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Aims: To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth., Background: Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems., Design: A mixed method concept mapping study., Method: Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth., Results: Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems., Conclusion: Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support., Impact: Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed., (© 2019 John Wiley & Sons Ltd.)

Aims and Objectives: To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment., Background: Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making., Design: A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment., Methods: This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment., Results: The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information., Conclusion: The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care., Relevance to Clinical Practice: Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To describe Chinese women's experiences with "zuo yue zi" in British Columbia, Canada., Background: Women born in China and Taiwan are increasingly immigrating to westernised countries. Many women choose to follow traditional Chinese postpartum practices, also called "zuo yue zi." Few studies have examined women's use of traditional practices in western countries., Design: The study used a qualitative descriptive design., Methods: We recruited 13 mothers who were: aged 19 or older, immigrants from mainland China, Hong Kong or Taiwan in the last 5 years, and caring for infants born in the previous 6 weeks. Semistructured interviews were conducted in Mandarin, translated into English, transcribed and analysed using inductive content analysis., Results: The core theme was Chinese women's novel encounters with "zuo yue zi." The women's expectations of "zuo yue zi" were acquired through birth experiences or interactions with family and friends. The participants struggled with implementing traditional practices because social support and formal institutional structures were lacking. They modified their expectations about "zuo yue zi." Factors affecting their practices were catalysts and deterrents. Catalysts included help from Chinese family members, friends and informed healthcare providers. Deterrents included unregulated paid helpers, uninformed care providers, financial constraints and structural limitations in their new environments., Conclusions: Chinese immigrant women struggled to modify and implement traditional practices in their adopted country when they encountered financial constraints, unregulated paid helpers and varying support from health care providers., Relevance to Clinical Practice: Some postpartum women following "zuo yue zi" believed that the practice would prevent chronic illness and strengthen their intrafamily relationships. Immigrant mothers require nursing support to follow traditional postpartum practices. Nurses can advocate on patients' behalf to increase care providers' knowledge about "zuo yue zi" and public awareness for necessary regulated institutional structures., (© 2017 John Wiley & Sons Ltd.)

Aim and Objectives: To examine what it means to be a mother of a late preterm infant including a mother's level of confidence in caring for her late preterm infant over time and the effect of maternal depression of this experience., Background: Little is known about mothers' experiences of caring for their late preterm infants in the community, including their level of confidence and parenting stress within the context of a supported care environment by public health nurses., Design: A mixed methods study, sequential explanatory quantitative and qualitative study., Methods: A convenience sample of mothers with LPIs (n = 71) completed questionnaires on maternal confidence (3-4 weeks and 6-8 weeks), parenting stress (6-8 weeks), social support (6-8 weeks) and postpartum depression (6-8 weeks). A purposive sample of mothers (n = 11) underwent in-depth, semi-structured interviews., Results: Maternal confidence decreased from 3-4 weeks-6-8 weeks after delivery, and similar results were found for mothers who reported depressive symptoms. Narratives of the mothers suggested the decrease in maternal confidence over time was influenced by the demanding characteristics of the late preterm infant, the prospect of their rehospitalisation and the mother's reported interactions with public health nurses. Depression had an effect on maternal confidence; that is, the depressed mothers demonstrated less confidence about their caretaking role than the nondepressed mothers at 6-8 weeks. Mothers did not discuss mental health issues, which may reflect the protective effects of social support on emotional instability or an inability to recognise postpartum depression., Conclusion: The confidence of mothers with LPIs decreased over the first 2 months following delivery and being home with their infants. Assisting mothers to meet their personal needs and the needs of their infant should promote maternal skills, which will likely increase maternal confidence related to the care of their late preterm infant., Relevance for Clinical Practice: Characteristics of LPIs contributed more to parenting stress score than parent characteristics; mothers however attempted to normalise the late preterm infant in order to minimise the parenting stress. Evidence-informed brief interventions tailored based on late preterm infant and parent characteristics may improve maternal confidence over time. Healthcare professional should provide education and anticipatory guidance prior to discharge, consistent care in hospital and postdischarge as this may impact maternal level of confidence. Future research needs to examine standards of care for discharge of LPIs and adherence to these standards., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To understand how nurses view and experience caring for pregnant and postpartum women in nonmaternity care settings., Background: A degree of apprehension is perceived to exist among nurses in relation to caring for pregnant or postpartum women in nonmaternity care settings. The nature of nonmidwife nurses' concerns about caring for this group of women in these contexts, however, is not known., Design: A six-step systematic approach was employed for this review., Methods: In Step 1, the research question was developed; Step 2 involved developing the inclusion criteria for articles; the literature search strategy was devised in Step 3; Step 4 comprised the conduct of the literature search and selection of articles for review; in Step 5, the critical appraisal of selected studies and synthesis of data was undertaken; interpretation of the findings occurred in Step 6., Results: Following a process of elimination, the final number of articles retained for this review was three. Fifty-four Level 1 findings were extracted from these three articles which were subsequently collapsed into four Level 2 categories. Two Level 3 synthesised findings that characterise what is known about the topic of interest were then derived from these four Level two categories., Conclusions: Nurses are reportedly ill prepared for the experience of caring for pregnant and postpartum women in general care settings. A combination of a lack of education and a need to 'learn on the job' reportedly evokes stress, trauma and a sense of professional inadequacy., Relevance to Clinical Practice: This review identifies lack of knowledge and of adequate supervision for nurses in this context, which in turn poses a clinical risk to pregnant and postpartum women in their care. Effective strategies to establish initial and ongoing collaborative education and clinical practice guidelines are required., (© 2016 John Wiley & Sons Ltd.)

