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Background: The postpartum period is critical for maternal health status after childbirth. The traditional Chinese postpartum confinement practice, "doing-the-month", is considered especially effective in helping mothers recover during the postpartum period. However, research has not provided evidence to confirm its benefits. Postpartum depression is a common postpartum disease that seriously threatens maternal health. The systematic review aims to explore the association between "doing-the-month" and postpartum depression in the Chinese female population and to provide a scientific foundation for evidence-based postpartum maternal care., Methods: Five databases (PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, and Web of Science) were searched according to the protocol (INPALSY202320102). The JBI assessment tool was used to assess the quality of the included studies., Results: Sixteen quantitative studies from China and Chinese female immigrants in other countries, including 15 cross-sectional studies and 1 randomized controlled study, were identified. Four studies indicated that "doing-the-month" rituals reduced postpartum depression risk while 2 studies showed opposite results; 10 studies did not show a significant association between "doing-the-month" practices and postpartum depression., Conclusion: There is conflicting evidence regarding the association between "doing-the-month" and the likelihood of developing postpartum depression. Some studies have explored the impact of family ties, particular rituals, and specific stressors during the postpartum period on the occurrence of postpartum depression in Chinese women. According to current research, "doing-the-month" practice failed to show a significant protective effect on postpartum depression in the Chinese maternal population. Evidence-based medical health education for the Chinese postpartum female community is urgently needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Little is known about the physical therapists' practice and perceptions toward management of pregnancy/postpartum-related disorders in Taiwan. The aim of this study was to document current practice of physical therapy in antepartum and postpartum care in Taiwan., Methods: An exploratory, cross-sectional study was conducted in registered physical therapists living in Taiwan. An anonymized online survey was designed, piloted, and advertised widely from March 2020 to March 2021. Data were analyzed using descriptive statistics, Chi square analysis and multivariate logistic regression., Results: Of the 364 respondents, 37.6% had experience of treating pregnant or postpartum women in clinical practice. The most commonly treated pregnancy/postpartum-related disorder in practice was low back pain (61.3%). All respondents reported little to moderate level of confidence in their ability to manage pregnancy/postpartum-related disorder. Being female (p < 0.01); working at a regional hospital (p = 0.01), district hospital or district teaching hospital (p < 0.01), clinic (p = 0.01) or physiotherapy clinic (p = 0.01); and having prior experience of treating antepartum or postpartum women (p < 0.01) were significantly associated with willingness to provide customer-oriented service or health education to patients/clients with pregnancy/postpartum-related disorder after controlling for other confounding variables. The most commonly reported barrier was "lack of available training" (81.3%)., Conclusion: The majority of participating physical therapists indicated a positive attitude to antepartum and postpartum care but were not confident in management of various pregnancy/postpartum-related disorder in practices. The findings of this study highlight the educational needs related to antepartum and postpartum care in clinical practice for physical therapists in Taiwan., (© 2022. The Author(s).)

Objective: The COVID-19 pandemic saw universal, radical, and ultra-rapid changes to UK National Health Services (NHS) maternity care. At the onset of the pandemic, NHS maternity services were stripped of many of the features which support woman and family centred care. In anticipation of unknown numbers of pregnant women and maternity staff potentially sick with COVID-19, services were pared back to the minimum level considered to be required to keep women and their babies safe. The aim of this survey was to understand the impact of COVID-19 public health messaging and pandemic-related service changes on users of maternity care in the UK during the pandemic., Methods: We conducted an online survey to explore user's experiences of COVID-19 public health messaging and 'socially-distanced' maternity care across the UK. The study population consisted of women who had experienced pregnancy after the 11th March 2020 (when the WHO declared a pandemic), whether or not they were still pregnant. We collected data between June and September 2020. We used framework analysis for the free-text data and generated descriptive statistics., Findings: Women were generally happy to adopt a precautionary approach and stringently social distance in the context of a relatively unknown pathogen and in an environment of extreme anxiety and uncertainty, but were acutely aware of the negative impacts. The survey found that the widespread changes to services caused unintended negative consequences including essential clinical care being missed, confusion over advice, and distress and emotional trauma for women. COVID-19 restrictions have resulted in women feeling their antenatal and postnatal care to be inadequate and has also come at great emotional cost to users. Women reported feeling isolated and sad in the postnatal period, but also frustrated and upset by a lack of staff to help them care for their new baby., Key Conclusions: With growing evidence of the impact of the virus on pregnant women and an increased understanding of the unintended consequences of unclear public health messaging and overly precautious services, a more nuanced, evidence-based approach to caring for women during a pandemic must be prioritised., Implications for Practice: All maternity services should ensure they have clear lines of communication with women to keep them updated on changing care and visiting arrangements. Services should ensure that opportunities to provide safe face-to-face care and access for birth partners and visitors are maximised., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021. Published by Elsevier Ltd.)

Competing Interests: Competing interests: none.

Background: Women across the world value choice and control throughout their maternity care experiences. In response to this health policy and frameworks are adapting and developing. The concepts of choice and control are extrinsically complex and open to interpretation by healthcare professionals and service users, with the two not necessarily aligning. Depending on a number of factors, women's experiences of choice and control within the same maternity care system may be very different. This study aimed to investigate the factors influencing women's perceptions of choice and control during pregnancy and birth in Ireland., Methods: We conducted a cross-sectional study using an adapted version of the UK national maternity experience survey (National Perinatal Epidemiology Unit). During March - July 2017, a sample of 1277 women were recruited from the postnatal wards of three maternity units and a tertiary maternity hospital. Poisson regression was used to assess the association between twelve factors and a series of measures of the women's perception of choice and control., Results: Most women reported not having choice in the model or location of their maternity care but most reported being involved enough in decision-making, especially during birth. Women who availed of private maternity care reported higher levels of choice and control than those who availed of public maternity care. This factor was the most influential factor on almost all choice and control measures., Conclusion: Most women experiencing maternity care in Ireland report not having choice in the model and location of care. These are core elements of the Irish maternity strategy and significant investment will be required if improved choice is to be provided. Availing of private maternity care has the strongest influence on a woman's perceived choice and control but many women cannot afford this type of care, nor may they want this model of care., (© 2021. The Author(s).)

