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BACKGROUND: Postnatal mental health problems (PMHPs) are prevalent and negatively affect mothers, children, and society. International and local guidelines recommend that Singapore primary care physicians (PCP) screen, assess, and manage mothers with PMHPs. However, little is known about their experiences and views. METHODS: We conducted semi-structured interviews with 14 PCPs in Singapore. Interview questions elicited perspectives on the identification and management of mothers with PMHPs. The interview guide was developed from a conceptual framework incorporating the knowledge-attitudes-practices, self-efficacy, and socio-ecological models. Interviews were audio-recorded and transcribed. Thematic analysis was used to identify emergent themes. RESULTS: Singapore PCPs viewed themselves as key providers of first-contact care to mothers with PMHPs. They believed mothers preferred them to alternative providers because of greater accessibility and trust. In detection, they were vigilant in identifying at-risk mothers and favoured clinical intuition over screening tools. PCPs were confident in diagnosing common PMHPs and believed that mothers not meeting diagnostic criteria must be readily recognized and supported. In managing PMHPs, PCPs expressed varying confidence in prescribing antidepressants, which were viewed as second-line to supportive counselling and psychoeducation. Impeding physician factors, constraining practice characteristics and health system limitations were barriers. Looking forward, PCPs aspired to leverage technology and multidisciplinary teams to provide comprehensive, team-based care for the mother-child dyad. CONCLUSION: Singapore PCPs are key in identifying and managing mothers with PMHPs. To fully harness their potential in providing comprehensive care, PCPs need greater multidisciplinary support and technological solutions that promote remote disclosure and enhanced preparation for their role.

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INTRODUCTION: Globally an estimated 1 in 16 women per year experience an unwanted pregnancy (UWP). In the Netherlands, general practitioners (GPs) play an important role in providing care for women with UWP; however, it is unknown how many of these women consult their GP about the pregnancy. UWPs are a major life experience with a possible influence on mental health. Data that GPs register about UWPs, psychosocial problems, and contraceptive use could give more insight into care needs. AIMS: To create an overview of (i) the prevalence of UWPs in general practice, (ii) the prevalence of psychosocial problems in women with UWP, and (iii) contraceptive use of women with UWP. METHODS: GP registration data were analysed from 58 general practices located in Northern Netherlands between 2015 and 2019. Patient files were checked for registration of ICPC and ATC codes concerning pregnancy, psychosocial health, and contraceptive use. Chi-square and Fisher's exact test were used to calculate differences between women with a UWP and women with a wanted pregnancy (WP). An analysis of registration dates was conducted to determine when the psychosocial problems were registered in relation to the pregnancy. RESULTS: Of female patients of reproductive age, 1.6% had a UWP and 11.8% had a WP. Women with a UWP reported statistically significantly more psychosocial problems. Furthermore, statistically significantly more contraceptive methods were prescribed to women with UWP compared with both women with WP and women without pregnancy. DISCUSSION AND CONCLUSION: The finding that women with UWP experience more psychosocial problems can be used to improve aftercare and can be incorporated into current guidelines for GPs.

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OBJECTIVE: To determine if the patient reported experiences (PREMs) of women in maternity care differ by whether or not they had a postnatal consultation before leaving the birth institution. METHODS: Secondary analysis of cross-sectional data to compare PREMs of women who had received an individual consultation (86 %), a group consultation (3 %), and women who had received no consultation (11 %). PREMs were collected using a self-administered questionnaire. Eight summated scales were constructed from 29 single items, pertaining to different parts of the received care. Scores ranged between 0 and 100, with high scores representing positive experiences. RESULTS: Among the 8156 sampled women, 3387 (42 %) responded. There were statistically significant (p ≤ 0.002) differences (from 3.7 to 16.3 points) on all eight scales. The scores from women who had an individual postnatal consultation were consistently higher than the scores from the other groups. The largest difference was in the scale with the worst score: information about women's health during the postnatal stay. CONCLUSION: Women who participated in individual postnatal consultations reported more positive experiences compared to those who did not. PRACTICE IMPLICATION: The consistent differences found in this study provide support for administering individual postnatal consultations.

