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For new families giving birth in a hospital setting, the COVID-19 pandemic has presented numerous challenges to their birth, breastfeeding, and postpartum experiences. We present experiences of three first-time, healthy mothers and their babies, as they gave birth in the hospital and were breastfeeding during the start of the pandemic in Philadelphia, PA. Each case is framed in the mother's prenatal goals, infant feeding intentions, birth, breastfeeding, and postpartum experiences. Shared concerns and experiences among the three participants are described in five key areas: 1) Recommendations changing every day, 2) Guilt, concern, and stress, 3) In-person versus telehealth visits, 4) Missing time with family and friends, and 5) Silver linings. Through these mothers' experiences, nurses and other health care providers can learn from their perceptions and events and proactively work to ensure we provide sound anticipatory guidance, enhance our communication, and improve provision of evidence-based lactation care and support.

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

Objective: To describe the utilization and quality assessment of a population-based program to help health care providers address mental health and substance use disorders among pregnant and postpartum women, the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms)., Methods: The Massachusetts Child Psychiatry Access Program for Moms builds health care providers' capacity to address perinatal mental health and substance use disorders through 1) trainings and toolkits, 2) telephonic access to perinatal psychiatric consultation, and 3) facilitating referral to community resources. Clinical encounter data were collected during telephone consultations. Focus groups were conducted with health care providers and staff from enrolled practices. In-depth interviews were conducted with patients served by the practices that participated in the focus groups. Transcribed interviews were analyzed by two researchers using an iterative, interpretive process with a grounded theory framework., Results: In the first 3.5 years, MCPAP for Moms enrolled 145 obstetric practices, conducted 145 trainings for 1,174 health care providers, and served 3,699 women. Of telephone consultations provided, 42% were with obstetric care providers-midwives and 16% with psychiatrists. Health care providers perceived that MCPAP for Moms facilitates health care providers detecting and addressing depression and women disclosing symptoms, seeking help, and initiating treatment. Obstetric practices reported that they need additional support to more proactively address and further improve depression care., Conclusion: The high volume of encounters, sustained utilization over 3.5 years, and qualitative themes identified from health care providers and patients demonstrate that MCPAP for Moms is a feasible, acceptable, and sustainable approach to increasing access to evidence-based treatments for perinatal mental health and substance use disorders on a population-based level.

Separation of mothers and infants after birth is standard practice for many hospitals, yet not evidence-based. Nonseparation clearly has numerous benefits. However, newborns lack a voice to make choices to direct their course of care. The evidence supports nonseparation strategies for mothers and infants that promote attachment, physiologic regulation, nutrition, sleep, communication, and management of stress/pain. Moreover, the evidence is compelling that nonseparation is essential. The time has come to act on the evidence and begin seeing the care we provide through the newborn's eyes.

Background: Negative experiences in the health care system, including perceived discrimination, can result in patient disengagement from health care. Four million US women give birth each year, and the perinatal period is a time of sustained interaction with the health care system, but potential consequences of negative experiences have not been examined in this context. We assessed whether perceived discrimination during the birth hospitalization were associated with postpartum follow-up care., Methods: Data were from the Listening to Mothers III survey, a nationally drawn sample of 2400 women with singleton births in US hospitals in 2011-2012. We used multivariate logistic regression to estimate adjusted odds of having a postpartum visit in the 8 weeks following birth by perceptions of discrimination due to (1) race/ethnicity; (2) insurance type; and (3) a difference of opinion with a provider about care., Results: Women who experienced any of the 3 types of perceived discrimination had more than twice the odds of postpartum visit nonattendance (adjusted odds ratio=2.28, P=0.001), after adjusting for socioeconomic and medical characteristics., Conclusions: The postpartum visit is an opportunity for a patient and clinician to address continuing health problems following birth, discuss contraception, and screen for chronic disease. Forgoing this care may have negative health effects. The findings from this study underscore the need to reduce discrimination and improve maternity care experiences.

