Thesis (M.S.)--Boston University

Objective: Mastitis is a common and painful condition experienced in up to 33% of breast-feeding women (Cusack & Brennan, 2011; Jahanfar, Ng & Teng, 2009; Scott, Robertson, Fitzpaterick, Knight, & Mulholland, 2008; Spencer, 2008). The period following having a baby may be emotionally and physically demanding due to the physical, hormonal and lifestyle changes a woman undergoes (Cusack & Brennan, 2011). Developing mastitis during this time may therefore be debilitating and has been found to be a common reason for discontinuing breastfeeding. This study aimed to explore women’s experiences of breast-feeding and mastitis, the formal and informal support that was available to them when they had mastitis, and the impact it had on whether they continued or discontinued breastfeeding (Amir, Forster, Lumley & McLachlan, 2007; Cleminson, Oddie, Renfrew & McGuire, 2015). Method: Grounded theory was used to analyse the data. Sixteen women who had experienced mastitis were included in the study. Results: All of the women intended to breast-feed. However, they often experienced problems early on (i.e. engorgement and nipple damage) that were unexpected and left them feeling exhausted and emotional. These problems precipitated mastitis. Mastitis was for most, a very difficult experience sometimes leading to discontinuation of breast-feeding. Delaying help-seeking negatively affected health outcomes. Determination and receiving good advice and support were fundamental factors in breast-feeding continuation. Conclusion: Improved support, communication, and advice with breast-feeding from the outset would reduce the risk of problems occurring and persisting, and potentially reduce the risk of mastitis developing. Early diagnosis and treatment of mastitis once it has developed is very important. Understanding that breast-feeding is a skill that often encompasses both ups and downs may reduce the pressure women put on themselves when they feel like they are failing because it is not going as well as they expected it to. Once mastered, women found breast-feeding to be a lovely bonding experience that exceeded their expectations.

<p> Postpartum depression (PPD) is a heterogeneous syndrome that is one of the most common complications of childbirth. Previous literature suggests that seven to twenty percent of U.S. women experience perinatal mood symptoms, making PPD treatment vital for the well-being of mothers and their infants. However, there is a paucity of literature focusing on the perinatal experiences of women of color, including Muslim women, which suggests further research is needed to better understand PPD in this population. The current study describes the characteristics of a convenience sample of U.S. Muslim women&rsquo;s postpartum depressive symptoms and identifies associated risk and protective factors in this sample. Muslim women living in the United States (<i>N</i> = 261) participated in an online survey, which inquired about demographics, perinatal medical and risk factors, mental health (depression and anxiety), tolerance of ambiguity, acculturation, and gender role attitudes. Participants also provided details about religious and cultural contexts of their perinatal experiences. Data were analyzed utilizing both quantitative and qualitative approaches.</p><p> Overall, the majority of the sample was married and highly educated compared to the general U.S. Muslim population. Results showed that 28% of the sample endorsed clinical levels of depression. Across a series of multiple linear regression analyses, we noted that Islamic religiosity, tolerance of ambiguity, religious practice during pregnancy, engaging in the five daily prayers postpartum, and Tehneek predicted lower postpartum depressive symptoms. Islamic religiosity, engaging in the five daily prayers postpartum, and Tehneek also predicted life satisfaction. Finally, qualitative analyses revealed that at least some women in the sample experienced ambivalence toward some culturally specific practices in the perinatal period. Results of the current study provide a foundation for future research, which should focus on developing and assessing prevention programs, screening tools, and interventions that address the unique mental health needs of perinatal Muslim women.</p><p>

<p> Women involved with the criminal justice system face higher rates of unintended pregnancy than the general population, yet less than one-third use a consistent method of contraception. One study found that among women leaving detention, 43% had conceived within one year of release. Pregnancies that do occur are often high risk and result in poor outcomes for both mother and child. Lack of focus on family planning needs post-incarceration are due to competing factors women face related to daily survival and the added demands of meeting the requirements of probation.</p><p> This study examined the influences of pregnancy attitude, reproductive autonomy, personal factors and prior related behaviors on the use of effective birth control among women on probation living in southern New Mexico including the U.S.- Mexico border region. Using a quantitative correlational design framed by Pender's Health Promotion Model, 52 women were surveyed at five different Adult Probation and Parole Offices in two U.S.-Mexico border counties and two additional counties in southern New Mexico. Data analysis was conducted using descriptive statistics and logistic regression (single, multivariate, and hierarchical) to answer the following questions about women on probation: Do personal characteristics (contraceptive self-efficacy, birth control method prior to incarceration, age, ethnicity, and parity) significantly predict current birth control method? Which combination of personal characteristics (ethnicity, contraceptive self-efficacy, age, and parity) best predicts higher negative pregnancy attitudes and higher reproductive autonomy? Do pregnancy attitude and reproductive autonomy significantly predict current birth control method.</p><p> Results indicated a significant relationship between increased levels of reproductive autonomy (an interpersonal influence) and effective use of birth control among women on probation. While statistical significance was attained for two additional variables, contraceptive self-efficacy and prior birth control use, the results were not decisive due to widened confidence intervals. Use of a hierarchical logistic regression was effective for entering predictor variables into the regression based upon Pender's theoretical framework as a guide. Implications for nursing research, education, and practice were discussed. Future studies using larger sample sizes and additional settings would increase validity and generalizability.</p><p>