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BACKGROUND: The women-friendly care approach focuses on women's rights to have access to quality care for themselves as individuals, as mothers, and for their infants. However, access to quality health services is not guaranteed for many women, particularly in low and middle-income countries. Hence, this study aimed to assess the level of women-friendly care provision and associated factors among mothers in the immediate post-partum period at public hospitals of Bale Zone, Southeast Ethiopia 2021. METHODS: An institutional-based cross-sectional survey was employed among mothers in the immediate post-partum period in public hospitals of Bale Zone from March 1-30, 2021. A total of 363 mothers were recruited by systematic random sampling technique in this study. Data was collected through pre-tested structured questionnaires. A 21-verified questionnaire was used to measure the outcome variable. The data were entered into Epi Data version 4.6.2.0 and exported to the statistical package of social science version 26.0 for analysis. A variable with a P value of less than 0.25 in the bi-variable binary logistic regression model was transferred to a multivariable binary logistics regression model. Hosmer and Lemeshow's goodness of fit model was checked. Adjusted odds ratio with 95% confidence intervals were used to estimate the strength of association between the outcome variable and independent variables. A p-value less than 0.05 was considered as significantly associated. RESULTS: The level of women-friendly care provision among mothers in immediate post-partum at public hospitals of Bale Zone was found to be 61% [95% confidence interval (55.73-66.04)]. Being prim para mother [Adjusted odds ratio = 1.88(1.07-3.33)], having planned pregnancy [Adjusted odds ratio = 1.94(1.04-3.63)] and staying at a health facility after delivery [Adjusted odds ratio = 4.8(1.71-13.39)] were found to be statistically significant predictors of level of women-friendly care provision. CONCLUSION: The women-friendly care provision among mothers in the immediate post-partum period in this study area was found to be low against most of the pre-existing findings. Strong counseling on planned pregnancy and staying at a health facility after delivery is recommended.

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BACKGROUND: Nearly a year after COVID-19 was initially detected, guidance for pregnant and new mothers remains varied. OBJECTIVE: The goal of this systematic review is to summarize recommendations for three areas of maternal and fetal care-breastfeeding, post-partum social distancing, and decontamination. SEARCH STRATEGY: We searched PubMed, Embase and Web of Science spanning from inception to November 9, 2020. SELECTION CRITERIA: Articles were included if they focused on COVID-positive mothers, commented on at least one of the three areas of interest, and were published in English. DATA COLLECTION AND ANALYSIS: Our combined database search yielded 385 articles. After removing duplicates and articles that did not cover the correct populations or subject matter, a total of 74 articles remained in our analysis. MAIN RESULTS: Most articles recommended direct breastfeeding with enhanced precaution measures. Recommendations regarding post-partum social distancing varied, although articles published more recently often recommended keeping the mother and newborn in the same room when possible. Decontamination recommendations emphasized mask wearing, good hand hygiene, and proper cleaning of surfaces. CONCLUSION: In general, there was a focus on shared decision making when approaching topics such as breastfeeding and post-partum social distancing. Guidelines for decontamination were fairly uniform.

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AIM: There are ongoing discussions whether cesarean section is the safest mode of childbirth to prevent pelvic floor disorders. Pelvic floor electromyography (EMG) allows the analysis of external anal sphincter (EAS) function during voluntary contractions. The primary objective of this study was the evaluation of EMG amplitude of external anal sphincter in women who had vaginal delivery, compared to women who had cesarean section. The secondary objective was to evaluate the anal incontinence score changes before and after delivery between the groups, and to look for any relationship between the clinical and EMG findings. METHODS: Multichannel surface EMG was detected during maximal contractions in three sessions: (i) during pregnancy, (ii) 6 weeks after delivery and (iii) 1 year after delivery. Women were divided into two groups: cesarean section and vaginal delivery. RESULTS: External anal sphincter EMG amplitude decreases 6 weeks after vaginal deliveries from 10.1 to 8.6 µV with effect size of 0.4, but returns to baseline after 1 year. No differences were observed between groups in all other variables. CONCLUSION: No differences were observed after 1 year in EMG activity between the two groups; however, a slight decrease of sphincter muscle amplitude was noted 6 weeks after vaginal delivery. The delivery mode does not have effect on the EAS amplitude 1 year after delivery. Incontinence score slightly increased in both groups after delivery, with no significant differences between the two groups. No association was observed between the increase of incontinence score and the decrease of EMG signal amplitude.