Many women who quit smoking after learning they are pregnant revert back to smoking after birth of their baby. The high rate of recidivism suggests that women need education about risk of relapse and effective strategies to remain smoke free even before they are discharged from the hospital. Despite evidence that smoking cessation and relapse prevention counseling is effective during early postpartum, many nurses do not provide their patients with this important information, perhaps because they feel inadequately prepared to do so. Helping Women Stop Smoking in Pregnancy and Beyond is an education program designed to help perinatal nurses inform women of negative risks of smoking and offer women strategies to avoid the high probability of resuming smoking after birth. It includes evidence-based interventions that can be used by nurses to provide effective smoking relapse prevention counseling to women during postpartum.

Research examining needs of postpartum transgender men in relation to lactation and infant feeding is missing from nursing literature. Accordingly, little is known about how perinatal nurses can best support this unique subset of postpartum patients. Case studies presented here reveal that transgender men would appreciate care from nurses who are knowledgeable about transgender individuals and their healthcare needs, but this type of care is not always available. Nurses need more education about how to best support transgender patients and families in order to achieve optimal lactation and infant nutrition in this population.

Most pregnancies are a time of joy and anticipation, but unfortunately there are families who instead suffer one of life's most difficult events: a perinatal loss. Although grief processes have some common aspects, grief over a child can be especially intense, and those grieving such a loss have unique needs. One of the things that nurses can do to assist families in these situations is to assist them by creating memories of their child to help ease perinatal grief. This article describes the Precious Prints Project, a perinatal memory-making program designed to comfort families grieving the loss of a child. We discuss the development and implementation of this project, explore the literature, and show the strategies used to address the challenges encountered.

Objective: To explore the perinatal experiences of African American women in Florida for obtaining information about breastfeeding and also their breastfeeding experiences., Methods: This qualitative study utilized convenience sampling of 253 African American women 18 to 35 years old in three Florida counties. Data were derived from the Healthy Futures Perinatal Research and System Design study. One month after giving birth, face-to face interviews were conducted using an interview schedule. Questions about breastfeeding education and experiences were explored. Taped responses were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were identified., Results: Most women received some information about breastfeeding during prenatal care. Mothers who chose to breastfeed were usually aware of some of the benefits for the baby and occasionally benefits for themselves. Mothers who did not breastfeed were concerned about pain associated with breastfeeding, time constraints, returning to work or school, personal health choices, or felt uncomfortable with the idea of breastfeeding. Factors facilitating breastfeeding included healthcare providers that encouraged the practice, knowing the advantages, attending a breastfeeding class or support group, breastfeeding in the birth or recovery room, latch assistance, rooming-in, nesting, and the availability of a breast pump. Reasons for supplementation and cessation were latch problems, pain, concerns the baby wasn't getting enough, mother-infant separation, and medical complications., Implications: Intensified prenatal and postpartum efforts to support breastfeeding are needed to increase breastfeeding initiation and duration for African American mothers.

In the western world, most women deliver their infants in a hospital setting. The purposes of this article are to provide guidelines and suggest best practices related to hospital-based care for postpartum depression by perinatal nurses; with this information, policies, procedures, and educational programs can be implemented to improve nursing care of new mothers. Hospital-based perinatal nurses need to "launch" new mothers from the hospital into the community so that the new mothers are prepared for self-monitoring for symptoms of depression, and know what steps to take if they do experience depressive symptoms.

Nurses play a vital role in mothers' early experiences with breast-feeding. Literature enumerates both supportive and nonsupportive behaviors, as well as the "interpersonal" aspect of breast-feeding support, although little direction is given to nurses about how to facilitate the relationship. This article conceptualizes breast-feeding support within Gadamerian hermeneutics as a conversation among nurses, mothers, and their newborns. Hermeneutically, breast-feeding conversation encompasses a text (a particular feeding at the breast), conversational partners (a mother, her newborn, and a nurse), and a dialogue that facilitates effective breast-feeding and maternal breast-feeding confidence through interpretation or understanding of the text. History and language are essential as a partnership is formed.