Background: Factors that influence breastfeeding initiation and duration have been well established; however, there is limited understanding of in-hospital exclusive breastfeeding (EBF), which is critical for establishing breastfeeding. Grady Memorial Hospital, which serves a high proportion of participants receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and racial/ethnic minorities, had an in-hospital EBF rate in 2018 by the Joint Commission's definition of 29% and sought contextualized evidence on how to best support breastfeeding mothers., Objective: The objectives were to (1) identify facilitators and barriers to in-hospital EBF and (2) explore breastfeeding support available from key stakeholders across the social-ecological model., Design: In-depth, semistructured interviews were conducted and analyzed using thematic analysis., Participants: The sample included a total of 38 purposively sampled participants from Grady Memorial Hospital (10 EBF mothers, 10 non-EBF, and 18 key stakeholders such as clinicians, community organizations' staff, and administrators)., Results: Key themes included that maternal perception of inadequate milk supply was a barrier to in-hospital EBF at the intrapersonal level. At the interpersonal level, a personable and individualized approach to breastfeeding counseling may be most effective in supporting EBF. At the institutional level, key determinants of EBF were gaps in prenatal breastfeeding education, limited time to provide comprehensive prenatal education to high-risk patients, and practical help with latching and positioning. Community-level WIC services were perceived as a facilitator due to the additional benefits provided for EBF mothers; however, the distribution of WIC vouchers for formula to mothers while they are in the hospital undermines the promotion of EBF. Cultural norms and a diverse patient population were reported as barriers to providing support at the macrosystem level., Conclusion: Multipronged approaches that span the social-ecological model may be required to support early EBF in hospital settings., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: The days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia., Methods: A community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively., Results: The study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization., Conclusion and Recommendation: The study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia., Competing Interests: No author has competing interest.

Background: The burden of maternal and neonatal morbidity and mortality is a global health concern with the highest burden documented after childbirth in women and babies living in sub-Saharan Africa. To date, there is limited information on the quality of postnatal care and/or whether evidence-based interventions to improve postnatal care in a way that meets the specific health needs of each mother and her baby have been lacking. There is also limited data related to how quality of care (respectful or disrespectful) influences women's decision to access postnatal care., Objective: To systematically review available qualitative evidence for how quality of care (respectful or disrespectful) influences perceptions and experiences of, and decisions to, access postnatal care for women living in sub-Saharan Africa., Search Strategy: CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2009-2019. Grey literature was searched on Google Scholar., Selection Criteria: Qualitative literature in English describing women's perceptions and experiences of the quality of care they received after childbirth and how this influenced their perceptions of and decisions to access postnatal care., Data Analysis: Thematic analysis was performed to extract subthemes and themes. Outcomes were themes from the qualitative data used to form a thematic synthesis., Results: Fifteen studies were included with data from 985 women interviewed face-to-face across eight countries. Descriptions of respectful care included healthcare providers being kind, supportive and attentive to women's needs. Women described preferring healthcare services where the healthcare providers communicated in a respectful and caring manner. Descriptions of disrespectful care included verbal and/or physical abuse and power imbalances between women and healthcare providers. Some women were denied postnatal care when attending a healthcare facility after giving birth at home. There is evidence to suggest that vulnerable women (adolescents; women with poor socioeconomic status; women who are HIV positive) are more likely to receive disrespectful care., Conclusions: This systematic review describes how aspects of respectful and disrespectful maternity care influence women's perceptions and experiences of, and decisions to access postnatal care services. There is a need for a renewed focus to prioritise respectful maternity care and to sustainably provide good quality postnatal care to all women and their babies in a way that meets their expectations and health needs., (© 2021. The Author(s).)

Objective: To analyze women's desires, expectations and experiences regarding skin-to-skin contact and breastfeeding in the first hour of life of their newborns., Methods: Qualitative research carried out in a teaching hospital in the Northeast Region of Brazil. The patients were followed longitudinally during prenatal care, at birth and during the puerperium. The participants were pregnant women during normal risk prenatal care, aged over 18 years old. Structured and semi-structured interviews were carried out in the prenatal period, participant observation at the time of delivery and new interviews in the puerperium. Content analysis was applied in the thematic modality., Results: 18 women between 21 and 38 years old were enrolled in the research. Women expressed the desire for skin-to-skin contact and breastfeeding as immediate practices right after delivery and birth. However, many women did not believe it was possible, and the performance of routine procedures was considered the main obstacle. These expectations that skin-to-skin contact and early breastfeeding would not be carried out were confirmed in the experiences immediately after birth., Conclusions: The expectations and experiences brought by these women suggest a flaw that starts in prenatal care and implies difficulties in implementing the studied practices. Thus, the empowerment and participation of women can become an important tool in the humanization of birth.

Background: Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras., Methods: Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit., Results: Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity)., Conclusions: Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.

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.

Introduction: Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling., Methods: Qualitative research including focus groups and 1:1 semi-structured interviews with women and staff. Participants were first- and second-generation Pakistani women with a child/children aged up to 5 years, or pregnant; community and hospital midwives, obstetric doctors who counsel or provide PNC. Data were coded and categorised using QSR NVIVO10. Inductive thematic analysis was carried out., Results: Women were receptive to discussion of contraception, including antenatally, and welcomed translated information. Some said the decision on PNC was theirs or made jointly with their husband; however, they acknowledged that in some marriages the husband will take the decision. Women stated they may face family expectation to have a baby early in marriage. Language was identified as a challenge by maternity staff, who utilised translation services to ensure women received the information they needed on contraception., Conclusions: Pakistani women value antenatal discussion about PNC. Maternity staff have an important role in providing quality information on contraception and should be supported with translated resources in a range of formats. Most importantly, staff should adopt a tailored approach to identify the individual woman's needs and preferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Being pregnant, giving birth, and becoming a mother the first months after birth, is for women with type 1 diabetes mellitus (T1DM) a period of difficult challenges. In order to identify their need of support from healthcare, the aim of this study was to describe healthcare during pregnancy, labour, birth, and up to 12 weeks after birth as experienced by Swedish women with T1DM. We used a phenomenological reflective lifeworld research approach, and made 1-2 individual interviews with ten women in late pregnancy and/or 2-3 months after. Transcribed interviews were analysed through focusing on the meanings of the study phenomenon. The results revealed how the diabetes disease, as well as the risks and responsibility that comes with it, become more visible during the period in question, due to a constant monitoring, performed by the woman herself as well as by the healthcare professionals. The essential meaning of the phenomenon is a need to share the burden of risks and responsibilities with healthcare professionals. The complex situation that these women are in, both as experts on their illness and care and in need of care, requires a care that make women feel capable and responsible, but at the same time offers support and relieve them of their responsibility when needed.

