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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.

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: Peer support may help mothers to feel satisfied with their breastfeeding and to continue breastfeeding. However, previous researchers have not examined the influence of peer support on the three breastfeeding-satisfaction domains., Research Aim: We aimed to examine the influence of telephone-based peer support on the following three domains of breastfeeding satisfaction among Japanese mothers: maternal satisfaction, perceived benefit to the infant, and lifestyle compatibility with breastfeeding., Methods: Breastfeeding mothers were recruited at four maternity hospitals in Japan to participate in a randomized controlled trial. Data were collected 1 month and 4 months postpartum. Among all of the participants ( N = 114), those in the intervention group ( n = 60) received telephone-based peer support until 4 months postpartum, and participants in the control group ( n = 54) received conventional support. Breastfeeding satisfaction was measured using the short version of the revised Japanese Maternal Breastfeeding Evaluation Scale. Generalized estimating equations and effect size analyses were used to examine the influence of the intervention., Results: On the subscale measuring lifestyle compatibility, participants with peer support had a higher score than those without peer support: regression coefficient 1.54 (95% confidence interval [0.03, 3.04]). The effect size was 0.40 standard deviations among participants with low and mid-level scores at baseline., Conclusion: Although peer support did not change maternal satisfaction or perceived benefit to the infant, it did increase lifestyle compatibility with breastfeeding among these Japanese mothers. This is evidence in favor of increasing the use of peer support.

Background: Early initiation of breastfeeding and exclusive breastfeeding can reduce infant mortality. Breastfeeding support interventions such as counselling may improve adherence to recommended practices. However, it is not known if these interventions work at the population level., Objective: The aim of this study was to assess the relationship between early postnatal breastfeeding support and recommended breastfeeding practices., Design/setting: We pooled data from 11 Demographic and Health Surveys in Africa (n = 7), South East Asia (n = 2), the Americas (n = 1), and Europe (n = 1) to analyse these associations at the population level., Participants: We limited the data to the most recent live births in the two years before the survey, including 41,431 births., Analysis: We fitted three multivariable logistic regression models to estimate the relationship between early postnatal breastfeeding support (a newborn postnatal check within an hour of birth plus counselling and observation of breastfeeding within two days) and three breastfeeding outcomes (early initiation of breastfeeding, absence of prelacteal feeding, and exclusive breastfeeding), adjusting for sociodemographic characteristics and birth-related factors., Findings: Early breastfeeding support was associated with a 24% increase (OR=1.24 95%CI=1.11,1.39) in the odds of initiating breastfeeding within one hour of birth. No relationships were found between breastfeeding support and prelacteal feeding in the first three days or exclusive breastfeeding at six months., Key Conclusion: While postnatal breastfeeding counselling and observation may improve early initiation of breastfeeding, impact is not persistent for longer term breastfeeding outcomes., Implication for Practice: Improved training for breastfeeding support and an enabling policy environment are required to improve breastfeeding practices for women and newborns., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest. The contents expressed in the article are those of the authors and do not necessarily reflect the policies or views of the organisations they are affiliated with., (Copyright © 2019. Published by Elsevier Ltd.)

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.

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: Breastfeeding initiation rates in some developed countries are high (98 % in Sweden and 96 % in Australia) whereas in others, they are not as favourable (46 % to 55 % in Ireland). Although the World Health Organization recommends exclusively breastfeeding for six months, 15 % of Australian women, 11 % of Swedish women and less than 7 % of Irish women achieve this goal. Awareness of what women in different countries perceive as essential breastfeeding support is a gap in our knowledge., Methods: Our aim was to explore Australian, Irish and Swedish women's perceptions of what assisted them to continue breastfeeding for six months. An exploratory design using critical incident techniques was used. Recruitment occurred through advertisements in local newspapers and on social networking platforms. Initial sampling was purposive, followed by snowball sampling. Telephone interviews were conducted with 64 Irish, 139 Swedish and 153 Australian women who responded to one question "what has assisted you to continue breastfeeding for at least six months?" Content analysis was conducted and common categories determined to allow comparison of frequencies and priority ranking., Results: Categories reflected the individual mother, her inner social network, her outer social network (informal support either face to face or online), and societal support (health professionals, work environment and breastfeeding being regarded as the cultural norm). Categories ranked in the top five across the three countries were 'informal face to face support' and 'maternal determination'. Swedish and Australian women ranked "health professional support" higher (first and third respectively) than Irish women who ranked 'informal online support' as second compared to ninth and tenth for Swedish and Australian women., Conclusions: The support required to assist breastfeeding women is complex and multi-faceted. Although common international categories were revealed, the ranking of these supportive categories varied. We must recognize how the cultural context of breastfeeding support can vary for women in differing countries and acknowledge the resourcefulness of women who embrace innovations such as social media where face to face formal and informal support are not as accessible.