Aims: To examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period., Background: Difficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of 'breastfeeding difficulty' is wide and includes biological, psychological and social factors., Design: A cross-sectional self-report survey., Methods: Data were collected between December 2012 and February 2013. 217 women with an infant aged 0-6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale., Results: A short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score., Conclusions: Understanding women's specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding women's breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch., (© 2015 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: HIV-positive pregnant women are at heightened risk of becoming lost to follow-up (LTFU) from HIV care. We examined LTFU before and after delivery among pregnant women newly diagnosed with HIV., Methods: Observational cohort study of all pregnant women ≥18 years (N = 300) testing HIV positive for the first time at their first ANC visit between January and June 2010, at a primary healthcare clinic in Johannesburg, South Africa. Women (n = 27) whose delivery date could not be determined were excluded., Results: Median (IQR) gestation at HIV testing was 26 weeks (21-30). Ninety-eight per cent received AZT prophylaxis, usually started at the first ANC visit. Of 139 (51.3%) patients who were ART eligible, 66.9% (95% CI 58.8-74.3%) initiated ART prior to delivery; median (IQR) ART duration pre-delivery was 9.5 weeks (5.1-14.2). Among ART-eligible patients, 40.5% (32.3-49.0%) were cumulatively retained through 6 months on ART. Of those ART-ineligible patients at HIV testing, only 22.6% (95% CI 15.9-30.6%) completed CD4 staging and returned for a repeat CD4 test after delivery. LTFU (≥1 month late for last scheduled visit) before delivery was 20.5% (95% CI 16.0-25.6%) and, among those still in care, 47.9% (95% CI 41.2-54.6%) within 6 months after delivery. Overall, 57.5% (95% CI 51.6-63.3%) were lost between HIV testing and 6 months post-delivery., Conclusions: Our findings highlight the challenge of continuity of care among HIV-positive pregnant women attending antenatal services, particularly those ineligible for ART., (© 2013 Blackwell Publishing Ltd.)

Objectives: To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care (ANC) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania., Methods: Cluster randomised trial in Ngorongoro district, Arusha region, involving 16 health units (8 per arm). Nine hundred and five pregnant women at 24 weeks of gestation and above (404 in the intervention arm) were recruited and followed up to at least 1 month postpartum., Results: Skilled delivery care uptake was 16.8% higher in the intervention units than in the control [95% CI 2.6-31.0; P = 0.02]. Postnatal care utilisation in the first month of delivery was higher (difference in proportions: 30.0% [95% CI 1.3-47.7; P < 0.01]) and also initiated earlier (mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days, P < 0.01) in the intervention than in the control arm. Women's and providers' reports of care satisfaction (received or provided) did not differ greatly between the two arms of the study (difference in proportion: 12.1% [95% CI -6.3-30.5] P = 0.17 and 6.9% [95% CI -3.2-17.1] P = 0.15, respectively)., Conclusion: Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women's and providers' satisfaction with available ANC services. Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services., (© 2013 Blackwell Publishing Ltd.)