Background: The recent use of antenatal care (ANC) has steadily improved in low- and middle-income countries (LMIC), but postnatal care (PNC) has been widely underutilized. Most maternal and newborn deaths occur during the critical postnatal period, but PNC does not receive adequate attention or support, particularly in Sub-Saharan Africa. In Ghana, the majority of mothers attend four ANC assessments, but far fewer receive the four recommended PNC visits. This study sought to understand perceptions toward PNC counselling administered prior to discharge among both mothers and healthcare providers in the Greater Accra Region of Ghana., Methods: Facility assessments were conducted among 13 health facilities to determine the number and type of deliveries, staffing, timing of discharge following delivery and the PNC schedule. Structured interviews were conducted for 172 mothers over four-months in facilities, which included one regional hospital, four district hospitals, and eight sub-district level hospitals. Additionally, healthcare providers from 12 of the 13 facilities were interviewed. Data were analyzed with Chi-square or students t-test, as appropriate, with p < 0.05 considered statistically significant., Results: Ninety-nine percent of mothers received PNC instructions prior to hospital discharge, the majority of which were given in a group format. Mothers in the regional hospital were significantly more likely to have been informed about maternal danger signs but were less likely to know the PNC schedule than were mothers in district and sub-district facilities. No mother recalled more than four maternal or five newborn danger signs. Thirty-eight percent of facilities did not have PNC guidelines. Most patient and providers reported positive attitudes toward the level of PNC education, however, knowledge was inconsistent regarding the number and timing of PNC visits as well as other critical information. Only 23% of patients reported having a contact number to call for concerns., Conclusions: Despite overall positive feelings toward PNC among Ghanaian mothers and providers, there are significant gaps in PNC education that must be addressed in order to recognize problems and to prevent serious complications. Improvements in pre-discharge PNC counseling should be provided in Ghana to give mothers and babies a better chance at survival in the critical postnatal period.

Objective: To explore what first time mothers in England expect from postnatal care while they are pregnant, what they would ideally like, where they get their information on postnatal care, and their views on the sufficiency of this information., Design: A qualitative descriptive interview-based study., Setting: England PARTICIPANTS: A maximum variation sample of 40 women who were currently in the third trimester of pregnancy; aged 16 or over; planning to give birth in England and had not given birth previously., Methods: Semi structured interviews were carried out between October 2017 and March 2018, by telephone (n = 32) and face to face (n = 8). Interviews were analysed using thematic analysis., Results: There were six themes and twelve subthemes. The themes were: (1) 'Piecing together snippets of information' containing subthemes 'Incomplete official sources' and 'Other mothers' stories'; (2) 'Planning ahead or going with the flow' containing subthemes 'Wanting more information' and 'Postnatal care not a priority'; (3) 'Judgement or reassurance' containing subthemes 'Real: Being judged', 'Ideal: Reassurance and non-judgmental advice'; (4) 'Focus of care' containing subthemes 'Real: A focus on checks and feeding', 'Ideal: More focus on mother's wellbeing'; (5) 'A system under pressure' containing subthemes 'Real: Busy midwives, reactive care', 'Ideal: Reliable, proactive information'; (6) 'Deciding about discharge', containing subthemes 'Real: Confusion about decision-making', 'Ideal: More control over length of hospital stay'., Key Conclusions: First time mothers' experience of the transition to parenthood could be improved by antenatal access to comprehensive information about the timing, location, content and purpose of postnatal care. Information should take a woman-centred perspective and cover all settings (hospitals, birth centres, home, community), including the roles and responsibilities of all the professionals who may be involved., Implications for Practice: Clear and comprehensive information about postnatal care should be provided to all women in ways that are accessible at any stage of pregnancy or the postnatal period. As women pregnant for the first time worry about being judged if they seek professional advice and reassurance postnatally, information about postnatal care should aim to address this., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: This study explored what support male partners of women admitted to Mother and Baby Units (MBUs) wanted., Background: Although research has highlighted the need to support male partners of women admitted to specialist MBUs, little is known about the type of support men want and how they wish support to be delivered., Methods: Ten men whose partner was admitted to a MBU in the United Kingdom or Australia participated in semi-structured interviews. Data were analysed using Thematic Analysis., Results: Five themes were identified: (1) A smoother journey to and from the MBU , (2) Feeling included , (3) Uncertainty about 'what is going on' , (4) Barriers to support and (5) Facilitators of support ., Conclusion: This is the first qualitative study to specifically explore the type of support male partners of MBU patients would like in terms of content, delivery and timing. Participants expressed the need to be involved in care decisions regarding their spouse and infant and to be offered advice from professionals. They highlighted barriers to accessing support and offered solutions to minimise those. In terms of clinical implications, we recommend a support package, which could be developed for MBUs to improve outcomes for male partners and their family.

Background: The postpartum period can be challenging for many women. For migrant women, the arrival of a new baby brings unique issues. This study aimed to explore the experiences of motherhood and postpartum support of Indian migrant mothers., Methods: A qualitative descriptive naturalist inquiry was adopted, with data collected through face-to-face, semi-structured, in-depth interviews with a purposive sample of 11 English speaking Indian migrant women over 18 years old, (6 weeks to 6 months postpartum) in 2016. The data were thematically analysed., Findings: Four themes were found in this study: the role of social support in postpartum care, support from health services, a psycho-emotional journey with socio-cultural expectations and struggling to bridge two cultures. Many of the women felt alone and were distressed with undertaking household duties and caring for older children, as this would not have happened in India. The women expressed needing practical support until they settled back into their normal lives. Women never sought professional advice for their ongoing mental health concerns. Conflicting advice from health professionals left some women confused about their expectations of traditional and modern postnatal care., Conclusion: This study gives a unique insight into the experiences of Indian migrant women following birth. There is a need for culturally sensitive and appropriate postnatal services that encourage Indian men to support their partners and help women to find alternative sources of culturally appropriate support. It is vital that mental health support is a key component of any such program of care., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

