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1.
BMC Pregnancy Childbirth ; 20(1): 703, 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208115

RESUMO

BACKGROUND: Trauma, natural and man-made catastrophic events can be predictors of postpartum psychological distress. In a public health response due to coronavirus disease 2019 outbreak, the Italian government imposed a lockdown from March 9 to May 3. This extraordinary situation may have been challenging for maternal psychological health. The aim of this study was to investigate the prevalence of depressive and post-traumatic stress symptoms in women giving birth during the Covid-19 pandemic and its associations with quarantine measures, obstetrical factors, and relational attachment style. METHODS: Women who gave birth in a high-volume obstetric/gynaecological medical centre located in an epidemic area during the Covid-19 pandemic (March 8 to June 15) were asked to complete an online survey about their childbirth experience and the perceived effect of the pandemic. The Edinburgh Postnatal Depression Scale (EPDS), the Impact of Event Scale-Revised (IES-R), and the Relationship Questionnaire (RQ) were administered to assess levels of postpartum depressive and post-traumatic stress symptoms (PTSS) and relational style of attachment, respectively. Multivariate analysis was applied to identify associations between quarantine measures, childbirth experience, attachment style, and EPDS and IES-R scores. RESULTS: The survey was completed by 163 women (response rate 60.8%). The prevalence of depressive symptoms was 44.2% (EPDS cut-off score ≥ 11) and the PTSS rate was 42.9% (IES-R cut-off score ≥ 24). Dismissive and fearful avoidant attachment styles were significantly associated with the risk of depression and PTSS, respectively. Perceived pain during birth was a risk factor for postpartum depression. Perceived support provided by healthcare staff was a protective factor against depression and PTSS. Another protective factor against PTSS was quiet on the ward due to the absence of hospital visitors. CONCLUSION: This study reports a high prevalence of postpartum depressive and PTSS in women who gave birth during the Covid-19 pandemic. Postnatal psychological distress seemed to be associated more with the prenatal experience and other individual factors than with the pandemic hospital restrictions. Early detection during pregnancy of an insecure attachment style is fundamental to provide targeted preventive and therapeutic psychological interventions.


Assuntos
Infecções por Coronavirus/psicologia , Depressão Pós-Parto , Pneumonia Viral/psicologia , Período Pós-Parto/psicologia , Gestantes/psicologia , Angústia Psicológica , Quarentena/psicologia , Adulto , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/etiologia , Depressão Pós-Parto/prevenção & controle , Feminino , Humanos , Itália/epidemiologia , Pandemias/prevenção & controle , Parto/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Prevalência , Psicologia , Sistemas de Apoio Psicossocial , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle
2.
PLoS One ; 15(10): e0239310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064737

RESUMO

Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women's understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants' weight gain are critically needed.


Assuntos
Infecções por HIV/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Estereotipagem , Adolescente , Adulto , Depressão/etiologia , Feminino , Gana , Infecções por HIV/patologia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Entrevistas como Assunto , Isolamento Social , Ganho de Peso , Adulto Jovem
3.
J Med Internet Res ; 22(9): e22002, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32857707

RESUMO

BACKGROUND: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. OBJECTIVE: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. METHODS: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included "COVID," "corona," and "pandemic." A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. RESULTS: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including "worried" (n=165, 19.9%), "risk" (n=143, 17.2%), "anxiety" (n=98, 11.8%), "concerns" (n=74, 8.8%), and "stress" (n=69, 8.3%). CONCLUSIONS: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.


Assuntos
Infecções por Coronavirus/epidemiologia , Internet , Saúde Mental/estatística & dados numéricos , Mães/psicologia , Poder Familiar/psicologia , Pneumonia Viral/epidemiologia , Período Pós-Parto/psicologia , Gravidez/psicologia , Estresse Psicológico/epidemiologia , Adulto , Ansiedade/epidemiologia , Austrália/epidemiologia , Criança , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Pandemias/prevenção & controle , Parto/psicologia , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Apoio Social
4.
PLoS One ; 15(8): e0238310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857816

