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Objective: To identify factors that affect the use of postpartum care services in developing countries., Data Sources: PubMed, CINAHL, Global Health, EMBASE, and grey literature were searched for relevant articles in 2015 and 2016 with no publication date limit imposed., Study Selection: Thirteen studies met inclusion criteria and were assessed for quality with the use of a checklist developed by Fowkes and Fulton (1991) and a checklist developed by the Critical Appraisal Skills Programme (2017)., Data Extraction: The integrative review framework of Whittemore and Knafl (2005) guided the conduct of the review., Data Synthesis: Results were synthesized based on the three delays model of Thaddeus and Maine (1994). Factors that negatively affected women's decisions to seek postpartum care (Phase I delays) included lack of women's autonomy, lack of exposure to mass media, no pregnancy/birth/postpartum complications, lack of awareness of postpartum care, negative provider attitude, lower levels of women's and husbands' education, women's and husbands' farming occupations, increasing number of children, and lower level of household income. Perceived easy access to a health care facility was associated with lesser odds of using postpartum care (Phase II delay). Hospitals, public health care facilities, and long queuing at a health care facility were associated with decreased postpartum care use (Phase III delays)., Conclusion: The most common determinants of how women used postpartum care were complications and the education levels and occupations of the women and their husbands. Further research is needed to identify health facility and accessibility factors that affect postpartum care use to develop effective interventions to improve the use of postpartum care., (Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF)., Design: Principal component factor rotation was used to conduct an exploratory factor analysis of the BIMF to determine if more concise versions exist., Setting: Patients were recruited from a large, urban medical center in the Northeast., Participants: The BIMF was administered at an initial home visit along with several other self-report and clinical assessments to women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale during the 4- to 6-week postpartum period., Methods: The BIMF was administered between October 2008 and September 2010. The distribution of BIMF item responses was examined along with interitem correlations. To establish construct validity, correlation coefficients were produced for the BIMF in relation to several other variables or assessments. A factor analysis was performed using principal component factor rotation., Results: The factor analysis revealed a two-factor solution. The items that loaded on factor 1 gauged the mother's perception of her own competency in the maternal role and the items that made up factor 2 focused on the mother's needs. Items related to judgment from others and anxiety did not load on either factor., Conclusions: The BIMF may be administered in its 18-item version, as two separate subscales, or in its original 20-item format. A clinical threshold should be developed to facilitate accurate identification of mothers who are struggling with functioning during the postpartum period., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To describe low-income, urban, first-time mothers' perceptions about self-care and infant care during the first 6-months postpartum., Design: Naturalistic approach., Setting: Recruitment from community centers and churches., Participants: Thirteen Hispanic and African American women who delivered their first infants within the past 6 months., Methods: Demographic and health information data were collected and analyzed using descriptive statistics. Semistructured interviews were conducted; data were coded and then clustered conceptually into categories., Results: Postpartum maternal self- and infant care issues included four categories: preparedness for discharge, confidence and satisfaction with mothering, concerns about infant care, and indifference to maternal self-care. Women were confident in caring for themselves and their infants and reported few unmet learning needs or health concerns. External sources of stress included finances, uncertain living arrangements, and relationship issues., Conclusion: Health care providers who care for low-income postpartum women need to acknowledge the influence of external stressors that contribute to health outcomes in this population. It is vital that nurses collaborate with other health care providers to make certain that community connections are made for women who might need additional services beyond the postpartum check-up visit., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period., Design: Longitudinal., Sample: Three public hospitals in metropolitan Brisbane, Australia., Participants: Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth., Methods: The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS)., Results: Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy., Conclusion: Social support is a significant and consistent predictor of a mother's HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To define aspects of social support that adolescents need from nurses when initiating breastfeeding in the early postpartum., Data Sources: MEDLINE and CINAHL databases for years 2000 to 2009., Data Extraction: Three searches were done using the following subject terms: adolescent mothers and breastfeeding (12 studies), adolescent mothers and breastfeeding and support (24 studies), and breastfeeding and adolescent mothers and attitudes (15 studies). The 18 studies that were chosen for this synthesized review illuminated the dimensions of social support identified by House., Data Synthesis: The four types of supportive behavior categories identified by House were described in these studies (informational, instrumental, emotional, and appraisal). Esteem support as defined by Sarafino seemed to be synonymous with appraisal support. Many studies identified the importance of network support as a fifth category of supportive behavior in increased breastfeeding duration among adolescents; network support was included in this synthesis. These five types of social support provide a framework for defining supportive nurse behaviors., Conclusions: Nurses in the early postpartum can promote the long-term health of adolescents and their children through the social support they offer adolescent mothers as they initiate breastfeeding. Network support appears to be essential to adolescents' breastfeeding experiences and needs to be included with informational, instrumental, emotional, and esteem/appraisal support when investigating support for this population. By integrating the five dimensions of social support into their care, nurses play an essential role in providing adolescents with the positive experiences that are so important to establishing breastfeeding., (© 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To investigate maternal and infant factors associated with midwife-reported crying problems in the early postpartum period., Design: Case control study., Setting: Postnatal home care in Switzerland., Participants: Seven thousand seven hundred and sixty-five mother/child dyads who received postnatal homecare by midwives (n=1,636 cases of midwife-reported crying problems, n=6,129 controls)., Methods: We investigated factors associated with infant crying problems during the postpartum period as documented in the Statistical Database of Independent Midwives' Services in Switzerland (2007). Using case control methodology, we matched all identified cases of crying problems with controls who had been cared for by the same midwife. A conditional logistic regression model was used to analyze the associations of reported crying problems with maternal and infant factors., Results: Maternal health and mood problems in the immediate postpartum period were significantly associated with reported crying problems. Maternal health and mood problems included physical complications after birth, psychological decompensation, and depression. Further risk factors for infant crying problems were planned resumption of paid work directly after paid maternity leave (at 15-16 weeks postpartum) and immigrant status. A protective effect was observed for higher parity., Conclusions: Crying problems in the early postpartum period are associated with mothers' physical, psychological, and social conditions. Care practices that promote new mothers' physical and psychological recovery after birth could be a promising strategy to prevent early crying problems. Specific support is important for mothers with early signs of depression or decompensation, intention to return early to paid work, immigrant background, and for first-time mothers.