In Australia, one of the most frequent reasons for not breastfeeding is a previously unsuccessful experience. This qualitative study used an appreciative inquiry approach to co-design a model of peer and professional breastfeeding support, in a metropolitan area of New South Wales (NSW) Australia, in collaboration with women who have had previous negative experiences of breastfeeding. In total, 30 mothers, health professionals and peer supporters participated in a two-part study, involving interviews and a collaborative workshop. The data were analysed using content analysis. The appreciative inquiry approach led to a solution focused attitude among participants and a commitment to improving breastfeeding support. We noted a level of apathy when the participant groups were interviewed individually prior to the collective workshop. During the collaborative workshop, all three participant groups came together to look at what was currently working well and designed improvements for the future. Midwifery care was identified as important for the start of the breastfeeding journey, during pregnancy and for the first 1-2 weeks after birth, but thereafter it was community and trained peer counsellors who were prioritised for breastfeeding support. Participants identified the need for a variety of support options including face-to-face meetings, Skype meetings, phone calls and/or texting. Workshop participants emphasised the need for women, especially those with previous negative experiences, to be linked in with their local peer support community group. An appreciative inquiry approach brought together all key stakeholders to develop practice-based change which included the end user and care providers. The collaborative workshop enabled participants to come together, as individuals, rather than as designated health professionals or trained peer counsellors, or breastfeeding women with negative experiences. This led to a unified approach and a harnessing of collective energy to initiate positive change., (© 2020 John Wiley & Sons Ltd.)

Background: In 2003, the World Health Organization recommended exclusive breastfeeding (EB) during the newborn's first 6 months of life and, if possible, during the first 2 years. However, EB rates resist these recommendations. In developed countries, only 1 out of 3 babies is breastfed during its first 6 months of life, and great differences between areas and countries can be observed. Only 35% of the newborns receive breastfeeding at 3-4 months of age. There are diverse strategies described in the literature that have proven their efficiency in improving breastfeeding rates. It has also been proven that professional support is an effective tool to extend any kind of breastfeeding; besides, it has been observed that mother-to-mother support also increases breastfeeding initiation, sustainment, and exclusive duration. The overall aim of the study is to assess the impact of the support groups on the sustainment of exclusive breastfeeding until 6 months after birth., Methods/design: This study is a cluster-random multicentric clinical trial with a control group and an intervention group, without blinding because it is impossible to mask the intervention. A randomization by centres of primary health (clusters) will be carried out. The women allocated to the intervention or control group will be randomized with a simple randomization sampling. The participants' breastfeeding rate will be followed up at the first 10 days, and at 2, 4, and 6 months of their newborn's life., Discussion: There is a need to assess the impact of mother support groups on exclusive breastfeeding. This study aims to analyse the outcomes related to the support received and to identify what should the structure of these groups be; in other words, to describe factors related to a better breastfeeding experience in order to help women increase breastfeeding rates., Trial Registration: The trial is prospectively recorded at the ISRCTN registry (Trial ID: ISRCTN17263529 ). Date recorded: 17/06/2020.

Background: Pregnant women in sub-Saharan Africa tend to have low adherence to antenatal and postnatal care regimens, contributing to high infant and child mortality rates. Despite low adherence figures and the high returns from attending antenatal and postnatal care visits, research on interventions to improve adherence is in its infancy. Our aim was to determine the effectiveness of existing interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa., Methods: Full text, peer-reviewed articles, published in English and listed in PubMed or PsycINFO through January 2018 were identified in a systematic review. Studies were restricted to randomized controlled trials only and had to assess intervention impact on antenatal and postnatal care adherence, operationalized as the frequency of visits attended. Two reviewers independently screened papers for inclusion and evaluated the risk of systematic error in each study using the Cochrane risk of bias tool. Any discrepancies were reconciled by a third independent reviewer., Results: The initial search generated 186 articles, of which, five met our inclusion criteria. Due to the small sample size and methodological variation across studies, a pooled effect size estimate could not be obtained. Therefore, effects on antenatal and postnatal care adherence were examined and reported at the individual study level. None of the interventions were directly aimed at improving adherence, but two of the five, both behavioral interventions, demonstrated effectiveness in increasing antenatal care (rate ratio 5.86, 95% CI 2.6-13.0, p<0.0001) and postnatal care adherence (31.3%, 95% CI 15.4-47.2, p=0.0009), respectively. Three home visit interventions had no effect on antenatal care adherence. Although the risk of bias was unclear or high in some cases, it remained low in most categories across studies., Conclusions: Results point to a large gap in the literature on interventions to address antenatal and postnatal care adherence in sub-Saharan Africa. Interventions drawing upon the executive function literature and the promising results of the behavioral interventions reviewed here are urgently needed to address these gaps., Trial Registration: The review was prospectively registered with PROSPERO, id number https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=88152, on February 7, 2018.

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.

Decision-making power and access to and control over resources are key elements of women's bargaining power within a household, and plays an important role in improving healthcare seeking behaviours for women and their children, which in turn augment maternal and child health outcomes. We examined the relationship between intra-household bargaining power and utilization of postnatal and child healthcare services within 6 months after delivery, based on cross-sectional survey data from Kyenjojo district, Tooro sub-region of Western Uganda. We assessed independent associations between women's intra-household bargaining autonomy and postnatal care attendance using a modified Poisson approach for common outcomes. We found that women who contributed to the decision-making processes on child healthcare, personal healthcare, and how to raise money for healthcare of family members were about 20% more likely to attend postnatal and child healthcare within 6 months of delivery, compared with women who were unable to make such decisions. Therefore, contributing to efforts that empower women to have greater control over child and personal healthcare through gender transformative approaches and policy engagements in important., Competing Interests: Declaration of Competing Interest All the authors declare no conflict of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Postpartum depression explains various groups of depressive symptoms and syndromes that can take place during the first 6 weeks following birth. The postpartum period is a critical time where both mild and severe mood disorders can occur. The familiar forms are baby blues and postpartum depression. Understanding the prevalence and associated factors of postpartum depression is mandatory for early detection and treatment., Methods: Institution based cross-sectional study was conducted from 1st May to June 30, 2018. The study participants were eligible women who came to Debre Berhan referral hospital and health centers for postnatal care and vaccination service. The Edinburgh postnatal depression scale was used to assess postpartum depression. A systematic random sampling technique was used to collect the data after determining the skip fraction (k = 2). The collected data were coded and entered into Epi-info version 7 and transported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression were done to identify associated factors. During bivariate analysis, variables with p-value < 0.05 were included in multivariate analysis. Odds ratios and their 95% confidence intervals were computed and variables with p-value less than 0.05 were considered to declare significantly associated factors (multivariate analysis)., Results: A total of 308 mothers who attended postpartum care we're included, which was a 100% response rate. The prevalence of postpartum depression was found to be 15.6% (95%CI = 11.7, 19.8). Being widowed/widower, having poor social support, having a current hospitalized child, and experienced a death of family member or close relative were significantly associated with postpartum depression., Conclusions: The prevalence of postpartum depression was lower than most studies done in different areas. Major life events and traumas are associated with an increased risk of postpartum depression. Health professionals should be aware of the mother's circumstances during the puerperium, they should initiate support to reduce the risk of depression in the postpartum period. Health care professionals working postpartum care clinics should give special attention to mothers who are widowed/widower, have poor social support, have a current hospitalized children, and experienced a death of family member or close relative.