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AIM: The aim of this study was to determine the efficacy of a single 40-mg intravenous (i.v.) dose of parecoxib as an adjunctive analgesia to intrathecal morphine after elective cesarean delivery (CD). METHODS: A total of 82 low-risk term pregnant women who were scheduled for elective CD during the June 2014-June 2015 study period were enrolled. Two hours after surgery, subjects were randomly assigned to receive either i.v. injection of 2 mL (40 mg) parecoxib (study group; n = 41) or 2 mL normal saline solution (control group; n = 41). Patient randomization into groups was determined by the hospital's central computer system. Outcome measurements included total postoperative supplemental meperidine consumption, recorded pain score by numeric pain rating scale at 6, 12, 18, and 24 h, postoperatively, and patient satisfaction. RESULTS: Patient characteristics and pregnancy outcomes were comparable between groups. Total postoperative meperidine consumption was not significantly different between groups (12.7 ± 18.8 mg vs 8.3 ± 16.7 mg; P > 0.05). Compared with control, the study group was significantly less likely to experience moderate to severe postoperative pain (score ≥ 4) at 6 h (0% vs 21.9%; P = 0.002). Study group patients reported higher satisfaction than control group patients (median score: 8 vs 6; P < 0.01). No patients in either group reported adverse effects from their assigned intervention. CONCLUSION: Parecoxib did not demonstrate effectiveness in reducing patient requirement for supplementary meperidine after CD. However, administration of a single 40-mg dose of i.v. parecoxib after elective CD demonstrated effectiveness in reducing pain scores, with a resulting increase in patient satisfaction.

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Uterine artery pseudoaneurysms (UAP) are a rare cause of post-partum hemorrhage. Conservative management is discouraged due to the risk of spontaneous hemorrhage. Intra-arterial embolization is highly successful (>90%) and offers definitive treatment. We present the case of a 27-year-old woman with significant delayed post-partum hemorrhage after cesarean section who was found to have a UAP on imaging. Her tortuous vascular anatomy and spasmodic aneurysmal neck presented technical challenges to embolization with traditional material, such as gel foam and coils. Intra-arterial thrombin was then employed with good technical and clinical outcome. To our knowledge, this is the first case describing the use of intra-arterial thrombin in the treatment of UAP. Given its success in this case, we argue that intra-arterial thrombin should be considered a viable alternative for embolization of UAP when more traditional techniques fail.

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INTRODUCTION: Maternal health constitutes the health of women during pregnancy, childbirth and the postpartum period. Bihar and Madhya Pradesh (MP) constitute the Empowered Action Group (EAG) states under National Rural Health Mission (NRHM) and are consistently having poor maternal health indicators. AIM: The main objective of this study was to assess the maternal health situation of Bihar and MP based on National Family Health Survey (NFHS-3) and 4 fact sheets. MATERIALS AND METHODS: The study adopted a narrative description in which the NFHS fact sheets (NFHS-3 & 4) of both these states were obtained from appropriate sources and compared for various maternal health indicators. RESULTS AND DISCUSSION: Albeit progress has been observed from NFHS-3 to NFHS-4 however, the progress is very dismal compared with the progress of other similar Indian states. Relatively MP has shown better progress compared to Bihar. Poor performance is being observed in all the three levels of maternal health; pregnancy {Ante-Natal Care (ANC), Tetanus toxoid (TT) and Iron and Folic Acid (IFA)}, child birth (Institutional delivery by Skilled Birth Attendant (SBA), Caesarean Section (CS) and post partum care (hospital stay and Janani Suraksha Yojna (JSY). The poor performance of both these states in all these indicators requires multipronged approach strong political will, health system strengthening, community mobilization and awareness. CONCLUSION: Given the status of maternal health in India and more especially in states BIMARU (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh) and EAG states (Empowered action group), improvement in the performance of maternal health related activities is highly necessary.

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Paternal postpartum depression may affect not only the mental health and wellbeing of fathers but their partners and children. We investigated the point and period prevalence of paternal postpartum depression and its association with factors measured during pregnancy in a regional longitudinal study in Nishio City, Aichi Prefecture, Japan, between December 1, 2012, and April 30, 2013. Data were collected once in pregnancy and five times in the first three months postpartum. The Edinburgh Postnatal Depression Scale was used to assess paternal depression, and data were collected in pregnancy on demographic and psychosocial factors. Of 215 fathers who returned at least one of the five postpartum assessments, 36 (17%) reported symptoms of depression in the first three months after birth. In logistic regression analyses, among a number of demographic and psychosocial characteristics that previously had been linked to paternal postpartum depression, only fathers' history of psychiatric treatment and depressive symptoms during pregnancy were associated with paternal depressive symptoms in the postnatal period. The results add to the growing body of evidence on prevalence of paternal postnatal depression and indicate that assessment and support for fathers are important starting in pregnancy. © 2016 Wiley Periodicals, Inc.