Objective: To explore awareness of postpartum depression and its symptoms and available community resources for women with postpartum depression., Design: Cross-sectional surveillance research, using population-based data., Setting: Eight communities in southern and eastern Ontario, Canada., Participants: A random selection of adults 18 years of age and older with telephones., Method: Logistic regression and chi-square test were used to analyze awareness of postpartum depression and its symptoms, the baby blues, and sources of assistance for women with postpartum depression., Results: The vast majority of respondents were aware of postpartum depression (90.1% +/- 0.6% confidence interval) (n=8,750) as compared with the baby blues (62.5% +/- 1.1%). Awareness of postpartum depression, its symptoms, the baby blues, and sources of assistance varied according to the demographic profiles of the respondents (family structure, education, and language spoken at home)., Conclusion: Awareness of the term postpartum depression does not necessarily imply awareness of its symptoms or sources of assistance. Public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families. Education should target individuals with lower levels of education and non-English-speaking groups.

Objective: To review the literature to describe Hispanic breastfeeding beliefs, attitudes, and practices in the United States., Data Sources: Using the search terms "Hispanics" and "breastfeeding," both CINAHAL and MEDLINE (Ovid) databases were queried. Only research studies conducted in the United States from 1998 and 2008 were included in the review., Study Selection: Fifty-five articles were located. Based on inclusion criteria, 38 research articles were included in this review., Data Extraction: Each study was analyzed in relation to the purpose of the review., Data Synthesis: Study findings were synthesized and organized into categories: acculturation status, breastfeeding intention, factors influencing initiation, breastfeeding barriers, breastfeeding support, and breastfeeding interventions., Conclusions: Breastfeeding initiation rates are high among Hispanics living in the United States. Newly immigrated women initiate and continue to breastfeed longer than more acculturated women. Unfortunately, exclusive breastfeeding and duration rates fall well below the desired goals of Healthy People 2010. Interventions aimed at encouraging and supporting women to maintain their cultural traditions, beliefs, and practices related to breastfeeding are needed.

