Women's perspectives on resilience and research on resilience in motherhood: A qualitative study.

PURPOSE: Definitional perspectives and operational approaches to the concept of resilience vary within the literature; however, little is known of women's opinions on current resilience research, or the philosophical and methodological directions women believe such research should take. This research explored women's perspectives on resilience research in the perinatal period and early motherhood and sought their opinions on the ways in which they believe research should be advanced. METHODS: Following ethical approval, online interviews were conducted with 14 ethnically and socioeconomically diverse women who were mothers. Findings from a concept analysis on resilience in pregnancy and early motherhood, conducted by the authors, were shared with women before and during the interview. Interviews were organised in sections corresponding to the findings within the concept analysis' four philosophical (Epistemology, Linguistic, Logic, Pragmatic) principles and thematically analysed. RESULTS: Epistemology-Women endorsed a dynamic process definition, and viewed resilience as influenced by multilevel, multisystemic processes. Linguistic-Women viewed words such as 'adaptation' and 'adjustment' as being more active and empowering than the term 'coping' in relation to motherhood. Logic-Women were resistant to the predominant operational conceptualisation of resilience as illness absence. Pragmatic-Women were wary of resilience research being used to reduce mental health support for other mothers and families. CONCLUSIONS: Women provided constructive criticisms on the current state of resilience literature. Women suggested actionable ways in which research may be developed to better align with the epistemological and ethical approaches women want to see in resilience and maternal mental health research. PATIENT OR PUBLIC CONTRIBUTION: Women who are mothers and participants in health research were consulted on their views of trends in mental health and resilience research in motherhood.

Systematic review of ethical issues in perinatal mental health research.

BACKGROUND: Maternal mental health during the peripartum period is critically important to the wellbeing of mothers and their infants. Numerous studies and clinical trials have focused on various aspects of interventions and treatments for perinatal mental health from the perspective of researchers and medical health professionals. However, less is known about women's experiences of participating in perinatal mental health research, and the ethical issues that arise. AIM: To systematically review the literature on the ethical issues that emerge from pregnant and/or postpartum women's experiences of taking part in perinatal mental health-related research. METHODS: Systematic review of nine bibliographic databases, from inception to July 2021. Qualitative, quantitative and mixed method studies were included if they reported on ethical issues experienced by perinatal women. Research ethical issues encompassed any issue relating to women's experiences of being offered study information, recruitment, consent, retention and respect for autonomy.Titles, abstracts and full text screening, appraisal of the methodological quality of included studies, and data extraction, were conducted independently by two reviewers. ETHICAL CONSIDERATIONS: Ethical approval was not required for this systematic review. FINDINGS: A total of 9830 unique citations was retrieved. Six studies met the inclusion criteria. Studies were clinically and methodologically heterogenous, and only one was purposively designed to explore women's experiences. The key finding was the establishment of trust between the researcher and participant in all stages of the research process. Findings are presented according to recruitment and consent processes, participation and retention, and study follow-up and completion. CONCLUSION: The establishment of trust between the researcher and perinatal women leads to a dynamic with research ethical implications relevant to all stages of perinatal mental health-related research. Further research on the research ethical issues experienced by perinatal women is required because of the limited literature.

Maternal mental health in the first year postpartum in a large Irish population cohort: the MAMMI study.

PURPOSE: The international perinatal literature focuses on depression in the postpartum period. Prevalence and pathways of depression, anxiety and stress from pregnancy through the first postpartum year are seldom investigated. METHODS: MAMMI is a prospective cohort study of 3009 first-time mothers recruited in pregnancy. Depressive, anxiety and stress symptoms measured using the Depression, Anxiety and Stress Scale (DASS 21) in pregnancy and at 3-, 6-, 9- and/or 12-months postpartum. RESULTS: Prevalence of depressive and stress symptoms was lowest in pregnancy, increasing to 12-months postpartum. Anxiety symptoms remained relatively stable over time. In the first year after having their first baby, one in ten women reported moderate/severe anxiety symptoms (9.5%), 14.2% reported depression symptoms, and one in five stress symptoms (19.2%). Sociodemographic factors associated with increased odds of postpartum depression, anxiety and stress symptoms were younger age and being born in a non-EU country; socioeconomic factors were not living with a partner, not having postgraduate education and being unemployed during pregnancy. Retrospective reporting of poor mental health in the year prior to pregnancy and symptoms during pregnancy were strongly associated with poor postpartum mental health. CONCLUSIONS: The current findings suggest that the current model of 6-week postpartum care in Ireland is insufficient to detect and provide adequate support for women's mental health needs, with long-term implications for women and children.

Positive postpartum well-being: What works for women.