Objective: to identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience., Setting: four maternity hospitals in North-West England., Design: 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: (a) following a previous birth and (b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data were analysed using a basic thematic approach., Participants: multigravida pregnant women aged 18+ years., Findings: the overall response rate was 28% (n=112); 43% (n=46) of the women had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/re-experienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled. Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options., Conclusion and Implications for Practice: women's views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth. The range of preferred timing and types of support indicate that flexible needs-based support options should be provided. Further research should assess if these findings are reinforced in a more diverse sample with a higher response rate., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: There is an abundance of published literature that describes the short- and long-term effects of breastfeeding for both the infant and mother. Despite the majority of women having good intentions to breastfeed, challenges that they encounter place their breastfeeding journey in jeopardy. Improving breastfeeding rates and durations is a significant public health priority at a local, national and international level., Aim: This pilot study aimed to identify and describe participating women's breastfeeding experiences in order to better understand why some achieve their breastfeeding goals, despite experiencing challenge and others do not., Method: A qualitative methodology was chosen to allow these mothers to have their voices heard. Twenty Australian Breastfeeding Association trainee counsellors, who were undertaking the Certificate IV in Breastfeeding Education, gave permission for the examination and analysis of their de-identified reflections on their own breastfeeding experiences. Data was examined and thematically analysed into identified themes., Results: Participants' breastfeeding experiences were identified into six themes: 1. expectation of breastfeeding, 2. motivation to breastfeed, 3. support to maintain breastfeeding, 4. returning to work, 5. the experience of breastfeeding and 6. social attitude to public breastfeeding. The responses and experiences were varied, with each woman describing a particular event that had a significant impact on her breastfeeding journey., Conclusion: It is not completely understood why some mothers continue with their breastfeeding journey, whilst others discontinue earlier than they had planned. Women in this pilot study reported that support, acceptability of breastfeeding to their family and social circle, public breastfeeding, issues around infant sleep and maternal fatigue were all significant issues for them as they navigated breastfeeding for the first time., Findings from this pilot study will be used to inform the development of a larger study which will further explore women's decision making, as well as identify what supports are needed to improve women's experience of breastfeeding.

