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.

No childbirth education (CE) programs are available in the public sectors in Jordan. Many studies from Jordan recommended that pregnant women be educated about their health needs during pregnancy and childbirth. From the literature, CE programs were found to have positive effects on pregnancy and childbirth outcomes. Four focus groups with pregnant women, midwives and physicians were conducted to examine the perceptions of pregnant women, midwives and physicians regarding the content, feasibility, and challenges of implementing a CE program in Jordan. The 4 focus groups, two with pregnant women (one group with 8 primiparous women and one group with 6 multiparous women), one with 8 midwives, and one with 6 physicians were presented with the content, timing, and a description of three existing CE programs. Findings indicated that pregnant women’s sources of knowledge about pregnancy and childbirth were mainly from other females and doctors but not from midwives. Younger pregnant women reported the Internet as an important source of pregnancy and childbirth knowledge. Findings showed that women were not sure of what they wanted to learn. Midwives and physicians wanted to include warning signs, physical exercises, psychological changes, vii nutrition, breast feeding, newborn heath, sexually transmitted diseases, pain management, postpartum physiology and care, family planning, and planning of pregnancy as content in a new CE program. All participants reported the need to include husbands in CE. However, husbands were considered a potential challenge to implementing a CE program. Other challenges were cost, staff, clients’ responses, and governmental policies. Midwives and physicians thought that CE should be included in free antenatal care. All participants reported support for a new CE program. Midwives and physicians suggested implementing the new program within the facilities of the Ministry of Health (MOH). This would decrease cost and the need for staffing for the new program. They suggested that the CE program could benefit from potential support from international sponsors that affiliate with the MOH. Potential benefits of CE could potentially help gain support from the MOH decision makers and the community in Jordan.

Every year, 16 million women aged 15 to 19 years give birth globally. Adolescent births account for 11% of all births globally and 23% of the overall burden of disability and diseases due to pregnancy and childbirth. In the United States, 750,000 adolescents (15-19 years) become pregnant each year, making the United States the developed country with the highest rates of adolescent pregnancy. The economic burden of adolescent pregnancy in the U. S. is $7-15 billion per year. Adolescent pregnancy brings risks associated with pregnancy induced hypertension, preterm infants, maternal and neonatal mortality. Social factors include poverty, low educational levels, alcohol, and drug use. Between 30-50% of adolescent mothers who have a first birth before age 18 years will have a second child within 12 to 24 months. Subsequent adolescent pregnancies compound fetal and maternal risks. Many vulnerable adolescent mothers succumb to external pressures and have a repeat adolescent pregnancy while others are able to overcome the challenges of an adolescent pregnancy and prevent a repeat adolescent pregnancy. This cross sectional survey designed study investigated the effects of resilience and social influences on contraceptive use or abstinence by Black and Hispanic adolescent parenting mothers to prevent a repeat adolescent pregnancy. 140 adolescent mothers were recruited from three postpartum units of a tertiary hospital system in Miami, Florida. The Wagnild and Young Resilience Scale and the Adolescent Social Influence Scale were used to measure resilience and social influences, respectively. Demographic data, length of labor, plan for contraceptive use or abstinence were measured by an investigator developed instrument. Point biserial correlation showed a significant positive correlation between Black adolescent mothers’ resilience and contraceptive use (r =.366, p2(11, N=133) = 27.08, p =.004. (OR = .28). These results indicate a need for interventional strategies to maximize resilience in parenting adolescents to prevent a repeat adolescent pregnancy.

Many babies are delivered by using the standard lithotomy birthing position. However, evidence shows several benefits to an upright birthing position. The purpose of this study is to discover birthing positions that lead to more positive outcomes in laboring women delivering in hospitals. This research was conducted by examining previous studies conducted on a similar topic. However, the studies found mainly focused on the benefits of squatting positions and the implementation of devices that helps achieve an upright position. All findings support an upright birthing position provides a more optimal position for birthing a child due to the force of a more natural pelvic expansion and gravity. One of the barriers of this area of study includes the lack of pregnant mothers willing to participate in a study skewing the reliability of many studies. In conclusion, the articles analyzed provide pertinent information that supports the intervention of nurses and midwives providing patient education to explore birthing options outside of standard practice that could lead to more positive outcomes.

Introduction and background Opioid use disorder (OUD) is an epidemic in the U.S. OUD affects both the mother’s and infant’s health. Substance-exposed infants suffer from decreased health outcomes relative to non-exposed infants. Purpose The aim is to identify infant health outcomes when pregnant women are prescribed medication-assisted treatment (MAT) for OUD. Among pregnant women with OUD in the U.S., is medication-assisted therapy as compared to no therapy associated with decreased negative infant health outcomes? Literature review Five studies on OUD and infant outcomes in the U.S. were reviewed. CINAHL and PubMed were searched using terms opioid use disorder, pregnancy, and neonatal abstinence syndrome (NAS). The search was limited to the last five years and full text only. Of the 815 results, five articles were selected that focused on infant outcomes and prevention of NAS. Articles were excluded if the focus was solely on the maternal outcomes, cost, or unoriginal research. One meta-analysis was included that compared two types of MAT for pregnant women with OUD. Findings MAT is correlated with a shorter hospital stay and less severe NAS symptoms in infants. Conclusion and implications Rates of NAS and OUD have increased significantly in the US. Some of the increase may be attributed to the transition to ICD-10 codes. MAT for pregnant women with OUD is associated with better health outcomes for infants. Patient-centered care could help decrease negative health outcomes for both infants and women with OUD. Future study should focus on degrees of opioid exposure and related outcomes.