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BACKGROUND: Some gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women, but this has not been examined in family practice. OBJECTIVE: We aimed to investigate intimate partner violence (IPV) prevalence in family practice and to investigate whether gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women. METHODS: We conducted a cross-sectional waiting room survey in 12 family practices in the Netherlands in 2012. Women were eligible if they were of 18 years or older. Questionnaires measured IPV and gynaecological and pregnancy-associated conditions. Chi-square tests were used to assess the differences in gynaecological and pregnancy-associated conditions between abused women and non-abused women. RESULTS: The response rate was 86% (262 of 306 women). The past-year prevalence of IPV in women who had had an intimate relationship in the past year and were not accompanied by their partner was 8.7% (n = 195). Lifetime prevalence of women who had ever had an intimate relationship, but not in the past year, was 17.6% (n = 51). Sexually transmitted infections (STIs) [odds ratio (OR) = 4.6, 95% confidence interval [CI] = 1.7-12.5, n = 240], menstrual disorders (OR = 3.7, 95% CI = 1.2-11.2, n = 143), sexual problems (OR = 3.3, 95% CI = 1.2-9.3, n = 229), miscarriages (OR = 2.5, 95% CI = 1.062-5.8, n = 202) and induced abortions (OR = 2.7, 95% CI = 1.028-7.3, n = 202) were significantly more common in abused women than in non-abused women. CONCLUSION: Family physicians should ask about IPV when women present with STIs, menstrual disorders, sexual problems, miscarriages or induced abortions. To improve the recognition of IPV, future research needs to investigate whether a combination of symptoms offers improved prediction of IPV.

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OBJECTIVE: to explore midwives' experiences and perceptions of skin-to-skin contact between mothers and their healthy full-term infants immediately and during the first day after caesarean section. DESIGN: qualitative interviews with semi-structured questions. SETTING AND PARTICIPANTS: eight midwives at three different hospitals in Stockholm participated in the study. All participants provided care for mothers and their newborn infants after caesarean birth. ANALYSIS: transcribed material was analysed and interpreted using qualitative content analysis. The analysis yielded the theme 'fighting an uphill battle'. FINDINGS: skin-to-skin contact was considered to be important, and something that midwives strove to implement as a natural element of postnatal care. However, in daily practice, midwives experienced many obstacles to such care, such as lack of knowledge among parents and other professionals about the benefits of skin-to-skin contact, the mother's condition after the caesarean section, and other organisational difficulties (e.g. collaboration with other professionals, lack of time). Introducing more skin-to-skin care was a challenge for the midwives, who sometimes felt both dismissed and disappointed when they tried to communicate the benefits of this type of care. CONCLUSION: skin-to-skin contact is not prioritised because many health care practitioners are unaware of its positive effects, and their care reflects this lack of knowledge. There is a need for education among all health care practitioners involved in caesarean procedures. Another difficulty is that many parents are unaware of the benefits of skin-to-skin contact. Maternity outpatient clinics need to inform parents about the benefits of such care, so mothers will understand the importance of skin-to-skin contact.

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OBJECTIVE: the Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum. DESIGN: prospective two-stage survey. SETTING: two rural hospitals in the south of Germany and in the north of Switzerland. PARTICIPANTS: all women giving birth between 1st October and 15th December 2012 with sufficient knowledge of German and whose babies were not referred to a neonatal care unit; 226 women were eligible to participate. MEASUREMENT INSTRUMENTS: two questionnaires including questions relating to socio-demographic factors and perinatal care, and incorporating the MGI, the Hospital Anxiety and Depression Scale (HADS) and the Postnatal Morbidity Index (PMI). All instruments were subjected to forward and back translation and pilot-tested; the first questionnaire was then administered in the first two days after birth and the second six weeks post partum. Parametric and non-parametric tests were computed using SPSS. FINDINGS: 129 surveys were returned an average of three days after birth and 83 after seven weeks. Higher postnatal quality of life showed a significant correlation with a lower anxiety and depression score (p<0.01), fewer maternal physical complaints (p<0.05) and more favourable baby adjective scores (p<0.05) after birth. Significant associations were found between MGI scores and sufficient help (p=0.03) as well as ability to cope at home (p<0.01). MGI scores three days and seven weeks after birth correlated highly significantly and positively (p<0.001). KEY CONCLUSIONS: convergent validity of the MGI with the HADS and the PMI suggests that the German version of the MGI is a valid indicator of physical and emotional post partum well-being. IMPLICATION FOR PRACTICE: the German version of the MGI can be used in the post partum period to identify women whose quality of life is impaired during the first days after birth, in order to initiate extended midwifery care and referral if necessary.