Objective: this study aims to contribute to the development of a conceptual framework that will inform maternity care improvements for expectant mothers with intellectual and developmental disabilities (IDD) by exploring the structure, functions, and perceived quality of social support received by women with IDD during pregnancy and childbirth., Design/setting: using a grounded theory approach, we conducted an exploratory study set in Ontario, Canada in 2015., Participants: the sample included four adult women with IDD who had given birth in the last five years., Measurements: data were collected using semi-structured interviews., Findings: the structure of social support received by women with IDD consisted of both formal and informal sources, but few or no friendships. Women with IDD reported high levels of informational and instrumental support and low levels of emotional support and social companionship. However, a high level of available support was not always perceived as beneficial. Emergent core categories suggest that social support is perceived as most effective when three conditions are met: (1) support is accessible, (2) support is provided by individuals expressing positive attitudes towards the pregnancy, and (3) autonomy is valued., Key Conclusions and Implications for Practice: our study confirms and identifies important gaps in the social support received by expectant mothers with IDD. Women with IDD currently lack accessible informational support, emotional support, and social companionship during pregnancy and childbirth. Additional findings regarding the structure and functions of social support are presented, and a preliminary conceptual framework of effective social support during pregnancy and childbirth, as perceived by women with IDD is also proposed. Findings suggest that increasing support accessibility should be a social and clinical priority; however, maternity care providers should be aware of stigmatizing attitudes and respect the autonomy of pregnant women with IDD as they prepare for motherhood., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: Our objective was to pilot a method of engaging fathers/partners of high-risk inner-city mothers in breastfeeding support., Materials and Methods: Breast for Success was a breastfeeding promotion initiative with a father engagement component. In collaboration with Community Endeavors, Inc., we organized father-friendly evening programs (one night per week for 3 weeks, repeating quarterly) led by a male facilitator to provide breastfeeding education, with ongoing availability of a resource specialist to link men to community resources relevant to their legal, financial, and health needs. Fathers/partners were recruited from community programs and via our community partner, The City of Cleveland Department of Public Health MomsFirst™ Project, a federally funded Healthy Start program. University Hospitals Case Medical Center Institutional Review Board approved the study., Results: Sixty-six fathers/partners attended eight evening programs, and 30 (45%) attended all three nights. Their median age was 27.5 years (range, 17-64 years), and 49 (74%) self-described themselves as African American. At the start of the groups, 39% (21/54 responding) had a breastfed child, and 64% (39/61 responding) said they were comfortable with breastfeeding for their own child. After Sessions 1, 2, and 3, respectively, 40 (85%), 42 (89%), and 33 (80%) were "more likely" to want their next baby to breastfeed. On average, in 62% of all responses (278/450 possible), men endorsed learning "a lot more" about the 10 breastfeeding curriculum topics presented., Conclusions: Recruitment of inner-city fathers/partners for a breastfeeding education program was feasible, and among men who attended, fathers' perceptions about their breastfeeding knowledge were positively impacted.

Background: Whilst 81 % of UK women initiate breastfeeding, there is a steep decline in breastfeeding rates during the early postnatal period, with just 55 % of women breastfeeding at six weeks. 80 % of these women stopped breastfeeding sooner than they intended, with women citing feeding difficulties and lack of adequate support. As part of efforts to increase breastfeeding continuation rates, many public and voluntary organisations offer additional breastfeeding support services, which provide practical support in the early postnatal period and beyond. This paper focuses on the qualitative experiences of UK users of Baby Café services to examine their experiences of breastfeeding and breastfeeding support., Methods: The study was based upon in-depth interviews and focus groups with users of eight Baby Café breastfeeding support groups across the UK. Thirty-six interviews and five focus groups were conducted with a total of fifty-one mothers using the service. Interviews and group discussions were analysed using N Vivo software to draw out key themes and discussions., Results: Whilst each mother's infant feeding journey is unique, reflecting her own personal circumstances and experiences, several themes emerged strongly from the data. Many women felt that they had been given unrealistic expectations of breastfeeding by professionals keen to promote the benefits. This left them feeling unprepared when they encountered pain, problems and relentlessness of early infant feeding, leading to feelings of guilt and inadequacy over their feeding decisions. Mothers valued the combination of expert professional and peer support provided by Baby Café services and emphasised the importance of social support from other mothers in enabling them to continue feeding for as long as they wished., Conclusions: The research emphasises the need for realistic rather than idealistic antenatal preparation and the importance of timely and parent-centred breastfeeding support, particularly in the immediate postnatal weeks. The findings suggest that effective social support, combined with reassurance and guidance from skilled practitioners, can help women to overcome difficulties and find confidence in their own abilities to achieve their feeding goals. However, further work is needed to make sure such services are readily accessible to women from all sectors of the community.

Exclusive breastfeeding is the optimal method of infant feeding for the first 6 months of life for both term and preterm infants. This recommendation is based on indisputable evidence that breastfeeding offers numerous infant and maternal health benefits. Several trials have shown the beneficial effect of peer and/or professional support on the duration of any breastfeeding up to 6 months. Although many well-established programs exist that provide this support in-person or via telephone, the Internet is a relatively new means to deliver breastfeeding help. Yet, mothers have a vast presence online and a clear desire to seek healthcare information on the Internet. The availability and accessibility of interactive communication technologies via the internet provide the opportunity for developing new methods of healthcare delivery. Our project uses information technology to deliver an innovative and cost-effective way to support breastfeeding mothers. Our new online breastfeeding support clinic has the potential to improve access to specialized professional breastfeeding support in combination with interactive peer support. This new online clinic can be readily implemented to all regions in Canada with reliable Internet access, with the potential to significantly impact the health of all Canadian infants and their families.