Aim: This paper is a report of a descriptive study of mothers' experiences in caring for preterm or term infants following discharge from a neonatal unit, including how they manage infant pain/discomfort., Background: Few studies have focused on the transition that parents experience after infants are discharged home and little is known about parents' caregiving experiences when their infant has pain/discomfort. Greater knowledge about these issues will help healthcare professionals to better support parents., Method: Nine mothers were interviewed in 2007-2008 about their caregiving experiences in the months following neonatal unit discharge. Interviews were conducted using a descriptive phenomenological approach and analysed using Giorgi's framework., Findings: Six themes formed mothers' experiences: apprehension, confidence, responsibility, awareness, normalcy and perspective. Mothers had apprehension about their infants' fragile health, losing support of the neonatal team, and performing medical procedures. They developed confidence as infant health improved. Responsibility for performing infant medical care often dominated mothers' experiences. Awareness of infant needs was described as a learning process utilizing external resources, trial-and-error, and an internal intuitive sense; particularly in identifying and dealing with infant pain/discomfort. During the transition to prior social environments, concerns about normalcy arose. Over time, mothers' gained a philosophical perspective and saw their experiences in a positive light., Conclusion: The apprehension-confidence continuum model provides a framework for nursing assessment of mothers' needs following their infants' discharge from a neonatal unit. Factors such as infant health, medical procedures, and family or health professional support may influence the degree of apprehension or confidence., (© 2011 Blackwell Publishing Ltd.)

Aim: This paper is a report of a study of factors which influence mothers' sense of security during the first postnatal week., Background: Mothers' sense of security the first postnatal week is not thoroughly elucidated in the literature., Methods: An interview study with a qualitative descriptive design was carried out, using thematic content analysis. Fourteen mothers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews between May 2008 and March 2009., Findings: Postnatal sense of security was dependent on support from staff, support from family and the capacity and health of the woman and the baby, and these themes had categories and sub-categories, including: Being met as an individual, being given relevant information, being prepared for the time after birth and having someone to turn to--knowing who to ask, having partner and/or significant others close at hand, mother's and the baby's own resources, being assured that her own physical health was good, and having planned follow-up regarding the baby's health after discharge., Conclusion: Staff attitudes should be continually discussed at all units providing maternity care. These discussions should include attitudes towards the father and the significance of his presence for the wellbeing of the family. Continued postbasic staff education in, for example, counselling and communication is necessary if services are to be improved so that parents' individual needs can be met. Preparation for the early postpartum period is important and all information given must be consistent, in particular information about breastfeeding., (© 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.)

Aim: This paper is a report of a study designed to test an explanatory theory of postpartum fatigue., Background: Postpartum fatigue is influenced by various factors and affects a mother's performance. A full understanding of postpartum fatigue is very important for developing effective nursing strategies to reduce postpartum fatigue and enhance mothers' performance., Methods: Healthy postpartum women were recruited from five medical centers and one midwifery office in urban area in Korea (n = 291) by convenience sampling. Data were collected at 4- to 8-week follow-up visits after childbirth in 2006, using a self-report questionnaire. The proposed fatigue theory incorporated postpartum fatigue, postpartum depression, sleep quality, childcare stress, unsatisfactory feeding, social support, infant difficulty and satisfaction with Sanhujori, the Korean traditional postpartum care provided for 3 weeks following delivery by non-professional caregivers. Structural equation modelling was used to test the explanatory theory of postpartum fatigue., Results: The modified fatigue theory showed good fit and high compatibility with the empirical data. In the final explanatory theory, postpartum depression and sleep quality directly affected postpartum fatigue, while childcare stress and the cultural phenomenon of Sanhujori had indirect effects on postpartum fatigue, via postpartum depression and sleep quality respectively., Conclusion: These findings suggest the potential role of comprehensive nursing focused on decreasing postpartum depression and improving sleep quality as a way to decrease postpartum fatigue. Also, nursing strategies for decreasing childcare stress and enhancing Sanhujori satisfaction may be helpful in reducing postpartum fatigue in Korean mothers., (© 2010 Blackwell Publishing Ltd.)