RESUMO

INTRODUCTION: Identifying the factors contributing to maternal satisfaction is a proxy measure to improve the quality of care. It evaluates the health service provision by understanding maternal perceptions and expectations and promoting adherence to health services. This study aimed to identify the sociodemographic, obstetric, and medical factors contributing to labor satisfaction among postpartum women and examine the association between labor and postnatal satisfaction. METHODOLOGY: A cross-sectional study using systematic random sampling in a ratio of 1:5 based on the delivery list in a labor room in a tertiary hospital was applied. Information was obtained from medical records for sociodemographic characteristics and obstetric and medical histories. Face-to-face interviews were performed to obtain responses for Malay versions of the Women's Views of Birth Labour Satisfaction Questionnaire and the Women's Views of Birth Postnatal Satisfaction Questionnaire. Simple and general linear regression analyses were performed. RESULTS: A total of 110 participants responded, accounting for a response rate of 100%. High-risk color codes, the period of gestation, household income, and were significantly associated with maternal satisfaction during labor. The association between labor and postnatal satisfaction was significant. CONCLUSION: Identifying these associated factors and differences may lead to understanding and contributing to specific and targeted strategies for tackling issues related to maternal satisfaction.


Assuntos
Trabalho de Parto/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Malásia , Satisfação do Paciente , Satisfação Pessoal , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários
5.
Am J Perinatol ; 37(12): 1271-1279, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32757185

RESUMO

OBJECTIVE: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety. STUDY DESIGN: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13, 2020 and April 26, 2020. Semistructured interviews were conducted via telephone at 1 and 2 weeks posthospitalization to assess maternal mental health. Depression screening was conducted using the patient health questionnaire-2 (PHQ-2). An online survey of labor and delivery health care workers assessed job satisfaction and job-related anxiety before and during the novel coronavirus disease 2019 (COVID-19) pandemic, as well as employees' subjective experience with universal testing. Patient and employee responses were analyzed for recurring themes. RESULTS: A total of 318 asymptomatic women underwent SARS-CoV-2 testing during this 2-week period. Six of the eight women (75%) who tested positive reported negative in-hospital experiences secondary to perceived lack of provider and partner support and neonatal separation after birth. Among the 310 women who tested negative, 34.4% of multiparous women reported increased postpartum anxiety compared with their prior deliveries due to concerns about infectious exposure in the hospital and lack of social support. Only 27.6% of women, tested negative, found their test result to be reassuring. Job satisfaction and job-related anxiety among health care workers were negatively affected. Universal testing was viewed favorably by the majority of health care workers despite concerns about delays or alterations in patient care and maternal and neonatal separation. CONCLUSION: Universal testing for SARS-CoV-2 in obstetric units has mixed effects on maternal mental health but is viewed favorably by labor and delivery employees. Ongoing evaluation of new testing protocols is paramount to balance staff and patient safety with quality and equality of care. KEY POINTS: · Women with SARS-CoV-2 had a negative hospital experience.. · A negative SARS-CoV-2 test was not reassuring for patients.. · COVID-19 negatively impacts healthcare workers' well-being..


Assuntos
Atitude Frente a Saúde , Infecções por Coronavirus/diagnóstico , Pessoal de Saúde/psicologia , Programas de Rastreamento/psicologia , Isolamento de Pacientes/psicologia , Pneumonia Viral/diagnóstico , Período Pós-Parto/psicologia , Gestantes/psicologia , Apoio Social , Adulto , Ansiedade , Infecções Assintomáticas/psicologia , Atitude do Pessoal de Saúde , Betacoronavirus , Técnicas de Laboratório Clínico , Feminino , Hospitalização , Humanos , Recém-Nascido , Satisfação no Emprego , Tocologia , Enfermeiras e Enfermeiros/psicologia , Enfermagem Obstétrica , Estresse Ocupacional/psicologia , Pandemias , Parto , Questionário de Saúde do Paciente , Médicos/psicologia , Gravidez
6.
PLoS One ; 15(8): e0237609, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833975