Purpose: Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women's trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories., Methods: Data from the All Our Families longitudinal birth cohort was used to assess women's perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership., Results: Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low., Conclusion: Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.

Background: The early postnatal period is a dangerous time for both mother and baby where morbidity and mortality are highly prevalent if proper care is not done. Post natal care (PNC) knowledge has significant role in reducing such complications. In this study, the knowledge of postpartum mothers on PNC and its determinants were determined., Methods: A cross-sectional quantitative study was conducted in postpartum mothers (PpM) who attended all maternal delivery services in Asmara. Data was collected by a structured questionnaire. All (n = 250) PpM who gave birth in December, 2017 were included in the study. Independent samples t-test and one way ANOVA were used to compare the scores in knowledge across categories of background characteristics using SPSS. Bonferroni post-hoc test was performed for variables that were found to be significant while using ANOVA tool. P-values less than 0.05 were considered as significant., Results: The percentage of PpM who cited vaginal bleeding, as a maternal danger sign, and fever, as a baby danger sign, were 83.2 and 58.8%, respectively. The majority (96%) of PpM responded the correct answer on where to go if they note any danger signs. In addition, more than nine tenth of PpM correctly identified injectable contraceptives (92.7%) and oral contraceptive (91.5%). The percentages of knowledge in recognizing the necessary nutrients ranged from 87.6% for carbohydrates to 46% for minerals. The percentages of correct knowledge regarding first baby bath, frequency of breast feeding, umbilical care, duration of exclusive breast feeding, need and purpose of vaccine were 40.1, 81.9, 77.4, 94.8, and 99.2% respectively. The mean PNC knowledge score was 24.89/60. The score of knowledge on postnatal care was found to significantly differ across the categories of residence (p < 0.001) and ethnicity (p = 0.015). An increasing trend of knowledge score was observed with increase in age group (p < 0.001), educational level (p = 0.021), gravida (p < 0.001) and para (p < 0.001)., Conclusion: Considerable gaps in knowledge regarding postnatal care among postpartum mothers were evident. Special attention should be laid on rural residents, single/living together, junior/below in educational level, primigravida/para, non-Tigrigna ethnicity, and 17 to 25 years old mothers.

A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified., (© 2019 Michigan Association for Infant Mental Health.)

Background: The early postpartum period is the most stressful period for a new mother, who is assuming new roles and responsibilities in life, and must deal with the demands from her newborn baby and her own care needs. Little is known about whether the current postnatal care services provided by hospitals and community centers meet the needs of women. The aim of this study was to identify the experiences of women in Shenzhen and the problems that they encountered during the first 6 weeks after giving birth; and to explore their expressed needs with regard to postnatal care services., Methods: This is a qualitative exploratory study. Data were collected in November 2018 through in-depth, semi-structured, face-to-face interviews. A purposive sample was recruited from a tertiary maternal hospital in Shenzhen, China. The dataset was analyzed using content analysis., Results: Twenty-two mothers were interviewed during their postpartum body check on the 30th or 42nd day after giving birth. Six themes were identified: "the self-care needs of women," "proficiency in infant care," "involvement of family in postpartum and infant care," "family conflicts over postpartum and infant care," "preparing for the transition to parenthood / grandparenthood," and "the need for comprehensive postpartum home visit services.", Conclusions: The concerns expressed by the women during the postpartum period were related to their need to recover physically and to their desire to be perceived as proficient in infant care. Support from husbands and grandmothers could facilitate or impede a woman's transition to motherhood, and the family's transition to parenthood / grandparenthood. There were disagreements arising from intergenerational beliefs about postpartum and child care. In providing postpartum care services to women in situations where the family is involved in their care, health professionals should consider the family as a whole.

Background: Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers' perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes., Methods: A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions., Results: The median score obtained for the questionnaire was 108, (Inter Quartile Range 96-114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38-45), 33 (IQR 30-35) and 32 (IQR 28-35) respectively. Attending teaching/ specialized hospitals (aOR=1.6, p < 0.001), 20-35 age group (1.8, p = 0.024), and services such as initiation of breast feeding within 1 h of delivery (2.1, p = 0.009), pain relief during episiotomy suturing (2.2, p < 0.001), practicing Kangaroo Mother Care (1.4, p = 0.035), receiving health advices by doctors or midwives (2.1, p < 0.001) were significant correlates of positive perceptions., Conclusions: Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data.

Objective: To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization., Design: Focus groups using semistructured interview questions., Setting: A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast., Participants: Women who planned to or had given birth, their partners, and the maternity nurses who cared for them., Measurements: Qualitative thematic analysis of focus group transcripts., Results: Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period., Conclusion: Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs., (Copyright © 2019. Published by Elsevier Inc.)

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.)