Objective: To determine whether breastfeeding self-efficacy predicts the duration and pattern of breastfeeding in a sample of Black women of African descent., Design: Descriptive, longitudinal, cohort study. Participants were recruited during the postpartum hospitalization and followed monthly for 6 months or until complete weaning. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale--Short Form (BSES-SF) (Dennis, 2003)., Setting: A large urban teaching hospital in New England., Patients/participants: Women who self-identified as being of African descent with full-term infants who were planning to breastfeed (N=125)., Main Outcome Measures: Breastfeeding pattern was determined by the total number of feedings the infant received in the past 24 hours and how many of these were breast milk. Duration of breastfeeding was defined as the number of weeks until complete weaning., Results: Higher levels of breastfeeding self-efficacy predicted longer duration and a more exclusive pattern of breastfeeding at 1 and 6 months postpartum, consistent with prior research (p<.01). Planned pattern of feeding predicted actual pattern of feeding at 1 month postpartum (p<.01). Returning to work after 12 weeks was protective of breastfeeding to 6 months postpartum (p<.01)., Conclusion: Theory-based interventions to enhance self-efficacy will help improve breastfeeding outcomes.

Births to women of advanced maternal age have increased dramatically over the last decade in both the United States. The majority of women who deliver their first baby after age 35 are healthy and experience positive birth outcomes. According to current research, primigravidas over 35 tend to be educated consumers. Their physical and psychosocial needs differ from those of the mother in her 20s, due to advanced age and factors related to difficulty conceiving and life circumstances. This paper presents (a) an overview of the possible risks to outcomes of childbearing for women over the age of 35; (b) a discussion of how women of advanced maternal age may differ from younger women related to developmental stage, stress or anxiety or both, decision making, and support systems; and (c) an exploration of tailoring nursing care strategies during the peripartum period specifically for this age cohort.

Objective: To assess the support needs, support resources, barriers to support, and preferences for support intervention for women with postpartum depression., Design: Multisite, exploratory, descriptive study in which qualitative data were collected on support needs, the availability of resources, perceived barriers to support, and preferences for support of women who have experienced symptoms of postpartum depression., Participants and Setting: Conducted in Alberta and New Brunswick; mothers were interviewed individually (Alberta, n= 24; New Brunswick, n= 17) and in groups (Alberta, n= 5; New Brunswick, n= 6)., Results: For most mothers, one-on-one support was preferred when postpartum depression is recognized. Group support should be available once the mothers start to feel better and are able to comfortably interact with other mothers in a group format. This suite of alternatives needs to be underpinned by concerted public education efforts.

Women with disabilities are growing in number and increasingly interested in becoming mothers and raising children. However, health care providers are often unfamiliar with the health care needs of this group of women and overlook the important issues that make the difference between positive and negative experiences of these women. This article describes the preconception, antenatal, pregnancy, and postpartum issues of women with disabilities and suggests approaches to ensuring that women with disabilities have successful reproductive experiences.

Objective: To understand the process of decision making by auxiliary nurses regarding postpartum bleeding among women in the Dominican Republic., Design: An ethnographic qualitative design of semistructured interviews and participant observation., Participants: Twenty four auxiliary nurses on a maternity unit of a referral hospital in the Dominican Republic., Findings: Auxiliary nurses use specific criteria and logic to decide if postpartum maternal bleeding is excessive. However, systematic postpartum assessments are not routinely conducted on every woman., Main Outcome Measures: A decision tree that traces how auxiliary nurses evaluate postpartum bleeding indicates that they have knowledge of contemporary obstetric nursing care, but the organization of care delivery is not structured for them to apply it routinely., Conclusions: A collaboration of U.S. midwives and Dominican nurses will build on the assets of the auxiliary nurses. Rather than focusing the content of educational conferences on current knowledge of labor and delivery, an important next step is modeling woman- and family-centered care. The U.S. midwives and Dominican nurses are committed to finding empowering and effective ways to improve maternity care.

Objective: To describe immigrant women's postpartum health, service needs, access to services, and service use during the first 4 weeks following hospital discharge compared to women born in Canada., Design: Data were collected as part of a larger cross-sectional study., Setting: Women were recruited from 5 hospitals purposefully selected to provide a diverse sample., Participants: A sample of 1,250 women following vaginal delivery of a healthy infant; approximately 31% were born outside of Canada., Main Outcome Measures: Self-reported health status, postpartum depression, postpartum needs, access to services, service use., Results: Immigrant women were significantly more likely than Canadian-born women to have low family incomes, low social support, poorer health, possible postpartum depression, learning needs that were unmet in hospital, and a need for financial assistance. However, they were less likely to be able to get financial aid, household help, and reassurance/support. There were no differences between groups in ability to get care for health concerns., Conclusions: Health care professionals should attend not only to the basic postpartum health needs of immigrant women but also to their income and support needs by ensuring effective interventions and referral mechanisms.