Objective: This study investigated changes in public health nurse practices and the incidence of abuse inquiry and disclosure., Design and Sample: A retrospective record review of cross-sectional data was collected before and after implementation of the Routine Universal Comprehensive Screening (RUCS) protocol within a maternal child home visiting program. Records of postpartum women receiving a universal home visit within 48 hr of discharge from the hospital were reviewed (pre-RUCS, n=459; post-RUCS, n=485). Also reviewed were the records of women receiving a family assessment for at risk home visiting (pre-RUCS, n=79; post-RUCS, n=66)., Measures: The variables collected consisted of abuse inquiry, abuse disclosure, and the alone status., Results: Documentation of women's alone status significantly improved for both types of home visits: the 48-hr home visits ( p<.001) and the at risk home visits ( p<.01). Disclosures of abuse significantly increased in both types of home visits ( p<.01). Ensuring privacy by not asking abuse questions if women were not alone during a visit significantly improved ( p<.001)., Conclusions: Implementing a protocol to screen for woman abuse into an existing maternal child home visiting program demonstrated improved practices related to the safety and privacy of women, and an increase in abuse disclosures.

Developing focused and relevant health promotion interventions is critical for behavioral change in a low-resource or special population. Evidence-based interventions, however, may not match the specific population or health concern of interest. This article describes the Multisource Method (MSM), which, in combination with a workshop format, may be used by health professionals and researchers in health promotion program development. The MSM draws on positive deviance practices and processes, focus groups, community advisors, behavioral change theory, and evidence-based strategies. Use of the MSM is illustrated in the development of ethnic-specific weight loss interventions for low-income postpartum women. The MSM may be useful in designing future health programs designed for other special populations for whom existing interventions are unavailable or lack relevance.

Background: Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary., Methods: A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual - Third Edition - Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support., Results: Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months., Conclusions: It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.

Aims: To explore nurses' attitudes towards perinatal bereavement care and to identify factors associated with these attitudes., Background: It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period., Design: Survey., Method: Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care., Results: The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21.6% (n = 141) of the nurses surveyed had bereavement-related training. In contrast, about 89.8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses' perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses' attitudes to perinatal bereavement care., Conclusions: Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care., Relevance to Clinical Practice: These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.

Background: Most research on maternal concerns has focused on their assessment during pregnancy and the early post-partum period. The aim of this study was to identify primary concerns of mothers later in the first post-partum year, changes over time, and factors that were associated with relatively intense concerns, including infant (difficult) temperament, hours employed out of the home and obstetrical complications during pregnancy or childbirth., Method: Data were obtained from 366 first-time (Israeli) mothers at 3 and 6 months post-partum by employing a new tool, the Mothers' Concern Questionnaire, along with standardized questionnaires, administered by phone., Results: Analyses revealed six dimensions of concerns (Family Health, Return to Work, Mother's Well-being, Relationships/Support, Infant Care, and Spouse). Of these, issues related to returning to work and family health were of most concern, and ratings were higher at 3 months than at 6 months post-partum. Women with higher-than-average total concern scores perceived their infant as more difficult, were more likely to have experienced an obstetric complication, and worked more hours out of the house than women with lower-than-average scores., Conclusions: The findings afford a first look at the profile of normative maternal concerns outside of the immediate post-partum period and identify factors that predict more intense concerns. These findings extend what we know about the issues of new mothers and can guide birth educators and help couples prepare themselves for parenthood.