Purpose: To describe new mothers' experiences with family-centered maternity care in relation to their confidence level and to determine how care could have been more responsive to their needs., Study Design and Methods: Using data from a prospective Canadian survey of 596 postpartum women, a subsample of women with low and high confidence (N = 74) was selected. Data were analyzed using descriptive statistics and content analysis., Results: Women with both high and low confidence expressed negative experiences with similar frequency (n = 47/74, 64%). Women wanted more nursing support for breastfeeding and postpartum teaching and education. Women who reported a language other than English or French as their first language were significantly less confident than English- and French-speaking women (p < .05)., Clinical Implications: A multilevel framework about family-centered care is presented for healthcare providers in prenatal, labor and birth, and postpartum care. It is recommended that nurses ask new mothers about their confidence level and give special consideration to cultural background in order to provide supportive care in hospital and community settings.

This article presents a case study of a new mother experiencing postpartum depression and altered attachment with her newborn. Theories related to postpartum depression and maternal-newborn attachment are reviewed, and evidenced-based strategies for care are discussed in the context of the case.

Purpose of Review: The postpartum period is a time of significant emotional, social, and physical change for most women. This review focuses on recent evidence supported by systematic reviews and randomized, controlled trials to guide the care of postpartum women who are otherwise healthy., Recent Findings: Mental health outcomes are improved with postpartum support in at-risk women. Postpartum depression can be treated either pharmacologically or with counseling; however, exercise and omega-3 fatty acids are emerging as potentially effective alternatives. Intrauterine devices are safe and effective methods of contraception in the postpartum period. There has yet to be an effective, postpartum, smoking-cessation program developed, although intensive motivational counseling shows some promising early results. Bladder dysfunction continues to be a significant problem for women even at 10 years postpartum. Pelvic floor muscle exercises can help prevent and treat incontinence at 12 months, but longer-term follow-up studies are needed. Prevalence studies suggest that bowel dysfunction is common in the postpartum period, but randomized, controlled trials are limited to treatment in women with third-degree perineal damage., Summary: Although some recommendations can be made for evidence-based postpartum care, many important questions related to the postpartum period have not been examined by rigorous methodologies.

Purpose: To evaluate the effectiveness of an interventional protocol for the early initiation of breastfeeding that would remove barriers in the labor, delivery, recovery (LDR) unit., Study Design and Methods: Descriptive design using 100 postpartum mothers who were interviewed before discharge at a large university hospital in the south-central United States. Descriptive statistics were used for analysis., Results: The protocol was effective for initiating breastfeeding, and breastfeeding increased from 53% to 66%., Clinical Implications: When barriers to breastfeeding are reduced in the LDR setting, women will breastfeed. It is possible that reducing hospital barriers to breastfeeding in the LDR can also set the stage for sustained breastfeeding during hospitalization and for less supplementation with formula.

This article focuses on assisting nurses with the promotion of exclusive breastfeeding in Hispanic women through the understanding of their heritage, cultural traditions, and acculturation. Nurses can incorporate these traditions into daily nursing practice in order to enhance the breastfeeding experience of Hispanic mothers. Because exclusive breastfeeding is low in minority groups in the United States, it is essential that nurses use the initial postpartum period to help educate women about exclusive breastfeeding. In order to accomplish this, nurses need culturally specific information, which promotes cultural traditions and also encourages breastfeeding.