The objective of this study was to understand the experience of a pregnant woman with needle phobia and examine its impact on her antepartum, intrapartum, and postpartum experience. A case study format was employed. A 21-year-old primiparous woman with diagnosed needle phobia was interviewed, and her prenatal and delivery records were reviewed. Three tasks during pregnancy were identified: seeking trusting relationships with health care providers; establishing and maintaining control and understanding; and coping with fear of needles, pain, and invasion. As frequent caregivers during childbearing, nurses with an understanding of needle phobia can help to establish trusting relationships with women with this phobia and support them and their families during childbearing and their encounters with needles., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

Objective: To describe policies, practices, and associated rationales of hospital obstetric units regarding mothers' support person options during childbirth and to explore practices concerning support of breastfeeding initiation after cesarean delivery., Design: Descriptive telephone survey., Setting: Hospitals in the southeastern region of the United States., Participants: Convenience sample of 154 obstetric nurse manager and nurse representatives employed by the participating hospitals., Main Outcome Measures: Types of policies regarding mothers' support person options during childbirth and immediate postpartum stage, initiation of breastfeeding after cesarean birth, and attitudes about policies., Results: All hospitals allowed two or more support persons during vaginal births, 89% permitted only one support person during nonemergent cesareans, and 58.0% of the nurse representatives believed that mothers should be allowed a second support person. Less than one third (31.2%) of the hospitals considered a mother's request to breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in the recovery room., Conclusions: Overall, maternal support policies, practices, and nurse representatives' attitudes were mother and family friendly, particularly related to vaginal births. Though breastfeeding initiation after cesarean birth was encouraging, support person options during nonemergent cesarean births and related rationales warrant further examination., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

As a rule, mothers are the primary caregivers of infants regardless of employment or marital status. Thus, any factors that impact mothering affect the infant and have public health significance. National attention is now focused on postpartum depression, a major variable affecting mothering. The impact of postpartum depression on the various components of the maternal role is described. Recommendations for health care practice include screening for depression across the first postpartum year and developing a strong network for mental health referrals., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

The role of grassroots organizations in supporting new mothers is reviewed. Postpartum Support International is an organization that links pregnant and new families with mental health resources and is a key advocate for mental health services for childbearing women., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

Objective: To explore the effects of a guided participation (GP) intervention on mothers' development of competencies in relating to their preterm infants in neonatal intensive-care units., Design: Mothers were enrolled in a randomized, longitudinal clinical trial to compare the effectiveness of GP with standard care teaching. Baseline data were collected when the infants were 29 weeks postconceptional age. The intervention (GP or standard care teaching) was administered, and relationship competencies were assessed through observation once per week for the next 6 weeks., Setting: Two neonatal intensive-care units in the Midwest., Participants: A convenience sample of 16 mothers of low-birthweight infants, 8 in each group., Interventions: GP of mothers in relating to their infants in the context of caregiving activities was compared with standard care teaching., Results: Mothers in the GP group had expectations and intentions that were more attuned and adaptive to their infants' needs. In addition, the GP group was consistently higher in relationship competencies than the standard care teaching group., Conclusions: GP can effectively support mothers in developing relationships with their preterm infants in the context of neonatal intensive-care unit caregiving activities.

Objective: To describe reports of low-income Black non-Hispanic women about the promotion of infant-feeding methods by nurses and physicians., Design: Ethnographic research conducted over 18 months with interviewing and participant observation of informants., Setting: The study took place in a Special Supplemental Nutrition Program for Women, Infants, and Children clinic and neighborhood in the New York metropolitan area., Participants: 130 Black non-Hispanic mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children were general informants. From this group, 11 primiparous key informants were selected for close follow-up during pregnancy and the 1st postpartum year., Main Outcome Measures: Audiotaped interviews and field notes were analyzed for mothers' descriptions of infant-feeding education and support from nurses and physicians., Findings: The informants reported limited breastfeeding education and support during pregnancy, childbirth stay in neonatal intensive care unit, postpartum, and recovery in the community. They also expressed trust/distrust concerns and varying degrees of anxiety about the ways they were treated by nurses and physicians., Conclusions: To decrease disparities in breastfeeding, this research suggests that health care professionals should focus their efforts on the development of trusting relationships and continuity of care along with clear, consistent breastfeeding education and support.

