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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.

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

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

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

The authors used a transcendental phenomenological approach to describe adolescent mothers' satisfactory and unsatisfactory inpatient postpartum nursing care experiences. They analyzed data from 14 in-depth interviews and found that adolescent mothers' satisfaction is dependent on their perceptions of the nurse's ability to place them "at ease." Nursing care qualities that contributed to satisfactory experiences included nurses' sharing information about themselves, being calm, demonstrating confidence in mothers, speaking to adolescent and adult mothers in the same way, and anticipating unstated needs. Nursing care was perceived to be unsatisfactory when it was too serious, limited to the job required, or different from care to adult mothers, or when nurses failed to recognize individual needs. In extreme cases, unsatisfactory experiences hindered development of an effective nurse-client relationship. These findings illustrate the value of qualitative inquiry for understanding patients' satisfaction with care, can be used for self-reflection, and have implications for nursing education programs.

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

Objective: To determine if there was an improvement in nurses' communication skills 5 months after a multiple component intervention to implement the Registered Nurses' Association of Ontario best practice guideline 'Establishing Therapeutic Relationships'., Methods: A matched pair, before and after design was used. Eight client scenarios with corresponding client comments were read aloud to nurses who were asked to respond verbally, as though they were interacting with the client. Responses were audio-taped and transcribed. The frequency and quality of nurses' active listening, initiating and assertiveness skills were measured pre- and post-implementation of the guideline., Results: Twenty-two nurses responded at both time points. Active listening skills were most frequently used. There was a statistically significant decrease in the number of active listening skills used, but a statistically significant improvement in the quality of active listening and initiating statements and frequency of initiating skills., Conclusion: Nurses demonstrated improvements in selected communication skills following the implementation of a multiple component intervention that included a best practice guideline., Practice Implications: A combination of strategies that support the implementation of a best practice guideline is described. Results indicate some improvement in communication skills that are essential to the establishment of therapeutic nurse-client relationships.

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