Purpose: : To examine the breastfeeding experiences and related behaviors of adolescent mothers after discharge from the hospital., Study Design and Methods: : Descriptive telephone survey with both open-and closed-ended questions. Outcome variables included breastfeeding experiences and infant feeding practices. A convenience sample of mothers (N = 53), ranging in age from 14 to 19 years, were interviewed by telephone 5 months to 2 years postdelivery., Results: : Over one half (60.3%) of the adolescent mothers breastfed for 2 months or longer (average 3.15 months), only 22.6% breastfed for 6 months or more, and 39.6% breastfed for 1 month or less. Friends, families, and healthcare professionals were supportive of breastfeeding, but participants found prenatal and postpartum education about breastfeeding to be limited. Many indicated that they were not plainly informed about the superiority of breast milk and the health advantages of breastfeeding. One mother stated, "They just asked if I wanted to bottle or breastfeed and didn't tell me about the benefits of breastfeeding.", Clinical Implications: : Nurses and physicians who provide care for childbearing women need to promote breastfeeding among adolescents in a better way. Prenatal anticipatory guidance related to the physical aspects of breastfeeding, support after adolescent mothers are discharged from the hospital, and advocacy for breastfeeding in the school and workplace setting are warranted. Nurses should consider establishing postpartum education programs for breastfeeding adolescents, for almost all of the participants in this study expressed the need for more postnatal breastfeeding support as indicated by this representative statement:"I think that it would help you to be able to breastfeed if nurses could phone call you more than just once; my baby latched on good in the hospital; I had trouble later after we went home."

Postpartum depression (PPD) strikes about 1 in 10 Western women. Studies of Western women have demonstrated that this emotional experience can occur during pregnancy and/or after delivery, and even in women who adopt an infant. Is PPD a universal experience or a morbid condition that is culture specific to Western/industrialized countries? The purpose of this literature review was to examine other cultures to ascertain whether PPD is a universal experience. The literature describes women throughout the world experiencing degrees of sadness postnatally, which persist up to 1 year. The risk factors for PPD also share similar themes cross-culturally, with one notable exception--the impact that the sex of the infant had on PPD, for a higher value for male children over female offspring was reported in literature from China, Turkey, and India. This literature review demonstrated that, although PPD is an experience that women in all cultures experience, the underlying cause for this malady in non-Western cultures is not attributed to biologic causes, and treatment is not generally based on a Western medical model.

Purpose: To determine (1) the rate of prenatal hepatitis B virus (HBV) vaccine acceptance in HBV nonimmune pregnant adolescents, (2) if postulated behavioral and attitudinal factors are associated with HBV vaccine, and (3) the rate of actual receipt of HBV vaccine postpartum in eligible subjects., Design and Methods: During 1999-2000, at an inner-city tertiary-care center prenatal clinic, 160 HBV nonimmune adolescents <18 years who were receiving prenatal and delivery care at the center were identified. The research nurse provided an HBV information pamphlet and offered immediate in-hospital postpartum HBV vaccination. Risk factors for nonacceptance of the vaccine were measured with structured questionnaires and medical record review documenting care attendance. Subsequently, all subjects, irrespective of prenatal acceptance of vaccine, were offered vaccine before postpartum discharge, and the rate of actual acceptance was determined., Results: In these predominantly African American (95%) adolescents, the rate of vaccine acceptance was 91%. Actual vaccination rate was 86%, but it was not associated with prior acceptance of vaccination or behavioral or attitudinal factors., Clinical Implications: Acceptance of vaccination and actual vaccination were high in this population of high-risk adolescents. The authors found that reoffering vaccine was a successful intervention, even with adolescents who had less-than-optimal attendance at prenatal visits. Given the high rate of acceptance and vaccination in this setting, the authors would encourage public health programs to implement vaccination programs in adolescent prenatal clinics and to offer vaccination postpartum to those who do not receive it prenatally.

Many infants die immediately prior to birth or in the neonatal period; thus, it is imperative that we begin to recognize the importance of integrating palliative care into pregnancy and the immediate newborn period. While advances in perinatal care have changed the decisions parents face when they receive a diagnosis of a life-limiting or life-threatening condition, the importance of perinatal palliative care has only recently been recognized as a viable option for care. Perinatal palliative care emphasizes the importance of planning for the limited amount of time families may have with their baby. This article provides a brief overview of perinatal palliative care, with a focus on who may benefit, the goals of care, and what services are provided. There is also a review of current palliative care programs and a discussion of how nurses can become more involved in this much-needed area of infant care.