Aim: This paper reports on a study to examine the effects of a theory-based interactive postpartum sexual health education programme on postpartum women's sexual health knowledge, attitudes towards sexual health, contraceptive self-efficacy and sexual self-efficacy., Background: Childbearing can challenge marital satisfaction and the sexual life of women, making the childbearing years a vulnerable stage in the sexual life of a woman. Although sexual education used to be a routine aspect of local postpartum teaching, this teaching was inadequate to satisfy women's informational needs related to sexual health., Methods: For this two-group, randomized controlled trial, 166 participants were recruited at a medical centre in northern Taiwan. The experimental group (n = 84) received the intervention. The control group (n = 82) received routine postpartum teaching. Participants in the experimental group were separated according to their learning preparedness, as determined by the transtheoretical model. Their level of preparedness was then matched to different sexual health education strategies used in the intervention. Data were collected in 2003 at baseline and at 3 days and 8 weeks following the intervention. Descriptive and repeated-measures anova were used to analyse data., Results: Sexual health knowledge, attitudes and sexual self-efficacy were significantly greater for women in the experimental group at 3 days and 8 weeks after the intervention programme than for those in the control group. However, contraceptive self-efficacy was not significantly different in the two groups., Conclusion: The longer-term effectiveness of our theory-based interactive postpartum sexual health education programme will be enhanced by matching teaching strategies to participants' stage of learning preparedness.

Background: To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period., Aim: To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan., Methods: This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale., Results: The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model., Conclusions: This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles., Relevance to Clinical Practice: This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.

Objective: Seeking care from a basic or comprehensive facility in response to obstetric complications is a key behaviour promoted in safe motherhood programmes. This study examined definitions of care seeking for maternal health complications used by families in rural Bangladesh, and the frequency and determinants of locally-defined care seeking practices., Methods: We conducted 24 semi-structured qualitative interviews with women who had recently given birth to characterize care seeking behaviours in response to perceived complications. Based on these findings, a quantitative household questionnaire was developed and administered to 1490 women, half of whom reported a 'serious or very serious' complication during their last pregnancy and/or delivery (n=769; 52%), and were included in the quantitative analysis., Results: Informants described three care seeking patterns in qualitative interviews: (i) sending a family member to purchase treatment to administer in the home; (ii) sending for a provider to treat the woman in the home and (iii) taking the woman outside the home to a facility or provider's office. The quantitative survey revealed that most women sought care for 'serious' complications (86%), with 42% seeking multiple sources of care. The majority of women purchased a treatment to administer at home (68%), while 20% brought a provider to the home. Thirty per cent of women were taken to a provider or facility., Conclusions: Families generally seek care for complications, but care seeking does not correspond to definitions used by maternal health programmes. Local definitions of care seeking must be considered in intervention design so that promotion of care seeking increases for facility-based care for life-threatening emergencies rather than unintentionally increasing the use of home-based treatments of little medical value for prevention of mortality.

Objective: Explore the feasibility, usefulness, and outcomes of a pilot program to support mothers in developing competencies for managing health problems of their very low birth-weight (VLBW) infants in partnership with the primary care clinician (PCC)., Design: In a randomized study, mothers who received guided participation (GP) and printed guidelines for managing VLBW infant health problems were compared with mothers who received only the guidelines and standard care (GL group)., Sample: All mothers (GP = 20; GL = 11) were at least 18 years old and English speaking. Infants were all VLBW (< or =1,500 g)., Intervention: GP began during the infant's neonatal intensive care unit stay and continued with public health nurses (PHNs) and a family service clinician through the infant's first 4 postterm months., Measurements: Intervention feasibility and usefulness were assessed with maternal and clinician feedback. Outcomes included maternal and clinician appraisal of mothers' use of clinical resources and mothers' perceptions of primary-care quality and the family-PCC relationship., Results: Intervention feasibility and usefulness were supported. GP and GL groups did not differ significantly on outcomes., Conclusions: Findings indicate a longer intervention period, GP organized by infant problem episodes, and enhancement of the PHN role in the context of interdisciplinary and interagency collaboration.