BACKGROUND: Women's experiences of pregnancy, birth and motherhood extend beyond healthcare provision and the immediate postpartum. Women's social, cultural and political environments shape the positive or negative effects of their experiences through this transition. However, there is limited research concerning the factors that women identify as being protective or promotive of maternal well-being in the perinatal period and motherhood transition. OBJECTIVE: To explore women's views on the factors within healthcare, social, cultural, organizational, environmental and political domains that do or can work well in creating positive perinatal experiences. DESIGN, SETTING AND PARTICIPANTS: A qualitative descriptive study with embedded public and participant involvement (PPI). Participants were 24 women who were maternity care service users giving birth in Ireland. RESULTS: Three themes were developed. The first theme, 'tone of care', related to women's interactions with and attitudes of healthcare professionals in setting the tone for the care they experienced. The second theme, 'postpartum presence and support', concerned the professional postpartum supports and services that women found beneficial in the motherhood transition. The final theme, 'flexibility for new families' addresses social and organizational issues around parents returning to paid employment. DISCUSSION AND CONCLUSION: Women suggested multiple avenues for promoting positive perinatal experiences for women giving birth in Ireland, which may be implemented at healthcare and policy levels. Women identified that maternal health education focuses on supporting informed decision-making processes as a positive and worry-alleviating resource. Additionally, women valued being met by healthcare professionals who regard women as the decision makers in their care experience. Exchanges in which healthcare professionals validate and encourage women in their mothering role and actively involve their partners as caregivers left lasting positive impressions. Extended and professional postpartum support was a common issue, and phone lines or drop-in clinics were suggested as invaluable and affirming assets where women could access personalized support with healthcare professionals who had the knowledge and skills to genuinely approach women's concerns. Social and organizational considerations involved supporting parents to balance their responsibilities as new or growing families in the return to work. PUBLIC OR PATIENT CONTRIBUTION: Maternity care service users were involved in the interviews and manuscript preparation.

Trajectories of Postpartum Recovery: What is Known and Not Known.

Women's postpartum health is a public health issue that has lifelong consequences. Timely recognition and treatment of physical and mental health issues can have positive health consequences while lack of access to effective treatments or health care services can lead to long-term health problems. To advance knowledge of priority health symptoms and trajectories of postpartum recovery from women's health perspectives, we share findings from the Maternal health And Maternal Morbidity in Ireland (MAMMI) study. Data from 3047 first-time mothers recruited to a longitudinal maternal health study in Ireland from 2012 to 2017 reveal the trajectories of maternal health and health problems experienced up to 12 months postpartum. Morbidities explored include urinary incontinence, pelvic girdle pain, and sexual and mental health issues. Viewed together, and over time, the scale and persistent nature of many physical and mental health problems become apparent, yet considerable proportions of women were not asked directly about health problems by health care professionals. When women do not know what is and is not normal postpartum, they may suffer in silence and the consequence is that health problems/issues that are preventable, and treatable, are likely to become chronic. To make positive contributions to women's health, maternity care systems must be truly woman-centered and structured in ways that place emphasis on women's own health needs. In systems where women's voices and concerns are acknowledged and central, women are likely to thrive and flourish in motherhood.

Winter rainfall predicts phenology in widely separated populations of a migrant songbird.

Climate change is affecting behaviour and phenology in many animals. In migratory birds, weather patterns both at breeding and at non-breeding sites can influence the timing of spring migration and breeding. However, variation in responses to weather across a species range has rarely been studied, particularly among populations that may winter in different locations. We used prior knowledge of migratory connectivity to test the influence of weather from predicted non-breeding sites on bird phenology in two breeding populations of a long-distance migratory bird species separated by 3,000 km. We found that winter rainfall showed similar associations with arrival and egg-laying dates in separate breeding populations on an east-west axis: greater rainfall in Jamaica and eastern Mexico was generally associated with advanced American redstart (Setophaga ruticilla) phenology in Ontario and Alberta, respectively. In Ontario, these patterns of response could largely be explained by changes in the behaviour of individual birds, i.e., phenotypic plasticity. By explicitly incorporating migratory connectivity into responses to climate, our data suggest that widely separated breeding populations can show independent and geographically specific associations with changing weather conditions. The tendency of individuals to delay migration and breeding following dry winters could result in population declines due to predicted drying trends in tropical areas and the tight linkage between early arrival/breeding and reproductive success in long-distance migrants.

Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study.

INTRODUCTION: Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period. METHODS: A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point. RESULTS: 2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth. Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter. Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum. CONCLUSION: Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.

Resilience in the Perinatal Period and Early Motherhood: A Principle-Based Concept Analysis.