Introduction: Above half of mothers in Ethiopia give birth at home. Home based care within the first week after birth as a complementary strategy to facility-based postnatal care service is critical to increase the survival of both mothers and newborns. However, evidence on utilization of postnatal care and location of service among mothers who delivered at home in Ethiopia is insufficiently documented. Therefore, this study assessed the magnitude and determinants for place of postnatal care service utilization among mothers who delivered at home in Ethiopia., Methods: We used the 2016 Ethiopian Demographic and Health Survey, and extracted data from 4491 mothers who delivered at home during 5 years preceding the survey. A multinomial logistic regression model was applied to examine the determinants of both facility and home -based postnatal care service utilization. Likelihood ratio test was used to see the model fitness and p-value of < 0.05 was used to determine statistical significance at 95% confidence interval., Results: From the total 4491 mothers who delivered at home, only 130(2.9%) and 236(5.3%) of them utilized postnatal service at home and at a health facility respectively. Being from an urban region (AOR = 0.378, 95%CI: 0.193-0.740), ever using the calendar method to delay pregnancy (AOR = 0.528, 95%CI: 0.337-0.826), receiving four and above antenatal care visits (AOR = 0.245, 95%CI: 0.145-0.413) and having a bank account (AOR = 0.479, 95%CI: 0.243-0.943) were the factors associated with utilizing home- based postnatal care. Similarly being a follower of the orthodox religion (AOR = 1.698, 95%CI: 1.137-2.536), being in the rich wealth index (AOR = 0.608, 95%CI: 0.424-0.873), ever using the calendar method to delay pregnancy (AOR = 0.694, 95%CI: 0.499-0.966), wantedness of the pregnancy (AOR = 0.264, 95%CI: 0.352-0.953), receiving four and above antenatal care visits (AOR = 0.264, 95%CI: 0.184-0.380) and listening to radio at least once a week (AOR = 0.652, 95%CI: 0.432-0.984) were the determinants of facility-based postnatal care utilization., Conclusion: The coverage of postnatal care service utilization among mothers who delivered at home was very low. Living in urban region, following the Orthodox religion, having higher wealth index, having a bank account, ever using calendar method to delay pregnancy, wantedness of the pregnancy, receiving four and above antenatal care visit and listening to radio at least weakly were associated with postnatal care service utilization. Therefore, targeted measures to improve socio-economic status, strengthen the continuum of care, and increase health literacy communication are critically important to increase postnatal care service utilization among women who deliver at home in Ethiopia.

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi-structured interviews were carried out with 18 women with 6- to 9-month-old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers' mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of 'turning points' where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling 'known' by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies., (© 2019 John Wiley & Sons Ltd.)

Background: The goal of postnatal care is to provide the highest possible quality of care and medical safety with the least possible intervention in order to optimize health and wellbeing of the new family. The aim of the study was to describe mothers´ experiences in relation to a new postnatal home-based model of midwifery care., Methods: The current study uses a cross-sectional mixed method design to assess a new postnatal home-based model of midwifery care in Sweden. Healthy women with an uncomplicated pregnancy and childbirth, and with a healthy baby answered an online questionnaire one week after birth. Data were collected during one year (2017-2018) and analyzed using descriptive and inferential statistics for quantitative data, and manifest content analysis for qualitative data., Findings: In total, 180 mothers with one to six children were included. They were most likely to have been discharged between six and 12 h after childbirth (56%) and 90% reported that the time for their discharge was good. The postnatal check-ups included were telephone contact (100%), home visit(s) (94%) and hospital visit(s) (98%). Most mothers had a positive postnatal care experience from using the new postnatal model of midwifery care (mean VAS 8.74, Std. Deviation 1.438). For 75%, of the participants, home-based postnatal care would be preferred for their next childbirth., Conclusion: Home-based postnatal care is well accepted by mothers who were discharged early after childbirth. Mothers with a positive experience of the new postnatal model of midwifery care would prefer home-based postnatal care for their next childbirth. Midwifery care should include home-based postnatal care., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Positive birth experiences lead to better postnatal functioning, and influence mode of delivery choice for subsequent pregnancies. Healthcare workers can influence the birth experience through relevant support and care. This study seeks to explore the experience of Sierra Leonean women in relation to ante-natal, intrapartum and post-partum care with special reference to their experience of caesarean section., Methods: In November 2016, individual semi structured interviews were performed with sixteen women of varying age from different geographical areas, levels of schooling, and parity. The interviews were analysed by systematic text condensation., Results: During interviews, participants mentioned a fear of dying or losing their baby. This fear was managed by praying and putting trust in a higher power. However, placing trust in healthcare workers was also described by some participants. Moreover, the present study demonstrates that women experienced a great deal of pain and discomfort after the caesarean section was performed, and that they found it difficult to return to expected activities. This was managed by a large amount of practical assistance from their social network. Healthcare workers were described as providing medicines, advice, and practical care. Negative experiences in which healthcare workers took money for medicines and refused to help women were also described., Conclusions: This study indicates that women locate resources to cope with pain and fear within themselves, while also utilising extended support from social networks and healthcare workers. This confirms that women from all backgrounds in Sierra Leone have access to resources for health and well-being., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care., Design: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis., Setting and Participants: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings., Findings: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication., Key Conclusion and Implications for Practice: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: The aim of this study was to assess the magnitude, patterns and predictive factors of unhealthy practice among mothers during pregnancy, childbirth, postnatal and newborn care in Southern Ethiopia., Results: Among the total participants, 29.0% mothers performed at least one unhealthy practice during pregnancy, childbirth, postnatal period and newborn care. This study identified the following harmful practices such as food prohibition (53.2%), home delivery (41.5%), discarding colostrum (18.6%), application of substance on the cord stump (12.1%), delayed breast feeding (28.4%), prelacteal feeding (43.0%) and early bathing (49.3%). Being grand multiparous (AOR = 2.528, 95% CI 1.037-6.166), being illiterate (AOR = 7.611, 95% CI 2.375-24.396) and lack of awareness on the effect of unhealthy practice (OR = 4.673, 95% CI 1.163-18.774) were independent predictors of outcome variable.

Background: Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal., Methods: A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data., Results: Overall, neonatal care utilization was 58.6% (53.3-63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13-3.75), ethnicity (2.28, 1.33-3.91), religion (2.37, 1.03-5.46), perceived quality of maternal and neonatal services (2.66, 1.61-4.39) and awareness on immediate essential newborn cares (2.22, 1.28-3.87) were identified as the determining factors of neonatal care utilization., Conclusions: The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother's level of awareness about neonatal care practices are recommended.