RESUMO

BACKGROUND: The role of maternal personality and perceived social support for peripartum changes in psychopathological symptoms remains unresolved. METHODS: In a regional-epidemiological sample of 306 women, depressive, anxiety, and stress symptoms were assessed three times during pregnancy and three times after delivery with the 21-item version of the Depression Anxiety Stress Scale. In pregnancy, the Big Five personality traits and perceived social support were assessed with the short version of the Big Five Inventory and the Social Support Questionnaire. RESULTS: Multilevel analyses revealed that depressive (b = -0.055) and stress (b = -0.047) symptoms decreased from early to late pregnancy. After delivery, anxiety symptoms were lower (two months postpartum: b = -0.193; four/ 16 months postpartum: b = -0.274), but stress symptoms were higher (two months postpartum: b = 0.468; four/ 16 months postpartum: b = 0.320) than during pregnancy. Across the peripartum period, more conscientious and more extraverted women experienced lower depressive and stress symptoms (b = -0.147 to -0.177), and more emotionally stable women experienced lower depressive, anxiety, and stress symptoms (b = -0.294 to -0.415). More emotionally stable women more strongly increased in anxiety during pregnancy (b = 0.019), and more extraverted women less strongly increased in depression after delivery (b = -0.010). Moreover, peripartum depressive, anxiety, and stress symptoms were lower in women with higher perceived social support (b = -0.225 to -0.308). CONCLUSIONS: Less emotionally stable, less conscientious, and less extraverted women and women with lower perceived social support seem to be at increased risk for peripartum psychopathological symptoms and might thus particularly profit from targeted prevention.


Assuntos
Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Mães/psicologia , Transtornos da Personalidade/epidemiologia , Período Pós-Parto/psicologia , Apoio Social , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Transtornos de Ansiedade/psicologia , Depressão/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Transtornos da Personalidade/psicologia , Gravidez , Estudos Prospectivos , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
7.
Adv Exp Med Biol ; 1252: 199-207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816283

RESUMO

Young breast cancer patients face numerous challenges during the cancer trajectory. As in the last decade, women tend to delay pregnancies to a later time in life, and clinicians are often faced with young breast cancer patients who want to start a family or complete it. Becoming a mother is a delicate developmental process in which the woman redefines and restructures her identity as she gets prepared for her new role and responsibilities. When there is a history of cancer or cancer diagnosis is communicated during the pregnancy, fears, worries, and concerns emerge and specific support may be necessary. Follow-ups during the post-partum period are also recommended as lactation issues should not be overlooked. In this chapter, we analyze the psychological aspects of cancer survivors and women with pregnancy-associated breast cancer, and the management of these issues.


Assuntos
Neoplasias da Mama/psicologia , Lactação/psicologia , Complicações Neoplásicas na Gravidez/psicologia , Ansiedade , Aleitamento Materno , Feminino , Humanos , Período Pós-Parto/psicologia , Gravidez
8.
PLoS One ; 15(8): e0238232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853233

RESUMO

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adulto , Estudos de Coortes , Aconselhamento/métodos , Revelação , Feminino , Humanos , Estudos Longitudinais , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Pesquisa Qualitativa , Estigma Social , Apoio Social , Tanzânia , Carga Viral/fisiologia , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-32698403

RESUMO

Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: This is a quantitative research design, carried out through a descriptive, cross-sectional correlation study. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). Women were selected during the immediate postpartum period. The variables analysed were postpartum depressive symptoms (Edinburgh scale), anxiety symptoms (STAI state anxiety questionnaire), perceived social support (Duke-UNC-11), family functioning (family APGAR), self-efficacy in care (Lawton), sense of coherence (SOC-13), perceived burden (Caregiver Strain Index) and stressful life events (Holmes and Rahe). The main analysis consisted of a multiple linear regression. Results: The regression model of depressive symptoms found a positive association with perceived burden (ß = 0.230, p = 0.015) and negative associations with self-efficacy in care (ß = -0.348, p < 0.001), social support (ß = -0.161, p < 0.001) and sense of coherence (ß = -0.081, p = 0.001). The regression model of anxiety symptoms obtained a positive association with perceived burden (ß = 1.052, p < 0.001) and negative associations with self-efficacy in care (ß = -0.329, p = 0.041), social support (ß = -0.234, p = 0.001) and sense of coherence (ß = -0.262, p < 0.001). Discussion: Firstly, depressive and anxiety symptoms in the puerperium period may be more prevalent than in other periods of a woman's life. Secondly, perceived social support, self-efficacy in caring for the newborn and sense of coherence may be protective factors for depressive and anxiety symptoms in the puerperium period. Finally, perceived burden in caring for the newborn may be a risk factor for these symptoms.