A context-specific delineation of research approaches to resilience in the perinatal and early motherhood literature is currently lacking. A principle-based concept analysis was used to establish a description of how women's resilience is currently conceptualised and operationalised within empirical research in the perinatal period and early motherhood (defined as up to five-years postpartum). CINAHL, Medline, PsychInfo, EMBASE, ASSIA, Web of Science, Scielo, Maternity and Infant Care, the Cochrane Library, and the World Health Organization were systematically searched (January/February 2020 and March 2022). Fifty-six studies met the inclusion criteria. Analysis demonstrated interchangeable use of associated concepts such as 'coping', 'coping strategies', and 'adaptation'. Resilience was frequently operationalised as the absence of illness symptomatology, rather than the presence of mental well-being. Investigations of positive areas of functioning were predominately related to the mother's family role. There was limited qualitative exploration of women's perspectives. Recommendations for the pragmatic application of resilience research were not well developed. The narrow operationalisation of resilience by mental ill-health and parental role, and the distinct absence of women's perspectives, restricts the logical maturity and pragmatic application of the concept. Future research may benefit from exploration of women's insights on indicators that might best reflect positive functioning and resilience in this period.

The maternal health-related issues that matter most to women in Ireland as they transition to motherhood - A qualitative study.

BACKGROUND: Many studies on women's maternity care experiences reveal recurring issues that are poor or less than optimal. Women's opinions on the maternal health-related issues that matter most to them are essential if care and services are to be improved. AIMS: To identify the maternal health-related issues that matter most to women in Ireland, based on their own experiences of maternity care, services and motherhood. METHODS: A qualitative exploratory study with 24 women. Following university ethical approval, audio-recorded one-to-one telephone interviews were conducted and thematically analysed. FINDINGS: We identified two themes, each with four subthemes, connected to a central concept of the invisible woman. Pendulum of care, and subthemes Inconsistent services, All about the baby, Induced anxiety and Information seesaw, illustrated the extremes of care and services that women experienced. Magnitude of motherhood, and subthemes Weight of responsibility, Real-time reassurance, Change of identity and Growth into advocacy, depicted the intensity of their new role while transitioning to motherhood. DISCUSSION: Findings articulate the issues that mattered most to women in Ireland as they transitioned to motherhood. Some women identified specific research topics/areas, but all of the issues identified can be translated into researchable topics that seek to improve local care and service provision. CONCLUSION: Given the recurring nature of women's less than satisfactory experiences of aspects of maternity care in many countries, it is likely that conducting research on issues that matters most to women will have the greatest impact on their health, wellbeing and lives as they transition to motherhood.

A test of the mismatch hypothesis: How is timing of reproduction related to food abundance in an aerial insectivore?

In seasonal environments, vertebrates are generally thought to time their reproduction so offspring are raised during the peak of food abundance. The mismatch hypothesis predicts that reproductive success is maximized when animals synchronize their reproduction with the food supply. Understanding the mechanisms influencing the timing of reproduction has taken on new urgency as climate change is altering environmental conditions during reproduction, and there is concern that species will not be able to synchronize their reproduction with changing food supplies. Using data from five sites over 24 years (37 site-years), we tested the assumptions of the mismatch hypothesis in the Tree Swallow (Tachycineta bicolor), a widespread aerial insectivore, whose timing of egg-laying has shifted earlier by nine days since the 1950s. Contrary to the mismatch hypothesis, the start of egg-laying was strongly related to food abundance (flying insect biomass) during the laying period and not to timing of the seasonal peak in food supply. In fact, food abundance generally continued to increase throughout the breeding season, and there was no evidence of selection based on the mistiming of laying with the seasonal peak of food abundance. In contrast, there was selection for laying earlier, because birds that lay earlier generally have larger clutches and fledge more young. Overall, initial reproductive decisions in this insectivore appear to be based on the food supply during egg formation and not the nestling period. Thus, the mismatch hypothesis may not apply in environments with relatively constant or abundant food throughout the breeding season. Although climate change is often associated with earlier reproduction, our results caution that it is not necessarily driven by selection for synchronized reproduction.

Motivators and challenges to research recruitment - A qualitative study with midwives.

OBJECTIVE: To explore midwives' experiences of recruiting participants to research studies conducted by other researchers. DESIGN: An inductive qualitative study. METHODS: Individual face-to-face or telephone interviews using a semi-structured interview guide. Interviews were analysed thematically. SETTINGS: One large urban maternity hospital in Ireland. PARTICIPANTS: A purposive sample of 19 midwives FINDINGS: Three co-dependent themes emerged: intrinsic motivations, extrinsic motivations and challenges. Intrinsic motivations included midwives' personal beliefs about the value of research in general, its potential to improve practice, and their perceptions of how robust a particular study was and how it might impact on an individual woman and her baby. This included an inherent desire to shield some women, those who were perceived to have ongoing health issues or be anticipating a sub-optimal pregnancy outcome, from being offered study information. Extrinsic motivations related to the complexity of a research study and a specific researcher's characteristics. Challenges to offering potential participants research study information and, therefore, to successful recruitment included time constraints, workload and the volume of research being conducted simultaneously. KEY CONCLUSIONS: Participants navigated the two, sometimes competing, worlds of clinical practice and clinical research. Set in the context of workload and the volume of research being conducted simultaneously, midwives' perceptions of a study's robustness, clarity, its potential impact on individual women and ability to improve practice governed their motivation to offer information on research studies to potential participants. IMPLICATIONS FOR PRACTICE: Inviting clinicians to assess the study information may improve its clarity and create opportunities to discuss the potential value and recruitment bias. Researchers should be available to address clinicians' questions about particular research studies. At an organisational level, a system for managing the volume of research activity is required.