Aim: The aim of the study was to investigate the effectiveness of informational support in reducing the Edinburgh Postnatal Depression Scale (EPDS) scores in Taiwan., Methods: Five hundred Taiwanese women were screened during the fourth week after giving birth and those with a score of over 10 on the EPDS were considered to be at risk of postnatal depression. Seventy postpartum women were randomly allocated to the experimental or control group. Only those in the experimental group received informational support about postnatal depression during the sixth week postpartum. Two groups were assessed by the EPDS at 3 months postpartum to explore their depressive status., Results: Taiwanese women who received informational support about postnatal depression 6 weeks after giving birth experienced lower EPDS scores at 3 months postpartum than those who did not receive this information., Conclusions: The findings suggest that informational support about postnatal depression given to women in the postnatal period may contribute to psychological well-being.

Background: Culture is often related to notions of well-being, illness, healing and health that inform individuals in their day-to-day activities. The postpartum period is noted for traditional practices related to rest, healing and the consumption of food and drinks, but a contemporary view of these practices is needed., Aims: To gain an understanding of the traditional practices that Thai women follow in relation to postpartum care and the rationales underpinning such practices., Methods: This descriptive study surveyed 500 Thai women living in Ubon Ratchathani, Thailand and attending their first postpartum hospital clinic appointment. A self-completion questionnaire was specially developed and pilot tested, and then administered to women attending the clinic., Data Analysis: Descriptive statistics were used in relation to the incidence of particular behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional practices., Results: The majority of Thai women adhered to traditional postpartum practices related to the notion of regaining 'heat'. These included 'lying by fire', food restrictions, taking hot baths and consuming hot drinks. Other activities involved not exposing the body to heat loss by keeping covered, not shampooing the hair, avoiding the wind and sexual abstinence. Younger, less educated, primiparous women were more likely to report traditional practices. Mothers and mothers-in-law were most influential in recommending these behaviours., Conclusions: Traditional postpartum practices are still dominant in contemporary Thai culture and are perpetuated by close female family relatives. Health professionals need to be aware of clients' culture and consider the extent to which professional care complements the mothers' traditional beliefs. Nurses need to educate women about the benefits of contemporary postpartum care and to provide strategies to help them to integrate their beliefs and the practices recommended in contemporary health care practice.

Aim: Maintaining privacy on post-natal wards: a study in five European countries Aim. To describe how mothers' privacy is maintained on post-natal wards in five European countries: Finland, Spain, Greece, Germany and Scotland [United Kingdom (UK)], Background: Privacy is an important concept in nursing and nursing ethics. Empirical studies in this field, however, are few. In this study, privacy is defined as comprising both physical and social-informational dimensions and both the perceptions of mothers and professional were investigated., Methods: The data were collected by a questionnaire from mothers (n=1192) and midwife/nursing staff (n=952)., Results: The results revealed differences both between the different countries and between patients' and professionals' views. Mothers in Finland, Germany and Scotland felt their privacy was maintained better than mothers in Greece and Spain. The differences in staff perceptions are less clear-cut. Different background factors emerge as statistically significant in different countries., Conclusion: Empirical studies in privacy are important and give ideas about the problems in nursing practice. Future analyses should look also at other areas of nursing.

Background: Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period., Aim: The purpose of this study was to determine postpartum women's health status in the wider social context of the Taiwanese family after women return home from the hospital or clinic., Method: A longitudinal study was conducted with data collected at the first, the third, and the fifth weeks of the postpartum period. Five hundred and twenty-six postpartum women were included in the study using stratified sampling from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress Scale (HPSS), Smilkstein's Social Support Scale, and the Chinese Health Questionnaire were used to obtain information about the women's postpartum stress, social support, and health status at each time point. Data were analysed with factor analysis, repeated measures MANOVA, and multiple logistic regression., Results: Three factors associated with postpartum stress were identified by factor analysis: (1) maternity role attainment, (2) lack of social support, and (3) body changes. Furthermore, the level of postpartum stress at the third and the fifth postnatal weeks was higher than at the first. Social support scores at this postnatal week were the highest among the three points in time. In addition, 29%, 41% and 41% of the women at the first, third, and fifth weeks, respectively, had minor psychiatric morbidity., Conclusions: Because the postpartum women's self-reported stress is relatively low whereas the social support is relatively high, especially from the family, this confirms Pillsbury's conclusion regarding the significance of social support during the Chinese women's postpartum period. The study also showed that the three factors associated with postpartum stress were important predictors of postpartum women's health status. Future studies should compare the level of postpartum stress, social support, and women's health status in both Western and Eastern cultures.