Purpose: To describe the breastfeeding experiences of women who returned to work after childbirth., Design and Methods: Descriptive, using questionnaires with 50 women. Content analysis of data obtained from women who responded to open-ended questionnaires at 16 weeks postpartum. Three procedures were used: coding data, categorizing text units, and refining the emerging themes., Results: Four categories emerged from the data:support, attitude, strategic plan, and psychological distress. The women expressed a need for support such as an accepting environment, spatial issues, modeling, and time allowance. They needed to maintain a positive attitude so they could commit to and accomplish their breastfeeding goals. The women developed strategic plans to help prevent breastfeeding problems as well as continue breastfeeding successfully. Finally, they described psychological distress as a conflict between the demands of work and the breastfeeding process. Associated feelings included guilt, stress, or having to sacrifice., Clinical Implications: These findings can help nurses and other healthcare professionals in providing anticipatory guidance to women who plan to continue breastfeeding after returning to work. Further research should investigate the relationship between psychological distress, work productivity, family functioning, and breastfeeding activities of working women who breastfeed.

Purpose: To gain insights into the perceptions of first-time mothers regarding nurses' support of breastfeeding., Study Design: Phenomenology., Method: Audiotaped interviews were conducted with 20 primiparous breastfeeding mothers within the first month after giving birth vaginally to healthy term infants. Data analysis was concurrent with data collection, and trustworthiness of the data was established., Results: Nurses provided emotional, informational, and tangible support. Nonsupportive behaviors were also identified, including a sense that the nurse was in a hurry, failed to offer breastfeeding assistance, and was inflexible while working with the mother and infant., Clinical Implications: Nurses can contribute significantly to the successful initiation of and continuation of breastfeeding, and provide new mothers with the confidence and reassurance critical for breastfeeding success.

Purpose: To investigate the lived experiences of women who initiate breastfeeding but stop within the first 2 weeks after birth., Design: Phenomenology., Methods: Interviews were recorded on audio tape, transcribed verbatim, and analyzed for themes by an interdisciplinary group of researchers., Results: Women described a clash or incongruity between highly idealized expectations and early breastfeeding problems. This led to incremental disillusionment and cessation of breastfeeding attempts. Women spoke poignantly about a sense of failure, guilt, or shame and had lingering self-doubts about not continuing with breastfeeding., Clinical Implications: Women need more accurate information about the process of initiating breastfeeding. Nurses should avoid teaching breastfeeding practices that can confuse infants and sabotage mothers and should work toward providing sensitive care that respects personal boundaries of mothers. Additionally, provisions need to be made for continued support and consultation after the mother's discharge from the hospital or birthing center. Finally, nurses and other health professionals should understand that women who stop breastfeeding at an early date may feel guilty about doing so, and may need assistance in resolving feelings about having made that choice.

Purpose: To explore the relationship between satisfaction with support and functional status after childbirth., Design: Prospective longitudinal survey design., Methods: Two hundred new mothers who had experienced a healthy pregnancy, normal delivery and puerperium, and delivered a healthy infant between 37 and 42 weeks gestation were approached while attending primary healthcare maternal-child health centers and immunization clinics in New South Wales, Australia. Measurement tools included the Inventory of Functional Status After Childbirth and the Support Behavior Inventory, and were administered at 6 weeks, 3 months and 6 months., Results: Significant increases in total mean functional scores, scores for household responsibilities, social activities, and self-care were noted. Although no significant correlation was found between satisfaction with social support and functional status after childbirth, satisfaction with support from one's partner decreased significantly during the 6-month survey period, as did satisfaction with support from others., Clinical Implications: It could be that providers need to assess the social support needs of their clients. A postnatal support plan could be used by mothers to negotiate the long-term involvement of others in household tasks and selected aspects of infant care.

Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of care quality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits.