Search

In order to explore the manner in which parenthood was discussed in midwifery consultations, 58 video-recorded consultations were analysed. A content analysis revealed a variety of topics concerning conversation on parenthood--topics of an intimate nature and discussions from a societal perspective. Parenthood was not of primary importance in visits, which were mostly directed by the midwives. A phenomenological hermeneutic analysis of the meaning of being a mother revealed a complex and difficult situation of being both needed and dependent. The meaning of being a father revealed a struggle between distancing from and closeness to the child. The mate relationship was indicated as important and under strain. The metaphor of the 'spiders web', where the mother is the spider with the child mostly on her back, the father entering the web on her terms, summarizes the understanding. The results from this study could provide a basis for reflection on the status of the topic of parenthood, on the meaning of being a mother and a father disclosed in the consultations, and ultimately on the organization of ante- and postnatal midwifery care.

The aim of the study "Good Nursing Care in the postnatal Wards: Mothers Views on the Aspects of Nursing Care was to describe important nursing activities and their realization in postnatal wards. Activities were classified into task-centred and human-centred ones, which were then assessed on the Leino-Kilpi "Good Nursing Care Scale" (GNCS). (Leino-Kilpi et. al., 1994). The purpose of this article is describe the results of the task-centred activities. Research material was collected using a structured Likert-scale form in May 1-15, 1995 from mothers who gave birth at one University Central Hospital (n = 123). According to the results, most nursing activities studied were important to the mothers. Physical activities were grated 'very good', decision making and support for the mothers' own initiative and continuity 'good', and councelling 'fair'. The councelling stressed certain issues, such as explaining hospital procedures and teaching the mothers self-care, breast-feeding and baby care, and all these were ranked good on the average. However, the general grade given for counselling was 'fair because the shortcomings in more individual councelling.

This descriptive study sought to define the relationship between women's health status and the experience of Sanhujori. Korean traditional non-professional postpartal care after delivery and abortion. A convenience sample of 308 women in 7 provinces in Korea including Seoul were studied from December, 1994 to December, 1996 for two years. Mean age of respondents was 50.5 years and mean number of children was 3. The rate of abortion was 91.5% and mean frequency was 2.2 times per woman. 82% of respondents did not have Sanhujori after abortion. The period and subjective evaluation of experience of Sanhujori after delivery were decreased according to the increment of the number of childbirth. The health status implies both subjective health status women perceived and physical symptom distress women are experiencing presently. The respondents expressed the physical symptom distress as painful one. 56.7% of respondents perceived unhealthy, such as sick and 99.6% complained more than one symptom. The factors related to health status were the first and third experience of Sanhujori after delivery, such as the period and subjective evaluation whether she did Sanhujori well or not; whether or not of Sanhujori after abortion and menopause; the number of child; and age, at the level of 1% or 5% of significance statistically. The factors related to the rate of physical symptom distress were only two: the first experience of Sanhujori after delivery, especially the subjective evaluation and whether women did Sanhujori after abortion or not, at the level of 1% or 5% of significance statistically. In conclusion, this finding reconfirmed the possible relationship between women's health status and the experience of Sanhujori after delivery & abortion. It provides a challenge to the professional care givers to research further on the effects of Sanhujori on the health status, health recovery after abortion or delivery from the various aspects through the cross-sectional and longitudinal research for the refinement of the reality of Sanhujori not only as cultural phenomenon but as conceptual model for the appropriateness of intervention and qualty of care for desirable health outcomes. Besides, it is indispensable to refine and reestablish postpartal caring system by finding universal law through international & cross-cultural research on postpartal traditional care for women's life long health toward the 21C.