Purpose: Social determinants of health (SDoH) and rurality have both been shown to contribute to severe maternal morbidity (SMM). Appalachian communities often embody this compounded risk, but regional SMM is under-explored. This study’s purpose is to explore SMM in rural areas of Appalachian states. Aims: There are two specific aims. 1) Describe the prevalence of rural SMM in Appalachian states. 2) Investigate the relationship between SMM and SDoH, specifically income, education, and care access. Methods: An IRB exempt, descriptive correlational study was conducted. Birth data (2018-2022) were extracted from the CDC WONDER database for 12 Appalachian states. Demographic, income, and education data were obtained from the U.S. Census. Access was measured by March of Dimes (MoD) maternity care categorizations. Descriptive statistics and Pearson’s correlations were conducted in IBM SPSS. Results: Rural SMM rates correlated with poverty (r =.803, p Conclusions: This study describes rural SMM in Appalachian states, showing correlation with poverty, education, and maternity care access. Limited access to care is correlated with a higher SMM burden for rural areas. This points to the need for further exploration into rural SMM, and the interplay of SDoH and geography in relation to maternal health.

Background: The Theory of Cultural Distress offers a framework for understanding the potential outcomes in patients who do not receive care that incorporates their cultural beliefs (DeWilde & Burton, 2017).This study represents initial steps in researching the theory byexploring the layering of stressors that place the patient at risk for Cultural Distress. Methods: Utilized aCross-sectional descriptive correlational analysis of intersecting identities (Structural Stressors), ethnicity-related stressors (Otherness) and ethnic-identity (Otherness) to develop understanding of the potential effects of these variables on psychological stress. Independent variables included intersecting identities, perceived ethnic discrimination, concern for stereotype confirmation, own group conformity pressure, and group membership. The dependent variable was perceived stress. Participants were also asked to define the word culture. Results: Stereotype confirmation concern, perceived ethnic discrimination, group membership, and own group conformity pressure were significantly associated with perceived stress. Intersectionality was not significantly associated with perceived stress but was significantly associated with perceived ethnic discrimination. Regression analysis revealed stereotype confirmation concern, own group conformity pressure, and group membership as significant predictors of perceived stress. Participant definitions of culture primarily fell under two themes, Collectiveness and Individualness, indicating that the way we live is highly influenced by our shared experiences, and also a product of individual choices. Discussion: Results indicated that structural stressors had no influence on psychological stress but were associated with perceptions of discrimination. The experience of otherness significantly influenced psychological stress. Additional research and tool development is needed to better understand how structural stressors may influence psychological stress.

The United States is ranked 27th in the world for maternal mortality, yet spends twice as much on maternity care services as countries with better maternal health indicators. Stuck in a technocratic and physician-dominated maternity care system, the U.S. depends on expensive technologies to control birth out of fear of pain and litigation, costing Americans billions of dollars and depriving women of the opportunity to have a transformative birth experience. Through an analysis of the medicalization of birth and the current biomedical model in birth, in conjunction with open-ended interviews with 5 hospital midwives and 3 homebirth midwives, the benefits and challenges of incorporating a midwifery model of care into our maternity services are explored. The midwifery model emphasizes that birth is not pathology and that psychosocial factors play a large role in birth outcomes. Basing their practice on collaboration, education, and support, midwives empower women, avoid unnecessary interventions, and offer a lower cost and higher quality care alternative. The current monopoly of women’s health services by physicians is unsustainable. Incorporating midwives into the maternity care team could provide a sustainable alternative with the caliber of maternity care services that U.S. women and families deserve.

Abstract Introduction and Background: According to the Centers for Disease Control and Prevention (2020), “postpartum depression is depression that occurs after having a baby which is more intense and lasts longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby.” It also states, “1 in 8 women report symptoms of depression after giving birth, about 1 in 5 (20%) women were not asked about depression during a prenatal visit, and over half (50%) of pregnant women with depression were not treated.” Purpose Statement: The purpose of this research is to investigate the connection between preventing postpartum depression or reducing postpartum depression with exercise interventions along with incorporating nursing and other healthcare professions. Literature Review: The design of studies included two randomized control trials, one randomized control trial with a prospective pretest-posttest experimental design, one cross-sectional descriptive design, and a population-based, prospective cohort design. These five articles were found through PubMed, Google Scholar, and the ETSU library database. Findings: Exercise interventions are beneficial to reduce postpartum depression symptoms. Nurses specifically can utilize this data to assist women with postpartum depression symptoms and provide better education throughout pregnancy and early postpartum to help prevent postpartum depressive symptoms. Conclusions: Future research is suggested to focus on the mode, frequency, intensity, and duration to describe the volume of physical activity in a given time frame that is needed to affect postpartum depression. Keywords: exercise, postpartum depression, nursing

Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more than 2 times the national average in 2017. The purpose of this descriptive cross-sectional non-experimental study was to examine how formal SUD nursing education, personal experiences, and participant characteristics predict attitudes and knowledge of nursing students and practicing perinatal nurses in Tennessee toward pregnant and perinatal women with an SUD. The sample consisted of 262 nursing students and 99 perinatal nurses across the west, middle, and eastern regions of Tennessee. A linear multiple regression showed that having a personal experience with a close friend with an SUD was predictive of improved knowledge scores of pregnant and perinatal SUDs. Independent samples t-tests were non-significant between formal SUD nursing education and attitudes and knowledge. Additionally, non-significant findings were seen between having a personal experience with a family member with an SUD and attitudes and knowledge. The findings suggest that Tennessee nursing education efforts were not influential in positively affecting attitudes and knowledge scores toward pregnant and perinatal women with an SUD. Future studies focused on exploring various educational interventions to promote knowledge, improve attitudes, and empathy in nursing populations toward pregnant and perinatal women with an SUD are warranted.