Foraging pattern of pine siskins and its influence on winter moth survival in an apple orchard.

Foraging by migratory pine siskins in an apple orchard infested with varying densities of winter moth was observed, and winter moth mortality in the presence and absence of birds was recorded. Time spent foraging in a tree and number of birds foraging per tree was positively related to larval density but number of larvae removed per leaf cluster or per unit time was not. Level of defoliation was a better predictor of the number of clusters searched per tree than was prey density. Despite poor predictability in allocation of search effort with respect to prey density, siskins acted as a source of strong compensatory mortality on the winter moth population.

Critical thresholds associated with habitat loss: a review of the concepts, evidence, and applications.

A major conservation concern is whether population size and other ecological variables change linearly with habitat loss, or whether they suddenly decline more rapidly below a "critical threshold" level of habitat. The most commonly discussed explanation for critical threshold responses to habitat loss focus on habitat configuration. As habitat loss progresses, the remaining habitat is increasingly fragmented or the fragments are increasingly isolated, which may compound the effects of habitat loss. In this review we also explore other possible explanations for apparently nonlinear relationships between habitat loss and ecological responses, including Allee effects and time lags, and point out that some ecological variables will inherently respond nonlinearly to habitat loss even in the absence of compounding factors. In the literature, both linear and nonlinear ecological responses to habitat loss are evident among simulation and empirical studies, although the presence and value of critical thresholds is influenced by characteristics of the species (e.g. dispersal, reproduction, area/edge sensitivity) and landscape (e.g. fragmentation, matrix quality, rate of change). With enough empirical support, such trends could be useful for making important predictions about species' responses to habitat loss, to guide future research on the underlying causes of critical thresholds, and to make better informed management decisions. Some have seen critical thresholds as a means of identifying conservation targets for habitat retention. We argue that in many cases this may be misguided, and that the meaning (and utility) of a critical threshold must be interpreted carefully and in relation to the response variable and management goal. Despite recent interest in critical threshold responses to habitat loss, most studies have not used any formal statistical methods to identify their presence or value. Methods that have been used include model comparisons using Akaike information criterion (AIC) or t-tests, and significance testing for changes in slope or for polynomial effects. The judicious use of statistics to help determine the shape of ecological relationships would permit greater objectivity and more comparability among studies.

Demographic consequences of age-structure in extreme environments: population models for arctic and alpine ptarmigan.

Organisms living in arctic and alpine environments are increasingly impacted by human activities. To evaluate the potential impacts of global change, a better understanding of the demography of organisms in extreme environments is needed. In this study, we compare the age-specific demography of willow ptarmigan (Lagopus lagopus) breeding at arctic and subalpine sites, and white-tailed ptarmigan (L. leucurus) breeding at an alpine site. Rates of egg production improved with age at the alpine and subalpine sites, but the stochastic effects of nest and brood predation led to similar rates of annual fecundity among 1-, 2-, and 3+-year-old females. All populations had short generation times (T<2.7 years) and low net reproductive rates (R0<1.2). Stable age distributions were weighted towards 1-year-old females in willow ptarmigan (>59%), and to 3+-year-old females in white-tailed ptarmigan (>47%). High damping ratios (rho>3.2) indicated that asymptotic estimates were likely to match natural age distributions. Sensitivity and elasticity values indicated that changes in juvenile survival would have the greatest impact on the finite rate of population change (lambda) in willow ptarmigan, whereas changes to the survival of 3+-year-old females would have a greater effect in white-tailed ptarmigan. High survivorship buffers white-tailed ptarmigan in alpine environments against the potential effects of climate change on annual fecundity, but may make the species more sensitive to the effects of pollutants or harvesting on adult survival. Conversely, processes that reduce annual fecundity would have a greater impact on the population viability of willow ptarmigan in arctic and subalpine environments. If these same demographic patterns prove to be widespread among organisms in extreme environments, it may be possible to develop general recommendations for conservation of the biological resources of arctic and alpine ecosystems.