Background: In a bid to increase consumer satisfaction, recent government reports have encouraged maternity services providers to offer women more choice about their care. At the same time, there has been considerable pressure on hospital managers and clinicians to drive down health service costs. Women need information about the likely effects of different service patterns on their wellbeing, and service providers about the implications of allowing women choice., Methods: This paper reports on a descriptive study in six districts in the Yorkshire Region and focuses on the implications of variation in length of stay. The aim of the study was to describe variation in the care process and to explore associations between care process variables, consumer satisfaction and maternal psychological wellbeing. One hundred and twenty randomly selected women in each district delivering in a specified four-week period were asked to complete postal survey questionnaires in the postnatal period., Results: There were significant differences between districts in terms of the length of postnatal hospital stay for women experiencing normal deliveries. Those women who thought that their postnatal length of stay was too short had significantly higher depression scores., Conclusions: Variation in length of postnatal hospital stay may have implications for consumer satisfaction, maternal psychological outcomes and resource use.

Midwives' clinical focus on contraception may not be the only way of meeting women's needs after childbirth. When a woman does not return to full sexual function, the explanations available to her tend to emphasise natural/biological, physical and psychological factors. These explanations may fall short of describing the experiences of many women. Midwives need to facilitate opportunities for women to raise issues and concerns significant to them so that women may explore changes in their experience of their own sexuality. To help women to anticipate changes in their lives after childbirth more fully, midwives need to facilitate discussion of sexuality--not just sexual activity--during antenatal preparation and postnatally.

Two Ontario sites were involved in the evaluation of an obstetrical discharge program. Before program implementation a group of eligible women were enrolled as the preprogram control group (n = 542). During the program, eligible women who agreed to early discharge (ED) became the ED group (n = 319), and those opting not to go home early but consenting to participate in the evaluation became the concurrent group (n = 456). All groups were mailed a self-administered postpartum questionnaire. On demographic characteristics, safety and satisfaction, the ED group was comparable to the concurrent group. Hospital readmission rates did not differ across groups after stratification by site or hospital. Multiple classification analyses revealed a similar pattern for overall satisfaction levels. This unique ED program, which allowed pre- or postnatal enrollment and did not require an initial home assessment, appears to be a safe, effective and flexible approach to obstetrical care.

This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (> 12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.

Objective: to determine the characteristics of a sample of women giving birth in one hospital in South Australia and these women's perceptions of the usefulness of the advice and care that they were given during the puerperium, Design: survey using questionnaires, incorporating Lipsett's (1984) questions, administered before the women left hospital and at six weeks postdelivery., Setting: one hospital in South Australia., Participants: a sample of convenience of 235 women completed the hospital questionnaire and 222 (95%) returned the six weeks postpartum questionnaire., Findings: the women's ages ranged from 17-44 years, 86% were living in a stable relationship and 42% were primiparous. Most women (74%) made comments on the helpfulness of midwives. The midwife provided emotional support (57%), answered questions (32%) and gave information (30%). However, midwives' attitudes were perceived as insensitive (18%) and judgemental (9%). Midwives gave conflicting advice (10%) and 40% of the women made one or more comments about midwife unhelpfulness. Sixteen per cent of the women made no comment on the helpfulness of the midwife., Implications for Practice: contact with midwives in the early postnatal period is an ideal time for helpful advice and support to be given but midwives are not always perceived as fulfilling this part of their role. There is a need to address the issue of conflicting advice.

Objective: To test the hypothesis that incentives enhance compliance with postpartum appointments., Method: We studied a multiracial group of 240, poor, 12-to-19 year olds. At 34 weeks gestation consecutively enrolled patients were randomized to incentive and non-incentive groups. Patients in the incentive group were told that they would receive a Gerry "Cuddler" if they returned for an examination within 12 weeks of delivery. The groups were compared with Student's t-tests and chi-square and logistic regression analyses., Results: We found no significant group differences in age, race, Medicaid status, gravidity, parity, the timing of the first prenatal visit, compliance with prenatal appointments, or well-baby care site. One hundred and seventy-five (73%) of the 240 patients returned for a postpartum examination. Patients randomized to the incentive group were significantly more likely to return for an examination within 12 weeks of delivery (82.4% vs. 65.2%, chi 2 = 9.0; p = .003). The logistic regression analysis revealed that in addition to membership in the incentive group, three characteristics were significantly associated with postpartum compliance: primiparity, compliance with prenatal care, and school enrollment., Conclusions: Among adolescents who obtained prenatal care in a multidisciplinary adolescent-oriented maternity program, the offer of an incentive significantly improved compliance with the 6-week postpartum appointment. Since other factors associated with improved postpartum compliance are less amenable to change we recommend that health care providers consider offering a postpartum incentive, especially to their multiparous adolescent patients who are not enrolled in school and/or are non-compliant with prenatal appointments.

