Over the last twenty years there has been an increasing international research interest in women's experience of postnatal perineal trauma and its impact on their physical, psychological and sexual health. To date, however, no research on perineal morbidity and general health has been undertaken in Malta. Using a longitudinal descriptive correlational design, a homogenous systematic sample of 144 Maltese postnatal mothers was recruited with the aim of exploring the relationship between perineal trauma and general health following normal delivery. Self-administered questionnaires within 48 hour s of delivery and again at 10 days, 6 weeks and 13 weeks sought to assess perineal pain, urinary and faecal continence, resumption of sexual intercourse and dyspareunia. The General Health Questionnaire-12 (Goldberg and Williams, 1998) assessed mothers' psychosocial health. Open-ended questions explored further their experience of perineal trauma and general health. The retention rate at the end of time 4 was 86.1%. Following descriptive and inferential statistical analysis, the key findings revealed a constant decline in perineal trauma and an inconsistent but significant rise in general health over time. Mothers sutured by senior hospital officers reported higher scores of well-being, and resumed sexual intercourse earlier than those sutured by registrars and senior registrars. Significant negative correlations persisted between postnatal total perineal trauma and resumption of sexual intercourse at 13 weeks but not at 6 weeks.Qualitative data generated three main themes: experiencing total perineal trauma, resuming sexual intercourse and maintaining general health. Mothers identified tiredness, exhaustion and emotional pain as other burdens alongside a painful perineum. 'Being not ready yet', 'fear of falling pregnant again' and 'caring for the baby and family' were reasons preventing postpartum sexual intercourse. Tedeschi, Park and Calhoun's (1998) post-traumatic growth theory provided an overarching theoretical framework.

Introduction. Infection prevention and control is both a national and international priority, with compliance with precautions being sub-optimal. One of the reasons suggested for poor compliance is a lack of appropriate education for health care professionals. There is a limited body of research available which considers infection prevention and control education for nursing students, particularly in clinical placements and no identified research in this area in midwifery. Aim. A body of research was undertaken with the overall aim of exploring and analysing the experiences and learning needs of nursing and midwifery students in relation to infection prevention and control in their clinical placements. Methods. An interpretivist approach was utilised to undertake semi-structured interviews with 32 nursing students, 15 midwifery students and 31 nurse mentors within a body of research comprising of three related studies. Date were analysed using Framework Analysis. Results. Several themes emerged from the body of work including the nature of infection prevention and control practice that is perceived as good or poor practice; attitudes towards infection prevention and control; barriers and motivators to learning about infection prevention and control; attitudes towards the infection prevention and control nurse and barriers to reporting poor practice. Conclusions. The body of work presented has several implications for future practice and research. New knowledge has been developed in particular in relation to perceptions of the role of the infection prevention and control nurse, barriers to reporting poor practice, the infection prevention and control education of midwifery students and the acceptance of poor practice as the norm. By triangulating findings from three separate but related studies, the research has been strengthened, providing additional support for the conclusions reached.

Introduction and Background The number of incarcerated pregnant women is increasing every day. At the same time, their quality of care is decreasing. From being treated like animals by jail staff to having unqualified staff members instructing them during labor, this has to change. Not only is the safety of the woman at risk, but most importantly her unborn baby. Purpose Statement Incarcerated pregnant women deserve the same healthcare as anyone else. The PICO question addressed in this paper is the following. In incarcerated pregnant women, how does ineffective health maintenance compared with effective health maintenance affect poor outcomes after childbirth? Literature Review CINAHL was used to locate five sources that were published within the last five years. The source had to include the words “childbirth,” “jail,” “prison,” “incarceration,” and “nurse.” If the article did not meet these guidelines they were excluded. One exception to these criteria was one source from 2013. The source was slightly outdated but had valuable data to be explored, so it was included. Findings Incarcerated pregnant women are de-humanized and maltreated every day and nothing is changing. Standards of care have been set in place for organizations, but they are not followed. Evaluation of these organizations and their healthcare is crucial to move forward and better health care for people in incarceration. Conclusions Insufficient research has caused a gap in literature. Limited resources are available to examine an incarcerated pregnant woman’s life and healthcare. Future research is essential to provided adequate care to these women.