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

Background: Maternal, neonatal and child health outcomes are worse in families from black and ethnic minority groups and disadvantaged backgrounds. There is little evidence on whether lay support improves maternal and infant outcomes among women with complex social needs within a disadvantaged multi-ethnic population in the United Kingdom (UK)., Method/design: The aim of this study is to evaluate a lay Pregnancy Outreach Worker (POW) service for nulliparous women identified as having social risk within a maternity service that is systematically assessing social risks alongside the usual obstetric and medical risks. The study design is a randomised controlled trial (RCT) in nulliparous women assessed as having social risk comparing standard maternity care with the addition of referral to the POW support service. The POWs work alongside community midwifery teams and offer individualised support to women to encourage engagement with services (health and social care) from randomisation (before 28 weeks gestation) until 6 weeks after birth. The primary outcomes have been chosen on the basis that they are linked to maternal and infant health. The two primary outcomes are engagement with antenatal care, assessed by the number of antenatal visits; and maternal depression, assessed using the Edinburgh Postnatal Depression Scale at 8-12 weeks after birth. Secondary outcomes include maternal and neonatal morbidity and mortality, routine child health assessments, including immunisation uptake and breastfeeding at 6 weeks. Other psychological outcomes (self efficacy) and mother-to-infant bonding will also be collected using validated tools.A sample size of 1316 will provide 90% power (at the 5% significance level) to detect increased engagement with antenatal services of 1.5 visits and a reduction of 1.5 in the average EPDS score for women with two or more social risk factors, with power in excess of this for women with any social risk factor. Analysis will be by intention to treat. Qualitative research will explore the POWs' daily work in context. This will complement the findings of the RCT through a triangulation of quantitative and qualitative data on the process of the intervention, and identify other contextual factors that affect the implementation of the intervention., Discussion: The trial will provide high quality evidence as to whether or not lay support (POW) offered to women identified with social risk factors improves engagement with maternity services and reduces numbers of women with depression. MREC NUMBER: 10/H1207/23, Trial Registration Number: ISRCTN: ISRCTN35027323.

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder. This study examined the role of health practitioner support and personal control during birth as predictors of post-traumatic stress (PTS) symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms., Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, 3 weeks and 3 months after the birth., Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (β = -0.41, R(2) = 16%) at both 3-weeks and 3-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms 3 months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention., Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth.

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

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

Aim: The Multidimensional Scale of Perceived Social Support (MSPSS) was developed to assess perceived social support, and has been widely used in Western samples. We attempted to translate and adapt this scale into the Urdu language, and herewith report on its psychometric properties in a rural Pakistani setting., Methods: The study sample consisted of 325 antenatal women who were registered with 'Lady Health Workers' in the Kallar Circle of Rawalpindi district. The subjects were assessed pre- and postnatally with measures of psychiatric distress, and social support and depression, respectively (using a guided structured interview)., Results: MSPSS scores were inversely related to measures of psychiatric distress and depression, thus supporting the construct validity of the MSPSS as a measure of social support. The internal consistency (Cronbach's alpha) of MSPSS was 0.92. Unlike previous research using the MSPSS in Western studies, the factor analysis revealed a single-factor solution that accounted for 53% of the variance., Conclusions: The Urdu translation of the MSPSS was found to have good construct validity, and internal consistency. However, the findings suggest that women in the study population perceived social support as a unitary construct, as opposed to a tri-dimensional one as identified in Western samples.

The purpose of this study was to explore relationships between functional status after childbirth and related concepts. The sample consisted of 177 women. The Personal Resource Questionnaire (PRQ) 85-Part 2, the State Trait Anxiety Inventory (STAI), and the Inventory of Functional Status After Childbirth (IFSAC) were used to measure variables. Data were collected during the third trimester of pregnancy and at 6 weeks postpartum. Overall, this group had relatively low levels of anxiety and high levels of social support and functional status after childbirth. The STAI demonstrated coefficient alphas from .90 to .93, the PRQ 85-Part 2 .87 to .93, and the IFSAC .90. The relationship between state anxiety in the postpartum period and FSAC (r = -.204, p = .008) was significant. Additional significant findings between social support, anxiety, and subscales of the IFSAC were found. Nurses must understand these relationships to develop and implement effective interventions. This study is clinically relevant to nurses involved in caring for pregnant and postpartum clients.