Introduction: Globally, 289,000 women die from complications related to pregnancy, childbirth, or the postnatal period every year. Two-thirds of all maternal deaths occur during the first six weeks following birth and more than two thirds of newborn deaths occur during the first week of life, These statistics underscore the importance of postnatal care, an often neglected service according to the World Health Organization (WHO). The purpose of this study was to assess the factors associated with postnatal service utilization in the Tigray region of Ethiopia., Methods: The study was a community-based, cross-sectional study. A multi-stage sampling method was used to select study districts randomly from the entire region. A total of 1,690 participants were selected using systematic random sampling. Participants were 18-49 years old, had given birth within the last six months, and were residents of the district for at least six months. Using SPSS version 20 means, frequencies, and percentages were calculated for the sub-group of participants who did attend postnatal care. Barriers to non-attendance of postatal care were analyzed using descriptive statistics. Bivariate analysis was undertaken to assess the association between demographic, obstetric, and knowledge regarding PNC and attendance at antenatal care. Variables with a P value, <0.05 were included in the multivariate logistic regression analysis to identify the determinant factors of postnatal care utilization., Result: Of the women surveyed, 132 (8%) obtained postnatal care. Women who did not receive postnatal care reported lack of awareness of the services (n = 1110, 73.3%). Most mothers who received postnatal care reported that they were aware of the service prior to the birth of their child (n = 101, 76.5%). Women were more likely to receive postnatal services if they lived in an urban area (odds ratio 1.96, 95% confidence interval 1.07, 3.59), had greater than a secondary education (OR 3.60, 95% CI 1.32,9.83), delivered by cesarean section (OR 2.88 95% CI 1.32,6.29), had four or more antenatal visits (OR 4.84, 95% CI 1.57,14.9), or had a planned pregnancy (OR 6.47, 95% CI 2.04,20.5)., Conclusion: Postnatal care service utilization is very low in Tigray region. Interventions targeted at increasing women's awareness of the importance of postnatal services and improving accessibility, particularly in rural areas, is needed., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To report on women's and families' expectations and experiences of hospital postnatal care, and also to reflect on women's satisfaction with hospital postnatal care and to relate their expectations to their actual care experiences., Design: Systematic review., Setting: UK., Participants: Postnatal women., Primary and Secondary Outcomes: Women's and families' expectations, experiences and satisfaction with hospital postnatal care., Methods: Embase, MEDLINE, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health (CINAHL Plus), Science Citation Index, and Social Sciences Citation Index were searched to identify relevant studies published since 1970. We incorporated findings from qualitative, quantitative and mixed-methods studies. Eligible studies were independently screened and quality-assessed using a modified version of the National Institutes of Health Quality Assessment Tool for quantitative studies and the Critical Appraisal Skills Programme for qualitative studies. Data were extracted on participants' characteristics, study period, setting, study objective and study specified outcomes, in addition to the summary of results., Results: Data were included from 53 studies, of which 28 were quantitative, 19 were qualitative and 6 were mixed-methods studies. The methodological quality of the included studies was mixed, and only three were completely free from bias. Women were generally satisfied with their hospital postnatal care but were critical of staff interaction, the ward environment and infant feeding support. Ethnic minority women were more critical of hospital postnatal care than white women. Although duration of postnatal stay has declined over time, women were generally happy with this aspect of their care. There was limited evidence regarding women's expectations of postnatal care, families' experience and social disadvantage., Conclusion: Women were generally positive about their experiences of hospital postnatal care, but improvements could still be made. Individualised, flexible models of postnatal care should be evaluated and implemented., Prospero Registration Number: CRD42017057913., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Men have a lot of influence on their partners' and children's health. However, studies have shown their involvement in antenatal care (ANC) and postnatal care (PNC) is relatively low owing to several factors., Aim: To explore the barriers to men's involvement in ANC and PNC in Butula sub-county, western Kenya., Setting: Butula sub-county, Busia county, western Kenya., Methods: A mixed methods study design, descriptive in nature, was used to collect both quantitative and qualitative data. A total of 96 men were selected to participate in the surveys. Also, four focus group discussions and four key informant interviews were conducted., Results: We found out that some men still participate in ANC and PNC despite the barriers. The perception that maternal health is a women's domain and existence of alternative traditional maternal services were key cultural barriers. The men's nature of work, low income and expenses incurred at ANC/PNC clinics were significant economic barriers. The lack of services targeting men, provider attitude, non-invitation to the clinic, time spent at the clinic and lack of privacy at the clinics were key facility-based barriers., Conclusion: A myriad of cultural, economic and health-facility barriers hinder men from active involvement in ANC and PNC. Awareness creation among men on ANC and PNC services and creating a client-friendly environment at the clinics is key in enhancing their involvement. This should be a concerted effort of all stake holders in maternal health services, as male involvement is a strong influencer to their partners' and children's health outcomes.

Aims: In October 2017, the 'Prenatal and Postnatal Health Care Service in Nara (PPHSN)' has piloted the introduction of a new telephone consultation service to support prenatal and postnatal health care and childcare. This study aimed to document the feasibility, acceptability and satisfaction with the service provided by a trained nurse specialist who can access to clinician support when necessary., Methods: The pilot study was conducted between November 2017 and February 2018. Japanese women who are undergoing a health checkup at the Nara Medical University hospital for delivery and post-partum women who had recently (<1 year) given birth at this hospital (they are raising a child) were invited to participate in the study. They called a free mobile phone number, and spoke to a trained nurse to consult maternal and newborn care practices. The PPHSN project also provided information for supporting raising a child. The postal survey of the PPHSN service was conducted in March 2018., Results: A total of 26 participants were enrolled. The questionnaire was answered by 23 (88.5%) participants, of which over half (52.2-95.7%) of participants declared they were 'strongly agree' plus 'agree' regarding 'patient-centered care', 'communication and information', 'technical quality', 'efficiency', 'access and convenience (feasibility)', and 'willing to use the service again (acceptability)'. The majority (95.7%) of respondents reported being willing to use the service again for a similar health problem., Conclusion: This study provided the first evidence of satisfaction with telephone or social networking consultation service by nurse specialists in Japan., (© 2019 Japan Society of Obstetrics and Gynecology.)