Assuntos
Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão Pós-Parto/psicologia , Depressão/diagnóstico , Depressão/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Apoio Social , Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Poder Familiar/psicologia , Gravidez , Autoeficácia , Senso de Coerência , Espanha/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
10.
J Prim Care Community Health ; 11: 2150132720944074, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32674654

RESUMO

Introduction/Objectives: National guidelines underscore the need for improvement in the detection and treatment of mood disorders in the perinatal period. Exposure to disasters can amplify perinatal mood disorders and even have intergenerational impacts. The primary aim of this pilot study was to use mixed-methods to better understand the mental health and well-being effects of the coronavirus disease 2019 (COVID-19) pandemic, as well as sources of resilience, among women during the perinatal period. Methods: The study team used a simultaneous exploratory mixed-methods design to investigate the primary objective. Thirty-one pregnant and postpartum women participated in phone interviews and were invited to complete an online survey which included validated mental health and well-being measures. Results: Approximately 12% of the sample reported high depressive symptomatology and 60% reported moderate or severe anxiety. Forty percent of the sample reported being lonely. The primary themes related to stress were uncertainty surrounding perinatal care, exposure risk for both mother and baby, inconsistent messaging from information sources and lack of support networks. Participants identified various sources of resilience, including the use of virtual communication platforms, engaging in self-care behaviors (eg, adequate sleep, physical activity, and healthy eating), partner emotional support, being outdoors, gratitude, and adhering to structures and routines. Conclusions: Since the onset of COVID-19, many pregnant and postpartum women report struggling with stress, depression, and anxiety symptomatology. Findings from this pilot study begin to inform future intervention work to best support this highly vulnerable population.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Período Pós-Parto/psicologia , Gestantes/psicologia , Adulto , Ansiedade/epidemiologia , Depressão/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Gravidez , Pesquisa Qualitativa , Resiliência Psicológica , Medição de Risco , Estresse Psicológico/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
11.
Arch Womens Ment Health ; 23(5): 625-633, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32613296

RESUMO

The postpartum period may be a particular window of vulnerability for eating disorder symptoms given changes to body shape and weight that women experience. However, no quantitative studies have identified risk factors for postpartum eating disorder symptoms, and current psychosocial frameworks of risk may be missing key elements unique to this period. This manuscript reviews existing quantitative and qualitative literature regarding the developmental trajectory of eating disorder symptoms during the perinatal period and proposes an application of three psychosocial models of eating disorder risk (objectification theory, the tripartite influence model of body image and eating disturbances, and social comparison theory) to the postpartum period. Drawing on quantitative and qualitative literature, this paper identifies novel postpartum-specific factors that should be included for consideration in psychosocial models (e.g., self-oriented body comparison and pressure to achieve a prepregnancy weight and shape). This review is the first to theorize potential postpartum-specific risk factors for postpartum eating disorder symptoms. Prior models of eating disorder risk omit key psychosocial factors that are unique to the postpartum period. Other limitations of prior research relate to measurement and methodology. This critical window of vulnerability has been largely ignored in the quantitative literature and necessitates further research.


Assuntos
Imagem Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Período Pós-Parto/psicologia , Peso Corporal , Feminino , Humanos , Período Periparto/psicologia , Gravidez , Fatores de Risco
12.
PLoS One ; 15(7): e0230992, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722725

RESUMO

BACKGROUND: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.


Assuntos
Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Ocitocina/sangue , Parto/fisiologia , Parto/psicologia , Feminino , Humanos , Comportamento Materno , Serviços de Saúde Materna , Tocologia , Modelos Biológicos , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Apoio Social , Estresse Fisiológico
13.
Womens Health Issues ; 30(4): 231-239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527464

RESUMO

BACKGROUND: Limited research has focused on longitudinal interrelations between perceived social support, perceived stress, and depressive symptoms beyond the first postpartum months. This study tested an alternative primary hypothesis within the stress process model examining whether perceived stress mediated the association between perceived social support and depressive symptoms from 1 to 24 months postpartum. Secondary purposes examined whether these factors 1) changed from 1 to 24 months postpartum and 2) predicted depressive symptoms. METHODS: Women (N = 1,316) in a longitudinal cohort study completed validated measures of perceived social support, perceived stress, and depressive symptoms at 1, 6, 12, 18, and 24 months postpartum via telephone interviews. Analyses examined changes in psychosocial factors (repeated measures analysis of variance) and the extent to which perceived social support and perceived stress predicted depressive symptoms and supported mediation (linear regression). RESULTS: Perceived social support decreased, perceived stress increased, and depressive symptoms remained constant from 1 to 18 months, then increased at 24 months. Low perceived social support predicted 6-month depressive symptoms, whereas perceived stress predicted depressive symptoms at all time points. Perceived stress mediated the association between perceived social support and depressive symptoms across 24 months such that low perceived social support predicted perceived stress, which in turn predicted depressive symptoms. CONCLUSIONS: Intervention scientists may want to focus on strengthening perceived social support as a means to manage perceived stress in an effort to prevent a long-term trajectory of depression.


Assuntos
Depressão Pós-Parto/etiologia , Depressão/psicologia , Mães/psicologia , Apoio Social , Estresse Psicológico/etiologia , Adulto , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Estudos Longitudinais , Período Pós-Parto/psicologia , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
14.
Rev Lat Am Enfermagem ; 28: e3293, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32578751

RESUMO

OBJECTIVE: to investigate female sexual function in women six months postpartum and to compare sexual function among women who had and who did not have severe maternal morbidity (SMM). METHOD: a cross-sectional study conducted with 110 women in the postpartum period, with and without SMM. Two instruments were used, one for the characterization of sociodemographic and obstetric variables and the Female Sexual Function Index (FSFI) for sexual function. Univariate, bivariate and regression model analyses were performed. RESULTS: FSFI scores showed 44.5% of female sexual dysfunction, of which 48.7% were among women who had SMM and 42.0% among those who had not. There were significant differences between age (P=0.013) and duration of pregnancy (P<0.001) between women with or without SMM. Among the cases of SMM, hypertensive disorders were the most frequent (83%). An association was obtained between some domains of the FSFI and the following variables: orgasm and self-reported skin color, satisfaction and length of relationship, and pain and SMM. CONCLUSION: white women have greater difficulty in reaching orgasm when compared to non-white women and women with more than 120 months of relationship feel more dissatisfied with sexual health than women with less time in a relationship. Women who have had some type of SMM have more dyspareunia when compared to women who have not had SMM.


Assuntos
Satisfação Pessoal , Período Pós-Parto/fisiologia , Comportamento Sexual/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Período Pós-Parto/psicologia , Comportamento Sexual/psicologia , Saúde Sexual , Sexualidade , Fatores Socioeconômicos , Inquéritos e Questionários
15.
Rev Bras Epidemiol ; 23: e200048, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491045

RESUMO

INTRODUCTION: No studies were found that evaluate the association between intimate partner violence (IPV) before childbirth and sexual issues in the postpartum period. METHOD: A cross-sectional study with 700 women who received prenatal care in a basic health unit in São Paulo, between 2006 and 2007. Sexual issues were assessed through a questionnaire created by the authors, and intimate partner violence was evaluated using a structured questionnaire developed by the WHO. Postpartum depression was evaluated using the SRQ-20 instrument, with a cut-off point of 7/8 considered to be the mediating variable. A path analysis was performed to determine the different pathways: the direct association between outcome and exposure, and the indirect pathways through the mediator. RESULTS: The prevalence of sexual issues, intimate partner violence and postpartum depression were 30; 42.8; 27.8%, respectively. Violence occurring exclusively before childbirth did not show a direct association (ED = 0.072 (-0.06 - 0.20, p = 0.060)) or indirect (EI: 0.045 (-0.06 - 0.20, p = 0.123)), with sexual issues. CONCLUSION: Longitudinal studies that include other mediators may provide a better understanding of the causal chain and elucidate variables that influence postpartum sexuality issues.


Assuntos
Depressão Pós-Parto/psicologia , Violência por Parceiro Íntimo/psicologia , Período Pós-Parto/psicologia , Comportamento Sexual/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Autorrelato , Disfunções Sexuais Psicogênicas , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
16.
J Clin Psychiatry ; 81(3)2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32369685

RESUMO

OBJECTIVE: To describe the demographic and clinical characteristics of pregnant and postpartum women in Japan with psychoneurological disorders who attempt suicide. METHOD: A nationwide retrospective cohort study was conducted using the Diagnosis Procedure Combination database, a national database on acute-care inpatients in Japan. All pregnant and postpartum women who had psychoneurological disorders (ICD-10 codes: O993, F530, F531) and were admitted to participating hospitals from January 2016 to March 2018 were identified. Among eligible patients, the prevalence of suicide attempts, risk factors for suicidal behaviors, maternal outcomes, and other characteristics were investigated. RESULTS: Among the 3,286 eligible patients (3,026 pregnant women and 260 postpartum women), 22 pregnant women and 16 postpartum women had attempted suicide. The prevalence of suicide attempts was significantly higher among postpartum women (6.2%) than among pregnant women (0.7%; P < .001). Postpartum patients were more likely to be aged 30 years or older and to have depression. Wrist cutting was the main method of suicide attempt among pregnant patients, whereas hanging was the main method among postpartum patients. Three postpartum patients died during hospitalization. CONCLUSIONS: Postpartum patients were more likely to be in critical condition and to use fatal suicide attempt methods compared with pregnant women.