Objective: To examine maternal satisfaction with nipple shield use and maternal and infant physiological outcomes of breastfeeding with and without nipple shields., Design: A descriptive study using a structured telephone survey to examine maternal satisfaction of nipple shield use and a within-subject design to compare maternal and infant physiological outcomes for a subset of mother-infant dyads., Setting: Breastfeeding sessions were conducted in Pacific Northwest hospitals., Participants: 32 lactating women with experience using nipple shields; a subset of 5 maternal-infant dyads participated in the physiological part of the study., Main Outcome Measures: Maternal response to survey explored maternal satisfaction with nipple shield use. To examine maternal and infant physiological outcomes, two measures were used: infant test weighing to evaluate breast milk intake and maternal prolactin and cortisol levels to evaluate breast milk production., Results: Maternal survey response indicated that use of nipple shields may prevent premature breastfeeding termination. Physiological results demonstrated no significant difference in maternal hormonal levels and infant breast milk intake for breastfeeding sessions with and without nipple shields., Conclusion: Use of nipple shields may be considered in face of potential abandonment of breastfeeding.

Behavior change models and theories have been useful in our efforts to help people stop smoking. However, models that were developed for the general population do not always fit special populations such as pregnant women. Many women stop smoking while pregnant, but most resume smoking after giving birth. To help women who stop smoking while pregnant to stay smoke-free, a model for tailoring a smoking resumption-prevention intervention to the special needs of pregnant and postpartum women is proposed. The intervention begins during pregnancy, continues postpartum, and addresses pregnancy and parenting contextual factors in women's lives. The model is based on motivational theory and includes conducting patient assessments, developing risk profiles, triaging women to different levels of intervention intensity, and matching intervention strategies to women's risk profiles.

Objective: To examine the types of help women received with breastfeeding both in the hospital and at home and the reasons why women stopped breastfeeding earlier than intended., Design: A descriptive design with open-ended questions., Setting: After participant recruitment in the postpartum hospital room, data were collected by phone 8 weeks after delivery., Patients/participants: Three hundred seventy-nine women planning to breastfeed for at least 8 weeks after uncomplicated delivery., Main Outcome Measures: Breastfeeding status at 8 weeks postpartum; report of help with breastfeeding in the hospital and at home., Results: Sixty-eight percent of women were still breastfeeding at 8 weeks, although 37% of those reported supplementing with formula. Of those who had stopped, the most common reason was insufficient milk supply. Other reasons included painful nipples and latch problems, personal reasons, returning to work or school, and drugs/illness of the mother or baby. Most women received help with breastfeeding in the hospital, but only 55% received help with breastfeeding after hospital discharge., Conclusions: The primary reasons for early cessation of breastfeeding are amenable to nursing intervention. Every opportunity should be taken to address these issues both in the hospital and through follow-up calls.

Objectives: To test the extent to which social support and variables included in the Transtheoretical Model were explanatory for exercise initiation and weight maintenance in postpartum women., Design: A cross-sectional descriptive design., Setting: Data were collected in the participant's homes., Participants: Postpartum women who had normal pregnancies were interviewed and measured on body fat, physical activity, and psychosocial scales., Main Outcome Measure: (a) Stages of exercise change measure, (b) Seven Day Recall, (c) Friend and Family Support for Exercise Scale, (d) Processes of Change Questionnaire, and (e) body fat measures including body mass index and percent body fat., Results: Forty percent reported engaging in vigorous activity less than 1 hour daily, 55% walked less than four city blocks daily, and 52% engaged in less than 2 hours of vigorous weekend activity. Multilinear regression showed that the processes of change contributed 36% to the body mass index, and 21% of the variance in waist-thigh ratio. Of the processes of change, environmental reevaluation correlated significantly with body mass index., Conclusion: The impact of a woman's weight on others as well as information concerning the health effects of obesity and physical activity could enhance the initiation of exercise in the postpartum woman.