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A 34-year-old full-term pregnant woman presented with abruptly aggravating dyspnea. A chest X-ray showed pulmonary edema, and an echocardiogram revealed a left ventricular ejection fraction of 39%. Despite conventional medical treatment for acute heart failure and mechanical ventilation, hypoxia and metabolic acidosis were aggravated, and the fetal heart rate decreased to 90 b.p.m., suggestive of fetal distress. We decided to initiate extracorporeal membrane oxygenation (ECMO) and perform a cesarean section. The infant was successfully delivered without hypoxic brain damage. The patient was weaned from ECMO 6 days after delivery and was extubated 1 day after discontinuation of ECMO. Left ventricular systolic function had completely recovered at this time. This is the first report of a patient with peripartum cardiomyopathy who had a successful delivery with the support of ECMO, demonstrating that ECMO can serve as a rescue therapy, not only treating peripartum cardiomyopathy but also permitting a safe delivery.

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AIM: To explore the experiences of women from three population groups of immediate skin-to-skin contact (SSC) with their newborn babies. METHOD: A mixed methods approach was adopted in a phenomenological study to elicit the experiences of English, Pakistani and Bangladeshi women. Audiotaped diaries, semi-structured interviews, photographs and video recordings were employed. Concept mapping was central to data analysis. RESULTS: This paper reports novel findings that women contextualized and accepted secretions and bodily fluids from birth. This contradicts the beliefs of midwives that Asian women find bodily secretions abhorrent and culturally unacceptable. All participants reported positive experiences of SSC despite varying degrees of soiling from birth fluids. LIMITATIONS: The study was conducted in a single setting, and participants may not have been representative of others in their cultural groups. Third-party translation may have added an unsought layer of interpretation. The imposition of cultural expectations by peers in the recruitment process excluded some potential participants. CONCLUSION: Stereotypical assumptions about cultural background often characterize professional responses. When this stereotyping was put aside, women of all three cultures, whether breastfeeding or bottle-feeding, were able to enjoy SSC with their babies. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings suggest that changes will be needed in professional practice to be more open to women's expressed preferences, in local policy to ensure that choices are made clear and are available, and in national strategic direction to ensure widespread adoption of positive practices for opportunities to increase breastfeeding, promote parent-child bonding and support patient choice to be realized.

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This study was designed to compare the educational needs and satisfactory about infant care of the mothers in the Post-partum Care Center for development of the educational program. The subjects for this study were 100 mothers in the Post-partum Care Center in Seoul and Buchon. The data were collected during the period from Feb. to March, 2000. The Educational Need and satisfactory for Infant Care was measured by questionnaire that has developed by researchers. The data were analysed by descriptive statistics, paired t-test using SPSS PC+ WIN.The results were as fellow; 1) The educational needs of the mothers in the Post-partum Care Center were high (mean=4.32). 2)The satisfactory of the mothers in the Post-partum Care Center of educational program of infant care were middle range (mean=3.60). 3) The educational needs of infant cares in the Post-partum Care Center were higher than satisfactory of the mothers in the Post- partum Care Center of educational program of infant care(t=7.71 p=.000). 4) The educational need by content was signs, symptoms and management of disorders(i.g. cyanosis, seizure, fever, etc.) were higher than general care of baby(i.g. feeding, diaper change etc.). In conclusion, when the infant caregiver in the Post-partum Care Center teaching the method of infant care to mother, there should be in consideration of educational need of mother. And its educational contents must be included of mental and emotional development and signs, symptoms and management of disorders.

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This study was designed to compare the educational needs and satisfactory about infant care of the mothers in the Post-partum Care Center for development of the educational program. The subjects for this study were 100 mothers in the Post-partum Care Center in Seoul and Buchon. The data were collected during the period from Feb. to March, 2000. The Educational Need and satisfactory for Infant Care was measured by questionnaire that has developed by researchers. The data were analysed by descriptive statistics, paired t-test using SPSS PC+ WIN.The results were as fellow; 1) The educational needs of the mothers in the Post-partum Care Center were high (mean=4.32). 2)The satisfactory of the mothers in the Post-partum Care Center of educational program of infant care were middle range (mean=3.60). 3) The educational needs of infant cares in the Post-partum Care Center were higher than satisfactory of the mothers in the Post- partum Care Center of educational program of infant care(t=7.71 p=.000). 4) The educational need by content was signs, symptoms and management of disorders(i.g. cyanosis, seizure, fever, etc.) were higher than general care of baby(i.g. feeding, diaper change etc.). In conclusion, when the infant caregiver in the Post-partum Care Center teaching the method of infant care to mother, there should be in consideration of educational need of mother. And its educational contents must be included of mental and emotional development and signs, symptoms and management of disorders.

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