Assuntos
Período Pós-Parto/psicologia , Complicações na Gravidez/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/psicologia , Estudos Retrospectivos , Tentativa de Suicídio/psicologia , Adulto Jovem
17.
BMC Public Health ; 20(1): 661, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398123

RESUMO

BACKGROUND: The postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia. METHODS: We used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance. RESULTS: About 23.7% (23.7, 95% CI: 20.7-27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34-3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04-3.10), women who attended 1-3 (AOR = 2.33; 95%CI:1.27-4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43-4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23-2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01-3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13-3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01-1.88) had higher odds of modern contraceptive use. CONCLUSION: Postpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls' education and encouraging women's participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Período Pós-Parto/psicologia , Gravidez não Planejada/psicologia , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Modelos Logísticos , Gravidez , Prevalência , População Rural/estatística & dados numéricos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
19.
Obstet Gynecol ; 135(5): 1038-1046, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32282598

RESUMO

OBJECTIVE: To describe patients' preferences for prenatal and postpartum care delivery. METHODS: We conducted a cross-sectional survey of postpartum patients admitted for childbirth and recovery at an academic institution. We assessed patient preferences for prenatal and postpartum care delivery, including visit number, between-visit contact (eg, phone and electronic medical record portal communication), acceptability of remote monitoring (eg, weight, blood pressure, fetal heart tones), and alternative care models (eg, telemedicine and home visits). We compared preferences for prenatal care visit number to current American College of Obstetricians and Gynecologists' recommendations (12-14 prenatal visits). RESULTS: Of the 332 women eligible for the study, 300 (90%) completed the survey. Women desired a median number of 10 prenatal visits (interquartile range 9-12), with most desiring fewer visits than currently recommended (fewer than 12: 63% [n=189]; 12-14: 22% [n=65]; more than 14: 15% [n=46]). Women who had private insurance or were white were more likely to prefer fewer prenatal visits. The majority of patients desired contact with their care team between visits (84%). Most patients reported comfort with home monitoring skills, including measuring weight (91%), blood pressure (82%), and fetal heart tones (68%). Patients reported that they would be most likely to use individual care models (94%), followed by pregnancy medical homes (72%) and home visits (69%). The majority of patients desired at least two postpartum visits (91%), with the first visit within 3 weeks after discharge (81%). CONCLUSION: Current prenatal and postpartum care delivery does not match patients' preferences for visit number or between-visit contact, and patients are open to alternative models of prenatal care, including remote monitoring. Future prenatal care redesign will need to consider diverse patients' preferences and flexible models of care that are tailored to work with patients in the context of their lives and communities.


Assuntos
Assistência à Saúde/métodos , Preferência do Paciente/psicologia , Cuidado Pós-Natal/psicologia , Período Pós-Parto/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , Inquéritos e Questionários
20.
Arch Womens Ment Health ; 23(5): 719-726, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32180010

RESUMO

The postpartum period has been associated with elevated rates of onset of obsessive-compulsive disorder (OCD) among women, with a prevalence of 2-9%. Postpartum OCD is often characterized by recurrent, unwanted, and highly distressing thoughts, images, or impulses of deliberate infant harm. This study investigated health practitioners' recognition of, and clinical management strategies for, postpartum obsessive-compulsive symptoms (OCS). Ninety-four perinatal health practitioners from a range of disciplines and professional backgrounds completed a survey comprised of a hypothetical case vignette and questions eliciting their responses to a clinical presentation of postpartum infant harming obsessions. Almost 70% of participants did not accurately identify OCS within the case. Furthermore, the majority of practitioners endorsed at least one contraindicated clinical management strategy likely to aggravate postpartum OCS. Accurate recognition of OCS was associated with the selection of fewer contraindicated strategies. Some aspects of practitioner training and experience were associated with correct OCS identification. These findings underscore the need for targeted, interdisciplinary education to improve the detection and management of women experiencing postpartum OCS.


Assuntos
Maus-Tratos Infantis/psicologia , Pessoal de Saúde/psicologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Período Pós-Parto/psicologia , Competência Clínica , Feminino , Humanos , Lactente , Transtornos Puerperais/psicologia , Inquéritos e Questionários
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