Objectives: To describe the postpartum learning needs of adolescent mothers and their mothers and to compare the differences between the learning needs of the 2 groups of women., Design: Descriptive cross-sectional survey design., Setting: One university hospital and 2 private Midwestern hospitals., Participants: Convenience sample of 100 women (50 mother/daughter pairs)., Main Outcome Measures: Postpartum teaching questionnaire-E, postpartum teaching questionnaire-F, and demographic questionnaire., Results: There were no group differences between adolescent mothers and their mothers on baby-care items, but there were group differences on 3 maternal-care items: emotional changes (p < .001), resumption of sexual activity (p < .001), and birth control (p = .009)., Conclusions: Nurses may need to use different teaching strategies for adolescent mothers and their mothers about resumption of sexual activity, but the teaching strategies necessary for other postpartum topics may be similar. Further research is needed to determine where those similarities may be and to determine the most effective teaching strategies for each group of mothers.

Objective: To determine the incidence of postpartum depressive symptomatology in a sample of immigrant Asian Indian women and to establish whether cultural factors such as arranged marriage or gender of the newborn are associated with differences in depression scores., Design: Quantitative, descriptive study., Setting: Ten private obstetric and pediatric offices in Northern California., Participants: A convenience sample of 58 self-selected immigrant Asian Indian women between 2 weeks and 12 months postpartum., Main Outcome Measure: Depressive symptomatology as measured by the 35-item self-report Postpartum Depression Screening Scale., Results: There was a minor depressive symptomatology rate of 28% and an additional major depressive symptomatology rate of 24%. No differences in depression scores were found with regard to arranged marriage or the gender of the newborn., Conclusions: Findings suggest that Asian Indian women living in the United States are just as likely to experience postpartum depressive symptomatology as White women. Therefore, it is critical to identify and refer women at risk for postpartum depression to ensure they do not become part of the 50% who remain undiagnosed. Health care providers need to become cognizant of the potential for postpartum depression and become skilled in the detection of this mood disorder.

Objective: To determine whether vulnerability factors (confidence with breastfeeding, postpartum depression, supplementation, and perceived adequacy of support) are associated with breastfeeding outcome at 6 weeks postpartum after controlling for age and education., Design: Secondary analysis of a cross-sectional telephone survey at 6 weeks postpartum., Setting: Ottawa-Carleton, Ontario, Canada., Participants: A proportionate, consecutive sample of breastfeeding women from each of four hospitals in the region (526/554, 95% response rate)., Methods: Stratified bivariate analyses were used to examine the relationship between each factor and breastfeeding outcome. Multivariate logistic regression analyses examined relationships between all factors and breastfeeding outcome., Results: In the logistic regression analyses, confidence with breastfeeding (odds ratio: 1.85, 95% confidence interval: 1.50-2.27, p < .001) and postpartum depression (odds ratio: 0.28, 95% confidence interval: 0.11-0.71, p= .007) were related to breastfeeding after controlling for age and education., Conclusions: Support for breastfeeding should include assessment of maternal confidence with breastfeeding and postpartum depression. Evaluation of intervention strategies to address these vulnerability factors is a priority.

Purpose: More than half of mothers with infants under 1 year are employed. This study explored the role of social support in facilitating women's return to employment during the 1st year postpartum., Design: Analysis of existing longitudinal, repeated-measures questionnaire data gathered at 4 and 12 months postpartum., Participants: 94 postpartum women who were married or partnered, employed, and residing in a large urban area in the northwestern United States., Outcome Measures: Satisfaction with decision to return to work, role performance, work-family balance., Results: Relationships between indicators of social support and return-to-work experiences were absent to modest. Satisfaction with child care was related to satisfaction with the decision to return to work. Workplace support was related to work-family balance at 12 months postpartum., Conclusions: Satisfactory child care arrangements and supportive relationships in the workplace are the most significant facilitators of women's return to work postpartum.

The National Institutes of Health Office of Minority Health challenges health providers to eliminate health disparities for Hispanic women, especially those women with limited English proficiency. This article addresses this challenge by identifying areas of health disparities for low-risk postpartum Hispanic women with limited English proficiency, by describing the legal basis for improving language access, and by proposing implementation of Office of Minority Health national guidelines. Health providers can use a social equity framework to support improvements in communication practices when language differs.