Aim: The aim of the study was to compare the factors which are associated with postnatal depression in the UK (United Kingdom) and Taiwan., Background/rationale: A comparative study of postnatal women in the UK and Taiwan was undertaken to investigate postnatal care and the prevalence of postnatal depression., Design/methods: The Edinburgh Postnatal Depression Scale (EPDS) was used to determine the prevalence of postnatal depression. A semistructured interview and validated questionnaire were used to collect data on maternal satisfaction with postnatal care and the factors associated with postnatal depression. A one in three random sample of women from two community midwife teams in Sheffield, UK and three public health stations in Keelung, Taiwan took part in the study., Results/findings: Fifty (94% response rate) women from Sheffield and 101 (83% response rate) women from Keelung, who were at low risk for maternal or foetal problems during labour and the postnatal period, agreed to participate. The prevalence of postnatal depression in the British and Taiwanese women was almost equal; 18% in the UK and 19% in Taiwan. In Taiwan, the prevalence of postnatal depression had a negative association with relationship with partner (Spearman correlation=-0.34, P < 0.001) and self-confidence (Spearman correlation=-0.28, P < 0.01, Spearman correlation). In addition Taiwanese women who felt more anxious after birth (10.9 +/- 7.9, P < 0.001, t-test) had a higher chance of postnatal depression. In the UK, there was a significant negative association between adaptation to the new role of motherhood and score on the EPDS (Spearman correlation=-0.47, P < 0.001). The overall scores for maternal satisfaction were 28.1 and 24.3 in the UK and Taiwan, respectively (P < 0.001, t-test). British women reported a better quality of care during the postnatal period in terms of emotional support and physical care., Conclusions: The findings of this study suggest that further cross cultural investigation could shed light on the relative balance of biological and cultural factors which may be associated with the onset of postnatal depression. As the prevalence of postnatal depression is similar in both cultures despite large differences in culture and postnatal care systems, some support is given to a hypothesis that postnatal depression has at least some biological determinants as well as cultural/social ones.

The nurse's view of the first meeting with parents of new-born children ma have consequences for the quality of future contact. A good start will lay a soli foundation for a lasting relationship, and have an affect on the nurse's work to support parents and children and to promote health. We do not know wha nurses mean by a 'good meeting'. The aim of this study was to discover how nurses view the first meeting as a general preventive measure aimed at all parents and their new-born children. Four focus groups interviews were held with nurses from different primary health care areas in the county of Skåne, southernmost Sweden. Analysis of the content in the transcribed interview texts disclosed eight subcategories: good contact/reciprocal relationship; willingness to listen; guest/ equal roles; time/peace and quiet; the family in its environment; socio-cultural aspects; confirmation/support; and individual advice. Three categories were established: creating trust; creating a supportive climate; and creating a picture of the family's life situation. The home visit was seen as an important way to establish trust and obtain a picture of the family's life situation, which was in turn essential for creating a supportive climate.

The aim of the study reported in this paper was to examine the effect of postnatal stay on breast-feeding rates at one month using a randomized control trial. Participants were recruited during parent-craft classes at a large teaching hospital in the north of England. Nulliparous women in the last trimester of pregnancy were randomly allocated to a short hospital postnatal stay (6-48 hours), or a longer stay (more than 48 hours). The mothers were contacted at one month following the birth to ask about the method of feeding. The study was approved by the hospital ethical committee, and participation was voluntary. The results demonstrated no significant effect of postnatal stay on breast-feeding rates at one month. The main limitation of the study was the reluctance of the mothers in the long stay group to stay in hospital for longer than three days. This resulted in only a small difference between the lengths of hospital stay of the two interventions. The overall breast-feeding rate for the study group had increased significantly when compared with local city wide rates. This increase may be as a result of a sampling bias or a Hawthorne effect.