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

The Edinburgh Postnatal Depression Scale (EPDS) was used to rate 217 patients at five days and six weeks post-partum. There was a highly significant positive correlation between the two scores, together with similar symptom profiles. Of the 25 women who suffered post-natal depression (6-week EPDS score greater than or equal to 13), 17 had similar symptoms in the first week post-partum (5-day EPDS score greater than or equal to 10). Low birth weight of the baby, delivery by Caesarean section, a delivery much more difficult than expected, and bottle feeding were all significantly associated with a high EPDS score in the first week post-partum. Bottle feeding and delivery by Caesarean section were the only factors associated with depression at the sixth week. A recollection of low mood after a previous birth was also associated with post-natal depression after the current birth. This, together with an EPDS score of 13 or more at five days post-partum, increased the risk of post-natal depression at six weeks 85-fold.

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

This article examines the rationales for commonly advocated postpartum family planning services and challenges the behavioral and biological assumptions on which they are based. An alternative approach to service delivery is suggested. Services should be designed to incorporate breastfeeding and to increase their acceptability to postpartum women.

The interaction of pregnancy and the rheumatic diseases has been described for most of the inflammatory joint disorders. However, the patient response to the challenge of motherhood and child rearing has seldom been taken into consideration. The current study presents data derived from a patient inquiry on these issues. The results demonstrate that while a wish for children is present even in disabled patients, the number of children regarded feasible depends largely on coping strategies, external help and the patient's own resources. Information before pregnancy is crucial, but often insufficient. Counselling should rely not only on medical facts, but also on patient experience.

Thirty-two Asian women living in East London were interviewed about their experiences of childbirth. A significant part of their accounts concerned their experiences in the postnatal wards. They reported fewer difficulties with infant feeding than their non-Asian counterparts in other studies, but there were indications of similar tensions between mothers and staff about how much responsibility mothers should take for their baby's care. Asian women raised several additional issues. Some centred on communication difficulties for Asian women who did not speak fluent English. Others point to their different ideologies around the care of the mother and baby and the nature of early mother-infant relations. Asian women viewed the opportunity to rest and recover postnatally as more central to their postnatal care than they considered hospitals did. Women had less to say and seemed less familiar with the discourse on bonding, and were less preoccupied with the establishment of close mother-infant relationship. The implications for ideas about 'normal' maternal behaviour and the quality of care are discussed.

Considering the importance of environmental design as behavioral context, a trial assessment was made in a postpartum recovery room, using systematic observation. Staff-patient and patient-patient interactions were also considered. Results indicate that alterations in some of the physical and programmatic environmental variables may contribute to improve patient assistance.

A nurse practitioner (NP) program to improve postpartum appointment keeping in an outpatient family planning clinic is described and evaluated. The subjects (N = 59) were non-high-risk obstetric patients prescheduled to be seen at 6 weeks postpartum by the NP. Two groups were identified by convenience sampling: Group A (n = 25), the nonintervention group, and Group B (n = 34), the intervention group. Two types of intervention were used: a postpartum telephone call after discharge (n = 11), or a predischarge postpartum visit (n = 23). Results suggest that those in the intervention group were more likely to keep their appointments (p less than .02); only the postpartum visit increased the probability of appointment keeping (p less than .05).

A 46-year-old mother with a history of chronic headaches and other symptoms, and a clinical diagnosis (in Western terms) of depression, ascribed her condition to non-observance of Chinese postpartum ritual. The characteristic features of "wind illness' are described. Western medicine proved useless but acupuncture was beneficial. The case underlines the importance of understanding the patient's own view of his/her illness and its causes in arriving at a correct diagnosis and intervening effectively: this is particularly true when the gap between the doctor's and the patient's cultures is wide. The value of the distinction between the disease (the pathological process, which may be universal) and an episode of illness (the personal and cultural construction of disease) is emphasized.

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