatal period. RELEVANCE TO CLINICAL PRACTICE: Without knowledge and skill among nurses in all aspects of perinatal mental health, women with significant mental health needs may be left to cope alone and lack the necessary prompt evidence-based interventions and supports.

Validation of the Edinburgh Postnatal Depression Scale for Use With Young Childbearing Women.

BACKGROUND AND PURPOSE: The Edinburgh Postnatal Depression Scale (EPDS) was created specifically to screen for perinatal depression. The purpose of this study was to assess the psychometric properties of the EPDS for use in a population of pregnant and postpartum 14- to 24-year-olds in Canada. METHODS: The Standards for Educational and Psychological Testing was used as the psychometric framework to assess the validity, reliability, and acceptability of responses obtained using the EPDS with pregnant and postpartum adolescents and young adults. RESULTS: There were 102 young women who were surveyed. Principal component analysis supported the EPDS as a 2-dimensional instrument. Test scores also showed the EPDS to be reliable and acceptable. CONCLUSIONS: The EPDS was found to be a psychometrically sound tool for use in this population of young childbearing women.

Cumulative trauma and partner conflict predict post-traumatic stress disorder in postpartum African-American women.

AIM AND OBJECTIVE: To describe relationships between cumulative trauma, partner conflict and post-traumatic stress in African-American postpartum women. BACKGROUND: Cumulative trauma exposure estimates for women in the USA range from 51-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post-traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality. DESIGN: This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women aged between 18-45 who had given birth. METHODS: Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post-traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis. RESULTS: All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life-threatening event for a loved one reported by 60% of the sample. Nearly, one-fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms. CONCLUSION: Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. RELEVANCE TO CLINICAL PRACTICE: The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African-American women. Healthcare providers need to be sensitive to patient life-threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post-traumatic stress symptoms during pregnancy.

Psychometric Properties of Newly Translated Creole Perceived Stress Scale and Daily Hassles Scale.

BACKGROUND: Mothers with postpartum stress have increased maternal/infant morbidity and mortality. Haitians, a growing minority excluded from most studies because of the lack of instruments in Creole. The Perceived Stress Scale (PSS) and the Daily Hassles Scale (DHS) measuring stress are not available in Creole. PURPOSE: To test the psychometrics of the newly translated Creole instruments. METHODS: A convenience sample of 85 Haitian mothers completed 2 instruments in Creole and English, 2 weeks apart using the process of cross-cultural adaptation. RESULT: Internal consistency reliability and stability were strong for both instruments (.80-.94). Reliability and validity support the translated Creole with this sample of Creole speaking mothers. CONCLUSION: Psychometric findings suggest the newly translated versions are good representations of the English versions and are ready for use.

Psychometric Properties of an Instrument to Measure Mother-Infant Togetherness After Childbirth.

BACKGROUND AND PURPOSE: The purpose of this research was to evaluate the psychometric properties of a new instrument to measure mother-infant togetherness, Mother-Infant Togetherness Survey (MITS). METHODS: Stage 1 examined content validity. Stage 2 pretested the readability and understandability and further examined content validity. Stage 3 examined women's ability to accurately self-report on the Delivery Events subscale. Stages 4 and 5 examined construct validity. RESULTS: Good content validity was obtained at the scale/subscale level (CVI = .91-1.00). Internal consistency reliability was evaluated at the scale/subscale level (α = .62-.89). Construct validity was supported with known groups testing and factor analysis. CONCLUSION: Study findings provide support for the reliability and validity of the MITS. Future research should be done to improve the internal consistency reliability of the Postpartum Events subscale.