Postpartum maternal well being across cultures has received limited research attention. We examined relationships among stress, social support, and health in 152 Chinese mothers <1 year postpartum in the United States. These mothers did not perceive high levels of stress, although they did not receive as much support as they indicated they needed; 23.7% of mothers scored high for depressive symptoms. About half of the mothers experienced interrupted sleep, decrease in memory, and lack of sexual desire. All health measures were inter-correlated. Social support moderated the effects of stress on depressive symptoms. Culturally relevant care that is perceived as supportive may promote postpartum maternal health.

Objective: to explore women's experiences of caesarean section., Design: a qualitative study using a grounded theory approach. Data were collected using unstructured, tape-recorded interviews which took place between 1999 and 2000., Setting: the South West of England., Participants: twenty-one women who had experienced a caesarean section-either by choice or of necessity-and who were first- or second-time mothers., Findings: four main categories emerged: expectations and reality, being in control, feelings of failure as a woman and feeling different. These all linked to the core category of achieving normality. Women strove to achieve normality after having a caesarean section. If they did not gain this sense of normality, the status passage to motherhood appeared to be more difficult., Implications for Practice: it is important for health-care professionals to identify and acknowledge the emotional and physical needs of women who experience a caesarean section. Improving communication and support antenatally and postnatally may have positive benefits for maternal well-being.

Objective: To determine the relationship between the traditional Chinese practice of postpartum care, known as zuoyuezi, and postpartum depression (PPD) in China., Methods: A total of 342 Chinese women were surveyed 6- to 8-weeks post partum using the Edinburgh Postnatal Depression Scale (EPDS) and items assessing sociodemographics, health history, peripartum experiences, zuoyuezi, and social support., Results: Prevalence of PPD was 15.5% (EPDS cutoff >or=13). PPD was associated with lower income, difficult pregnancy experience, poor infant health status, not attending childbirth classes, and low spousal involvement before and after delivery. Among the 96% of women who practiced zuoyuezi, those for whom the caregiver was her mother-in-law or who perceived zuoyuezi as unhelpful had twice the odds of PPD., Conclusion: These data highlight the importance of the peripartum experience in assessing PPD risk. Zuoyuezi is still commonly practiced in urban China, and further research is needed to explore its role in the potential prevention of PPD.

Knowledge of the experience of parenthood is usually from a woman's perspective. The resulting outcome is that knowledge about the experience of fatherhood has been limited. Fathers are starting to change this situation by sharing their experience as is evidenced by the overall response of 267 fathers to this study. This paper focuses on the exploration of 22 men's feelings and beliefs about fatherhood; and their expectations and views about parenting. The paper will also investigate how fathers' antenatal expectations matched the reality of early family life including emotional well-being, attitudes to parenting, adjustment to family life and sources of support. The quantitative and qualitative data of the 22 fathers who responded to both the antenatal and postnatal questionnaires used within this paper are drawn from a larger Queensland survey of women and men during the antenatal and postnatal period.

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

Background: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery., Methods: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner., Results: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively., Conclusions: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.

The first article in this series highlighted the challenges that mothers face in establishing breastfeeding (Wallis and Harper 2007). Breastfeeding a sick infant in hospital presents additional challenges such as small, sleepy babies, babies who may be nil by mouth for prolonged periods and babies who may find breastfeeding difficult due to mechanical problems. There is very little published abut the needs of babies with complex medical or surgical conditions who may have had significant delays in their feeding or numerous starts and stops along the way. This article and Part 2b in the November issue illustrate some of the common challenges and propose principles of care that are transferable to caring for other sick babies with similar problems.

Breastfeeding makes a vital contribution to the health and development of babies, as well as to long term health. Establishing breastfeeding may not be easy even for mothers with healthy full-term babies. Mothers in the paediatric environment experience additional challenges: sick babies, delayed onset of breastfeeding and having to establish and maintain breastfeeding in situations where privacy may be limited and anxiety levels high. This first part of a two-part article describes the development of a breastfeeding support service in a tertiary children's hospital. Institutional support, a dedicated post and a planned programme of training and education, with the development of specific resource materials, have resulted in a service that closely matches the expressed needs of mothers.