Introduction For uncomplicated pregnancies in the United States, a healthcare visit 4 to 6 weeks postpartum is recommended to assess a woman's mental, social, and physical health. We studied whether sociodemographic characteristics and pregnancy and delivery factors were related to the likelihood of missing a postpartum checkup. Methods We conducted a cross-sectional analysis of 64,952 women who completed the United States Centers for Disease Control Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 6 survey in 2009-2011 from 17 states and New York City that included a Yes/No question about receiving a maternal postpartum checkup. We calculated risk ratios (RR) with 95% confidence intervals (CI) to assess the association between maternal factors and lack of a postpartum checkup. Results Compared to women who attended a postpartum checkup (89.4%), women who missed the visit (10.6%) were younger, unmarried, less educated, with lower income, without insurance, and smokers (all p < 0.05). Compared to women with adequate prenatal care, women with intermediate (RR 1.79 (95% CI 1.70-1.88)) or inadequate (RR 2.71 (95% CI 2.53-2.91)) care were more likely to miss the checkup. Women were more likely to miss this checkup if their infant was born at a residence compared to a hospital (RR 2.27 (95% CI 1.71-3.01)), and were less likely to miss the checkup if their newborn had a 1-week well visit (RR 0.70 (95% CI 0.61-0.81)). Discussion Sociodemographic factors and noncompliance with other medical care were associated with missing a postpartum checkup. Women with a high-risk of not attending a postpartum visit should be targeted for interventions to increase their accessibility to care.

Background: Perinatal mental health (PMH) problems are a major public health concern because they may impair parenting ability which potentially has an immediate and long-term impact on the physical, cognitive and emotional health of the child., Aims: We evaluated a Perinatal Support Service (PSS) which supports positive attachment between mothers with PMH problems and their child, to evidence its impact on maternal mental health and maternal-infant interaction., Method: Using a mixed-methods approach, anonymised pre- and post-service outcomes data from 123 clients, 14 interviews and a focus group discussion were analysed., Results: We found significant improvement in anxiety (t (55) = 6.96, p < 0.01, 95% CI [3.15, 5.70]), and depression (t (55) = 6.58, p < 0.01, 95% CI [3.03, 5.68]) on the HADS, and on the GAD-7 (t (12) = 4.541, p = 0.001, 95% CI [3.48, 9.90]) after the PSS. Anxiety post service (M = 9.08, SD = 4.96) was lower than baseline anxiety (M = 15.77, SD = 4.68). Receiving emotional and practical support contributed to improvements in mental health and mother-child interaction., Conclusion: Given the paucity of PMH services in the UK, it is imperative that services such as the PSS continue to receive funding to address unmet PMH needs.

Background: Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh (UP) and examines its determinants., Methods: Data from a baseline survey of UP Community Mobilization (UPCM) project (2013) was utilized. A cross-sectional sample of currently married women (15 to 49 years) who delivered a baby 15 months prior to the survey was included. Information was collected from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care (ANC), delivery and postnatal care (PNC) services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates., Results: Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group (SHG) membership had no association with the utilization of maternal health services., Conclusions: Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group.

Background: Postnatal care (PNC) provides the opportunity for protecting the lives of women infected with human immune deficiency virus (HIV) and their babies. The prevention of mother-to-child transmission of HIV (PMTCT) guidelines provide a framework for implementation of PNC. There has been no empirical evidence on how the nurses at the clinic level implement these guidelines. In addition, there are reports that PNC has been neglected in South Africa., Aim: The study aimed to explore the implementation of PNC for HIV-positive women, by explicating nurses' views regarding their practices., Setting: The study was conducted in 2015 at three clinics at Mangaung Metro Municipality in the Free State., Methods: A qualitative, evaluative case study was conducted to provide a detailed account of the implementation of PNC, using 2015 PMTCT guidelines as a framework for evaluation. Eighteen key informants participated in three focus groups. Data were reviewed through direct thematic analysis., Results: Four themes emerged from data analysis, namely, guidelines as an empowering tool, implementation of HIV guidelines, perceived successes and challenges of postnatal HIV care, and measures to strengthen postnatal HIV care services. The study found that nurses interpreted and used guidelines to direct their practice. However, there were challenges and some successes., Conclusion: It was concluded that nurses had a good understanding of the guidelines provided for their practices and implemented them with various levels of success. Effective management of HIV-infected women during the postnatal period requires well-designed multidisciplinary collaborations, adequate resources, continuous professional development programmes, a high level of competence and confidence.

Background: Pregnancy and infant loss has a pervasive impact on families, health systems, and communities. During and after loss, compassionate, individualized, and skilled support from professionals and organizations is important, but often lacking. Historically, little has been known about how families in Ontario access existing care and supports around the time of their loss and their experiences of receiving such care., Methods: An online cross-sectional survey, including both closed-ended multiple choice questions and one open-ended question, was completed by 596 people in Ontario, Canada relating to their experiences of care and support following pregnancy loss and infant death. Quantitative data were analyzed descriptively using frequency distributions. Responses to the one open-ended question were thematically analyzed using a qualitative inductive approach., Results: The majority of families told us that around the time of their loss, they felt they were not adequately informed, supported and cared for by healthcare professionals, and that their healthcare provider lacked the skills needed to care for them. Almost half of respondents reported experiencing stigma from providers, exacerbating their experience of loss. Positive encounters with care providers were marked by timely, individualized, and compassionate care. Families indicated that improvements in care could be made by providing information and explanations, discharge and follow-up instructions, and through discussions about available supports., Conclusions: Healthcare professionals can make a positive difference in how loss is experienced and in overall well-being by recognizing the impact of the loss, minimizing uncertainty and isolation, and by thoughtfully working within physical environments often not designed for the experience of loss. Ongoing supports are needed and should be tailored to parents' changing needs. Prioritizing access to specialized education for professionals providing services and care to this population may help to reduce the stigma experienced by bereaved families.

Postpartum depression (PPD) is a major public health problem affecting 10-57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.

Background: The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization., Objective: In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs)., Methods: Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques., Results: More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas., Conclusions: The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care., (©Shangfeng Tang, Bishwajit Ghose, Md Rakibul Hoque, Gang Hao, Sanni Yaya. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 28.02.2019.)