Breastfeeding is the gold standard of infant feeding and its benefits extend beyond the mother and child. Multiple organizations recommend exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding rates nationally and in the state of Kentucky fall below the Healthy People 2020 goals. A mother’s intention to breastfeed has been shown to impact actual breastfeeding behavior. The current state of the measurement of intention was explored through a literature review. A majority of the measures were single item scales. The reliability and validity of the scales should be further tested in diverse populations. The purposes of this dissertation were to: a) explore the role of breastfeeding intention on duration of exclusive breastfeeding, and b) determine the common modifiable factors among women who breastfeed exclusively for at least four months. English speaking mothers 18 years of age and older were asked to participate if they had delivered a healthy infant in the last 72 hours and if they intended to feed their baby some amount of breast milk (n = 84). Mothers were followed for 16 weeks or until they weaned their infant, whichever came first. Social support, breastfeeding self-efficacy and breastfeeding intention were measured at baseline. Breastfeeding support and breastfeeding self-efficacy were measured at four and 16 weeks. Results indicated that mothers with stronger intention to breastfeed were more likely to breastfeed exclusively for a longer period of time. Mothers who breastfed their infant exclusively for 16 weeks were asked to participate in one of two focus group meetings (n = 15). The following five themes emerged from the data: 1) knowledge, 2) peer experience, 3) support, 4) perseverance, and 5) the public.

Health care providers’ (N = 421) implicit perceptions of pregnant women based on age, race or ethnicity, marital status, and socioeconomic status are assessed through a true-experiment design. Ordinal and binary regression analyses revealed that respondents felt more pity for an unmarried than married pregnant woman and more anger toward an unemployed pregnant woman without health insurance compared to a pregnant woman who was employed with health insurance. Male, Asian, and Hispanic respondents were less likely to help the pregnant woman, Black and protestant respondents were more likely to express some degree of anger toward the pregnant woman, and male and protestant respondents assigned more responsibility to the woman for her pregnancy. Additionally, respondents’ open-ended suggestions varied based on the pregnant woman’s characteristics. Implications and future directions are discussed.

For most of the 20th century, the saying “once a cesarean, always a cesarean” was a rule in the United States. Today, the National Institutes of Health (NIH) opposes the dictum and urges women to consider trial of labor after cesarean (TOLAC). However, the factors that lead to a successful outcome remain unclear, as research continues to be conducted in hopes of creating a predictive model for vaginal birth after cesarean (VBAC) success. The NIH’s request for more research in this area of obstetrics led to this retrospective cohort study of all TOLACs at Marin General Hospital (MGH) from 2000-2013. All labor trials were studied for patient demographics, details of labor, maternal and neonatal morbidities, insurance, and provider type. After confirming the quality of the data, verifying inclusion criteria and ignoring cases with missing data, a data set of 745 TOLACs with 13 explanatory variables of interest was prepared. A forward stepwise (Likelihood Ratio) binary logistic regression was run in IBM® SPSS® Statistics in order to create a model that could determine which variables were most predictive of delivery outcome in TOLAC patients. Ultimately, seven variables were predictive and were included in the model. Of the seven, the most predictive variable in determining VBAC success was provider type. The model concluded that a woman’s odds of having a successful VBAC were almost four times greater if she began her delivery with a certified nurse midwife, than if she began her deliver with a physician (odds ratio 0.27, 95% CI 0.17-0.44; < 0.01). The results from this study mimic the results of other models, and introduce labor support as a key factor in predicting VBAC success.

Traditionally, the lithotomy position is the most commonly used birthing position in western cultures. The purpose of this literature review was to examine the differences in maternal and neonatal outcomes when alternative labor positions are used. Implications for future use of alternative labor positions were explored. Peer reviewed, English-language research articles published from 2009 to 2015 were included for synthesis. Study results revealed that the lithotomy position is linked to multiple negative maternal outcomes. Birthing in a water pool or in a lateral position has been linked to more optimal maternal and neonatal outcomes compared to other positions. Health care providers, and nurses in particular, should be educated on the benefits and consequences of both the lithotomy position and alternative labor positions. Using this evidenced based research, health care professionals can educate women and families as they encounter the birthing process. Further research is needed to identify additional birthing outcomes of labor positions, specifically neonatal outcomes of the lithotomy position. In addition, research on innovative obstetric monitoring techniques will expand the opportunity to use alternative labor positions while protecting the mother and fetus.

Os objetivos do estudo foram: analisar a influência dos sintomas depressivos na qualidade de vida relacionada à saúde percebida por mulheres na gestação de baixo risco e pós-parto e verificar os fatores socioeconômicos e obstétricos associados à qualidade de vida e aos sintomas depressivos. Trata-se de um estudo longitudinal, com inclusão de 313 gestantes matriculadas em 11 Unidades Básicas de Saúde da zona sul do Município de São Paulo, SP. As participantes foram seguidas em quatro etapas: 20ª, 28ª, 36ª semanas de gestação e 45 dias após o parto, com ± 2 semanas em cada etapa. A coleta dos dados foi de julho de 2008 a março de 2010. A amostra final das quatro etapas constou de 132 mulheres. Os dados sociodemográficos e obstétricos foram obtidos por meio de entrevista na primeira etapa, com exceção dos do pós-parto, que foram coletados na quarta etapa. Para avaliação dos sintomas depressivos, foi utilizada a Edinburgh Postnatal Depression Scale (EPDS) e para avaliação da qualidade de vida relacionada à saúde, o questionário Medical Outcomes Study 36-Item Short Form Health Survey (MOS-SF36), que foram autoaplicados nas quatro etapas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa - Parecer nº 154/08-CEP/SMS. Os escores médios dos domínios do MOS-SF36 apresentaram declínio ao longo da gestação com recuperação no pós-parto, exceto Estado Geral de Saúde e Saúde Mental, com diferença significativa para Capacidade Funcional (p<0,000), Aspectos Físicos (p=0,001), Dor (p<0,001) e Vitalidade (p=0,002). A proporção de gestantes com sintomas depressivos variou nas quatro etapas, sendo de 29,5% na 20ª, 24,2% na 28ª, 24,5% na 36ª semanas de gestação e 33,6% com 45 dias de pós-parto. Houve correlação inversa significativa em todos os domínios do MOS-SF36 e a EPDS, com variação no coeficiente de Spearman de 0,234 a 0,785. Nas quatro etapas, os escores médios dos domínios mostraram diferenças significantes, na comparação entre gestantes sem e com sintomas depressivos, exceto Dor, na segunda etapa e Aspectos Físicos na quarta. Na regressão logística da qualidade de vida relacionada à saúde, os sintomas depressivos foram um fator de risco em todos os domínios, exceto Aspectos Físicos. Para os sintomas depressivos, as variáveis associadas foram situação conjugal, anos de estudo e número de consultas de pré-natal, como fatores de proteção e queixas como fator de risco. A presença dos sintomas depressivos na gestação e puerpério altera a percepção subjetiva da qualidade de vida relacionada à saúde em gestantes de baixo risco. / The aims of the present study were to analyze the influence of depressive symptoms on the health related quality of life (HRQOL) perceived by low risk pregnant women and at postpartum and verify the socioeconomic and obstetric factors associated with the quality of life and depressive symptoms. This is a longitudinal study and it was conducted with 313 pregnant women enrolled in 11 Basic Health Units of the southern area of São Paulo City, SP. The participants were followed up at their 20th, 28th, 36th weeks of gestation and 45 days postpartum, with ± 2 weeks in each periods. Data was collected from July 2008 to March 2010. The final sample of four periods consisted of 132 women. Sociodemographic and obstetric data was obtained by interviewing subjects in the first period and postpartum data in the fourth period. For the assessment of depressive symptoms, Edinburgh Postnatal Depression Scale (EPDS) was used and to assess the health related quality of life (HRQOL), the questionnaire Medical Outcomes Study 36-Item Short Form Health Survey (MOS-SF36), which were self-administered in four stages. The study was approved by the Ethics in Research Committee nº 154/08-CEP/SMS. The mean scores of the domains of MOS-SF36 presented decline over the gestation with postpartum recovery, except in General (Health) and Mental Health, with a significant difference in Physical Functioning (p<0,000), Role Limitation due to Physical Problems (p=0,001), Bodily Pain (p<0,001) and Vitality (p=0,002). The proportion of pregnant women with depressive symptoms was 29.5% at 20th, 24.2% at 28th, 24.5% at 36th weeks of gestation and 33.6% at 45 days postpartum. There was a significant inverse correlation among all domains of the MOS-SF36 and the EPDS, with Spearman coefficients range of 0.234 to 0.785. At the four periods, the mean scores of the domains showed significant differences between pregnant subjects with or without depressive symptoms except Bodily Pain in the second period and Role Limitation due to Physical Problems in the fourth one. At HRQOL logistic regression the depressive symptoms were a risk factor in all domains, except Role Limitation due to Physical Problems. To depressive symptoms, the associated factors were marital status, years of education and the number of prenatal consultations as protective factors and complaints as a risk factor. The presence of depressive symptoms at pregnancy and postpartum changes the subjective perception of Health related quality of life in low risk pregnant women.

With increased advances in technology, the overall survival rates in the Neonatal Intensive Care Unit (NICU) for premature infants at lower gestational ages, has also increased. Although premature infants survive at lower gestational ages, they are often discharged to home with unresolved medical issues. While the birth of a new baby for parents is a joyous occasion, they often have difficulty coping and transitioning into a parental role. Premature infants also have ongoing complications such as difficulty with feeding, developmental delays in growth, and long-term eye and respiratory complications. As a result of chronic health sequelae, premature infants require extensive utilization of hospital and community health resources. In addition, hospitals must coordinate between community resources, while preparing parents for specialized discharge teaching. Furthermore, individuals living in rural and underserved areas face unique challenges and barriers to access healthcare resources. An interpretive phenomenology study was conducted to bring insight and develop an understanding into how families perceive discharge readiness, accessing health care resources, and ability to cope at home after discharge from a Level III NICU located in Appalachia. Ten parents total were enrolled in the study and consisted of three couples, three married mothers, and two single mothers. Interviews were conducted over a period of six months and transcript analysis revealed development of major and minor themes. The studies overarching theme was Adapting to a New Family Roles, Finding Normalcy, which described parents experience of being prepared for discharge and their transition to home. Three major themes related to discharge readiness from detailed analysis included; 1) Riding out the storm, 2) Righting the ship, and 3) Safe port, finding solid ground. Subthemes that supported development of the major these were 1a) having the carpet pulled out from under me, 1b) things I lost, 1c) feel like an outsider, 1d) sink or swim, 2a) quest for knowledge, 2b) caring for me, care for my baby, 2c) customized learning, 3a) getting to know baby, 3b) becoming the expert, 3c) ongoing emotions, and 3d) adjusted parental role. Practice and research implications for discharge readiness include providing customized support for parents as they adjust to a new normal for their family, identify necessary resources, and become self-reliant once home.

Introdução: Os traumas perineais são um dos problemas mais frequentes durante o parto e podem afetar a saúde da mulher, interferindo em sua mobilidade, eliminação vesical e intestinal, cuidados gerais ao recém-nascido (RN) e outras atividades diárias. O local do nascimento, os profissionais que prestam assistência à mulher e as intervenções no parto influenciam a ocorrência do trauma perineal. Os centros de parto normal (CPN) favorecem a adoção de práticas para humanizar o parto e nascimento, respeitam sua fisiologia, a autonomia da mulher e dessa forma contribuem para o cuidado perineal. Objetivos: 1) Verificar a prevalência e o grau de lacerações perineais; 2) Analisar a relação entre a ocorrência e o grau da laceração perineal e as variáveis maternas, neonatais e assistenciais; 3) Analisar a relação entre o grau da laceração perineal e a prevalência do reparo perineal; 4) Analisar a relação entre a realização da sutura perineal e a prevalência de complicações na cicatrização perineal; 5) Verificar a prevalência do uso de métodos naturais no cuidado perineal após o parto. Método: Estudo transversal, com coleta de dados nos prontuários das mulheres que deram à luz no CPN peri-hospitalar Casa Angela, em São Paulo, SP, de janeiro de 2016 a junho de 2017 (n=415). Como exposição, foram considerados: idade materna, cor da pele, parto vaginal anterior, uso de ocitocina, compressa morna, posição no parto, duração do período expulsivo, distocia de ombros, peso e perímetro cefálico do RN, parto na água, grau de laceração perineal e reparo perineal. Como desfechos, foram considerados: laceração perineal, grau da laceração perineal, reparo perineal e complicações no processo de cicatrização. Os dados foram analisados por estatística descritiva e inferencial. O erro tipo I adotado foi de 5%. As variáveis com valor-p <0,20 foram inseridas em um modelo de análise múltipla. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo. Resultados: A prevalência de lacerações de primeiro e segundo graus foi de 61,9% e 26,3%, respectivamente. O períneo manteve-se íntegro em 11,8% das mulheres e não houve nenhuma episiotomia. As variáveis relacionadas com aumento da ocorrência e do grau das lacerações perineais foram: idade materna (aumento de 4% na chance para cada ano); período expulsivo do parto acima de 2 horas (2,8 vezes mais chance). Os fatores que se mostraram protetores contra a ocorrência e maior grau das lacerações foram: número de partos vaginais anteriores (redução 56% na chance para cada parto); posição materna diferente da vertical durante o parto (redução de 51% a 67% na chance, para as posições sentada, semi-sentada, quatro apoios e lateral). O reparo perineal foi realizado em 16% e 70,6% das mulheres com lacerações de primeiro e segundo graus, respectivamente. As complicações perineais predominantes foram o edema (53,6%) e a dor (29,4%) e reparo aumentou a chance dessas complicações (OR=2,5; 95%IC 1,5-4,3). A compressa de gelo no períneo foi usada em 53,8% das mulheres no pós-parto e a de calêndula em 36,6% delas. Conclusão: Fatores maternos e de assistência ao parto contribuíram para o aumento ou a redução da prevalência e grau da laceração perineal. Houve predomínio das lacerações de primeiro grau, reparadas em um número reduzido de mulheres. Quando o reparo perineal foi realizado, foi maior a frequência de complicações no processo de cicatrização, independentemente do grau da laceração. Os métodos naturais para o cuidado perineal foram usados em pouco mais da metade das mulheres. / Introduction: Perineal trauma often occurs during labour and can affect women\'s health by interfering with her mobility, bladder and bowel elimination, general newborn (NB) care and other daily activities. Place of birth, caregivers, and labour and delivery interventions influence the occurrence of perineal trauma. The birth centres (BC) favour the adoption practices to humanize the birth assistance, respecting its physiology, the womens autonomy and thus contribute to the perineal care. Objectives: 1) To verify the prevalence and degree of perineal trauma; 2) To analyse the relationship between the occurrence and degree of perineal trauma and maternal, neonatal and assistance variables; 3) To analyse the relationship between the degree of perineal trauma and the prevalence of perineal repair; 4) To analyse the relationship between the perineal suture and the prevalence of complications in perineal healing; 5) To verify the prevalence of the use of natural methods in perineal care after childbirth. Method: A cross-sectional study was carried out with data collection from the records of women who gave birth at Casa Angela alongside BC, in São Paulo, SP, from January 2016 to June 2017 (n=415). As exposure were considered: maternal age, skin colour, previous vaginal delivery, oxytocin use, warm compress, birth position, duration of the second stage of birth, shoulder dystocia, weight and head circumference of the newborn, water birth, degree of perineal trauma and perineal repair. As outcomes were considered: perineal trauma, degree of perineal trauma, perineal repair and complications in the healing process. Data were analysed by descriptive and inferential statistics. The type I error was 5%. The variables with p-value <0.20 were inserted in the multiple analysis model. The project was approved by the Research Ethics Committee of the School of Nursing of the University of São Paulo. Results: The prevalence of first and second degree trauma was 61.9% and 26.3%, respectively. The perineum remained intact in 11.8% of the women and there was no episiotomy. The variables related to increased chance of occurrence and degree of perineal trauma were: maternal age (each year increase 4% in chance); duration of the second stage of birth over 2 hours (2.8 times more chance). The factors that were protective against the chance of perineal trauma occurrence and second degree trauma were: number of previous vaginal deliveries (for each delivery, 56% chance reduction); maternal birth position (reduction from 51% to 67% of the chance for sitting, semi-seated, squads and lateral). Perineal repair was performed in 16% and 70.6% of women with first and second degree trauma, respectively. The predominant perineal complications were oedema (53.6%) and pain (29.4%) and repair increased the chance of these complications (OR = 2.5; 95% CI 1.5-4.3). The perineum ice pack was used in 53,8% and calendula compress in 36,6% of postpartum women. Conclusion: Maternal and childbirth factors contributed to increase or decrease the prevalence and degree of perineal trauma. There was a predominance of first degree trauma, which was repaired in few women. When the perineal repair was performed, the frequency of complications in the healing process was higher, independent of the degree trauma. Natural methods for perineal care were used in more than half of women.