In 1993 Lowe developed the Childbirth Self-Efficacy Inventory (CBSEI). This is a self-administered, 62-item, Likert tool which measures women's confidence in their ability to cope with labour. The tool is valid and reliable for use in American culture but had not been tested in Northern Ireland, therefore a replication study was deemed necessary. The research study set out to replicate Lowe's study and to test the potential application of this tool in clinical midwifery practice. A convenience sample comprising a cohort of 126 women attending an urban maternity unit in Northern Ireland formed the study population and a response rate of 64% was achieved. The tool was administered antenatally, intranatally and postnatally. The predictive validity of the instrument was tested to determine actual coping behaviours in labour (Pearson's r=0.3963, P < 0.00 for active labour; r=0.5149, P < 0.00 for second stage labour). This work confirms the CBSEI as a measurement of confidence in women's ability to cope in labour. The authors recommend the utility of the CBSEI in midwifery practice as a tool for the identification of women who will require extra support in labour and pregnancy.

The aim of this study is to explore and describe the new mother's experiences of postpartum care. It is part of an ongoing clinical longitudinal research project studying experiences of health, suffering and care and the organizational culture of Finnish maternity care. Postpartum care is seldom either technological or dramatic and has been shown to take low priority in both practice and research. This article uses the theoretical perspective of Eriksson as a basis for discussing insights gained from the phenomenological study. Nine women were interviewed at the end of their pregnancy, and 3 weeks, 3 months and 21/2 years after giving birth. The research approach was that of Colaizzi, which has its roots in phenomenological philosophy, and which attempts to present accurately the lived experiences of those studied. Data suggest that the transitional process from being an expectant mother to being a new mother occurs slowly but intensely in a unique way during the first days after the baby is born. The new mother experiences caring communion in sharing her life situation with the midwife, learning directly through the midwife's teaching and indirectly when the midwife enables her to be in peace and quiet together with her baby and family. Other new mothers are caring towards the woman reciprocally, sharing the same situation, helping one another and learning together. Three challenges in postpartum care emerge from this study. These are to understand the meaning of caring, to involve family and other new mothers more consciously, and to see the woman as a new mother who needs both to care and be cared for both by her family and friends and by professional carers.

The purpose of this study was to understand women's experiences in an early discharge programme. Using grounded theory, the investigator collected, coded, compared and contrasted data gathered in unstructured interviews with eight women. The women managed their early discharge experience, first, by taking control of their antenatal and intrapartal care once they were accepted into the programme and, later, by taking control of their postpartum recovery and their infants' care. Taking control was influenced by the women's beliefs about family and home; their personalities, e.g. their ability to accept help; and their available support. Their beliefs, personalities and available support were central to their motivation to participate in the early discharge programme and to their perception of a successful experience. The women used a number of strategies to take control. These strategies emerged during organizing antepartal requirements, meeting their own expectations during labour and birth, and learning to trust their abilities to manage self-care and parenting postpartum. The women anticipated their increased family involvement, family integration and participation in decision-making. They did not, however, anticipate their increased feelings of confidence and competence. Taking control has implications for health professionals who are working with childbearing women experiencing early discharge.

The frequency and pattern of clinic use by a sample of 60 working class families is described. An attempt is made to explain attendance and non-attendance in terms of the mothers' perceptions of the clinic's functions and relevance and in terms of certain social and organizational barriers. The implications of the findings for clinic use and for the organization and delivery of the service to working class families are discussed.

A sample of 15 women was interviewed 18-96 h postnatally to identify objective features of labour and postnatal care about which they expressed preferences. The importance of each item to a mother's satisfaction was then rated by a sample of 224 similar women. The same questionnaire was also completed by 28 midwives and 52 obstetricians. The items rated most important concerned the explanation of procedures and the involvement of mothers in administering or choosing them. Second was support from the presence of a partner and qualified hospital staff, third the physical comfort of the postnatal ward. The avoidance of obstetric interventions, such as episiotomy or use of forceps, was less important than the presence of these other features. The mean ranking given to each item by the midwives and obstetricians correlated very highly with that given by the mothers; those caring for obstetric patients are much more sensitive to their preferences than is popularly believed. There was no evidence that midwives perceived patients' needs more accurately than did the obstetricians. Discrepancies between the three groups' ranking of specific items may reflect the defence of their respective roles by each profession.