Objective: To describe the methodological differences of postpartum learning needs studies and organize them for comparison with similar studies., Data Sources: Computerized literature searches of CINAHL, MEDLINE, and Health Star databases., Study Selection: Reports published in English before 2003 and relevant to the keywords concerns, needs, interests, worries, priorities, postpartum, teaching, and learning., Data Extraction: Data were extracted and information organized according to subject parity, maternal self-care content, infant care content, length of data collection, and week of the postpartum period., Data Synthesis: Stitches, episiotomy, and postpartum complications were the most important maternal care learning needs during the first 3 postpartum days, and feeding and illness were the most important infant care learning needs during the first 7 postpartum days., Conclusions: More studies are needed to fill the postpartum learning needs research gaps, build on the findings of previous studies, and produce clinically useful information for practicing nurses.

Childhood sexual abuse has a lifelong impact on its survivors and may affect the childbearing experience in a variety of ways. Nurses caring for women during the perinatal period can benefit from understanding the phenomenon of child sexual abuse, its prevalence, and the sequelae experienced by childbearing women. Signs, symptoms, and correlates of prior sexual abuse manifested during the perinatal period are described, and nursing care responses are suggested. Nurses may be able to use this information to recognize survivors and facilitate both a positive childbirth experience and the healing process, by helping the survivor learn to trust, respect, and care for her body.

Objective: To synthesize the results of nine qualitative studies related to the transition to motherhood, using Noblit and Hare's method of meta-synthesis development., Data Sources: CINAHL, MEDLINE, PsycINFO, Sociological Abstracts, and Dissertation Abstracts, using the keywords transition, adaptation, motherhood, and mother., Study Selection: Studies were evaluated for inclusion related to study focus and comparability of findings. Nine studies were included in the final sample, four using a grounded theory methodology and five using either a phenomenologic or phenomenologic/hermeneutic method., Data Extraction: A series of overlapping, repeating steps as outlined by Noblit and Hare were followed in conducting this meta-synthesis. Detailed tables of metaphors, themes, concepts, and phrases from each study were constructed and studies were compared by means of reciprocal translations., Data Synthesis: Two processes inherent in maternal transition emerged: engagement and growth and transformation. In addition, five thematic categories signifying areas of disruption present in the maternal transition and 13 underlying themes were revealed., Conclusions: To facilitate maternal transition, nurses must remain sensitive to the maternal insecurity of primiparae and encourage their maximum maternal engagement, particularly during periods of forced mother-infant separation such as the newborn's admission to the intensive-care unit. In addition, prenatal discussion of realistic expectations for the transitional period, ongoing support through the first 6 months postpartum, and the use of role models should be integrated into postpartum support programs to assist mothers in negotiating typical areas of disruption during maternal transition.

Objective: To describe postpartum women's perceptions of the hospital environment and how it affects their postpartum experiences., Method: Descriptive study using content analysis of interview transcripts., Setting: Participants were interviewed in their homes within the first 3 postpartum weeks about their postpartum experiences., Participants: Thirty-one primiparous women who gave birth vaginally to full-term newborns. They were recruited from two large childbirth education programs in the Pacific Northwest., Results: The categories addressing the hospital environment were context, physical conditions, sociocultural conditions, contingencies, and consequences. Overall, these women had more negative perceptions than positive ones of the hospital environment. Women's perceptions seemed to be most influenced by the context of care. Women with mother/baby care had a greater proportion of positive perceptions than women with other care modalities., Conclusion: Nurses need to modify or change the hospital environment to promote more positive experiences for new mothers.

Objective: To describe how maternal-child staff nurses support breastfeeding mothers during the postpartum hospital stay and how these mothers perceive the support received from the nurses., Design: Ethnographic., Setting: Data were collected at a community hospital in southeastern Florida., Participants: Unstructured interviews were conducted with seven maternal-child nurses caring for breastfeeding mothers. The investigator observed 12 nurses' interactions with breastfeeding mothers and newborns. Eight breastfeeding mothers were interviewed, using a semistructured guide, in the hospital before discharge and at 2 and 6 weeks postpartum., Results: Nurses supported breastfeeding mothers by providing information and interpersonal support. Breastfeeding mothers expected the nurses to support their feeding efforts by providing information, encouragement, and interpersonal support., Conclusion: Health care providers can help breastfeeding mothers, but the support offered must be the kind that mothers want.