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

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

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

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

A cross sectional survey design was used to measure mothers' (n=36) expected involvement in the care of their parenting adolescent daughters and grandchildren after postpartum discharge, and to measure adolescents' (n=36) expectations about their mothers' involvement in the care of themselves and their newborns. Adolescents were first-time low-risk English-speaking mothers 15-19 years of age with low-risk newborns. No difference was found between the amount of care mothers expected to give their daughters and the amount of care that daughters expected to receive from their mothers, z = -.500, p = .62. No difference was found between the amount of newborn care mothers expected to give their grandchildren and the amount of newborn care that daughters expected their mothers to provide, z = -1.000, p = .32. Involvement of mothers in the postpartum care of their daughters and grandchildren needs further study, but with precautions, nurses may consider including mothers in the maternal and newborn care of adolescents.

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

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

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

Objectives: To evaluate to what extent teenage mothers are able to predict their postnatal support networks in the antenatal period, and the extent to which support correlates with depressive symptomatology and social class., Design: A prospective cohort study., Setting: Teenage antenatal clinic., Participants: Teenage mothers (n=124) aged less than 18 years., Intervention: Women were surveyed in the antenatal period and again 6 months postpartum about their anticipated and actual levels of support using the Maternal Social Support Index. The questionnaire covered key issues involved in discharge planning such as the availability of help with household tasks, emergency respite, and communication. Subjects also completed social class data and the Edinburgh Postnatal Depression Scale., Main Outcome Measure: Ability of pregnant teenagers to predict postnatal support and correlation of support with social class and depressive symptomatology., Results: The key finding was that teenage mothers significantly overestimated their support networks in the antenatal period compared to the reality experienced 6 months postpartum (P=0.0001). Dissatisfaction was most marked in the communication and daily activity support subscales. The level of support at 6 months postpartum correlated significantly with the Edinburgh Postnatal Depression score (P=0.0001) and with social class (P=0.017)., Conclusion: Services for teenage mothers that provide assistance with communication and daily support activities are required to help overcome the discrepancies between idealization and reality. Poor support correlates with depressive symptomatology and social class.

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.

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

The maternal process of managing established breastfeeding and, ultimately, weaning the child from the breast was explored using the grounded theory method. Data were analyzed from interview transcripts from mothers, field notes, postal questionnaires from fathers, and individual and discussion group interviews with child health nurses within a Western Australian context. A common social problem emerged for women in the management of their breastfeeding when personal expectations were found to oppose the expectations of others. Being confronted with these incompatible expectations resulted in confusion, self-doubt, and guilt for mothers. These findings are discussed to assist health professionals support breastfeeding mothers.

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

The current trend of health care services to encourage early discharge of women from hospital within three days of childbirth has produced some concerning issues. This paper explores the factors surrounding this trend and highlights the need for a postpartum midwifery community infrastructure to support women who are discharged from hospital before breastfeeding and parent education processes are established.

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

Objective: To investigate the similarities and differences between teenage and adult mothers and their level of self-esteem and satisfaction with social support at six weeks and six months postpartum., Design: A two group comparative study., Setting: Maternal child health, immunisation and midwives' clinics in New South Wales, Australia., Participants: 173 adult mothers and 72 adolescent mothers who had experienced a normal pregnancy, labour and delivery and delivered a healthy baby near term., Measurements and Findings: Rosenberg's Self-esteem Scale, Brown's Support Behavior Inventory and a personal information form were used. Irrespective of age, breast-feeding rates and satisfaction with social support decreased significantly during the early months postpartum. Furthermore, a significant inverse relationship was noted between maternal age and satisfaction with support and a positive relationship was identified between maternal age and self-esteem., Key Conclusions and Clinical Implications: Maternal self-esteem may be challenged by the demands of motherhood and dissatisfaction with social support could contribute to the decline in breast-feeding practices. Developing a postnatal support plan, including fathers in education programmes and offering courses and workshops designed to enhance self-esteem and parentcraft may assist mothers to assume baby care responsibilities and increase their satisfaction with support.

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