<p> Depression and anxiety during pregnancy can have a host of negative effects on mothers and their infants, such as premature delivery and increased risk for postpartum depression. Few studies have examined whether levels of the sex hormones progesterone and estradiol, which rise dramatically over the course of pregnancy, are associated with depression and anxiety. This study examined whether higher salivary progesterone and estradiol levels were associated with self-reported depression and anxiety scores among a sample of 128 low-income pregnant women, and whether these relationships were moderated by social support. The results showed that only social support levels had significant negative associations with both depression and anxiety levels. Sex hormones were not significantly associated with depression and anxiety, and social support was not a significant moderator in these relationships. Future studies should continue to address the dearth of research on assessing the roles of sex hormones in relation to mental health during pregnancy.</p><p>

<p> Childbirth trauma for mothers in hospital settings is an escalating reality in American healthcare. References on childbirth-related posttraumatic stress disorder (PTSD) show gaps in detection and care. Using hermeneutic and heuristic methodologies, this thesis explores cultural and individual factors that lead to the traumatization of women and the medical failure to restore them to holistic well-being. Literature reviewed contrasts contemporary childbirth paradigms&mdash;technocratic, holistic, and humanistic&mdash;and their implications on systemic protocols and birth outcomes. Somatic and psychospiritual modalities to treat trauma are introduced. The author&rsquo;s birth narrative and analysis illustrates the inner experience of trauma, while providing psychological insights using the Heroine&rsquo;s Journey as a framework for liberating women from patriarchal victimization and facilitating individuation&mdash;the Jungian model of psychological development. Clinical applications are offered that aim to be protective for would-be mothers and restorative for women suffering from childbirth trauma&mdash;providing healing on mental, emotional, and spiritual levels.</p><p>

Labour has been characterized as the most dangerous journey a woman undertakes. The reason being, that although it is a natural process, many labouring women suffer complications during labour and childbirth including prolonged or obstructed labour. These complications can result in maternal and infant morbidity and mortality. The partograph is a monitoring tool that can provide a continuous pictorial overview and is essential to monitor and manage labour. It is recommended by the WHO for use universally by midwives while monitoring labour. However partographs are poorly utilized and most parameters on the partograph are not monitored and findings after reviewing a labouring woman are not documented on the partograph. It is unclear how midwives working in Namibian Health services experience and utilize the partograph during the monitoring of a woman in labour. These may be the factors that hinder the effective utilization of the partograph. The objective of this study was to explore and describe the experiences of midwives regarding the utilization of the partograph for monitoring a labouring woman in a Namibian regional hospital in order to develop guidelines based on the findings to improve the use of the partograph by midwives in order to improve the management of labour. The research design was qualitative, descriptive, explorative and contextual in nature. The research population consisted of midwives working in a regional hospital in Namibia. A purposive and convenient sampling method was used to select participants. Specific inclusion criteria were met and consent was obtained from the participants and from the Regional Health Directorate Management of the hospital where the research was conducted. Interviews were conducted by an independent interviewer within the Department of Health to ensure an unbiased viewpoint. Data were collected by means of semi-structured in depth interviews with a guide, using an audio tape recorder. Field notes were used to record non- verbal communication. As soon as data were saturated, the interviews were stopped. They were then transcribed, verbatim and analysed using the Tesch’s approach as described in (Creswell, 2009:186). The service of an independent coder was utilized to ensure trustworthiness. Trustworthiness was further ensured by using the strategies suggested by Lincoln and Guba’s model, namely credibility, transferability, dependability and confirmability. Ethical considerations were honoured throughout by adhering to ethical principles during the study. These included ensuring that the participants` rights were respected, they were not harmed and fairness were ensured. On completion of the data analysis a literature control was conducted and existing literature was compared to the findings in order to identify similarities and differences and to verify whether the literature supported the findings. Four main themes that emerged during data analysis are:  Theme 1.Midwives found it a positive experience to use the partograph when caring for a woman in labour.  Theme 2. When a midwife experienced problems in using the partograph, it may lead to detrimental outcomes.  Theme 3. Utilizing the partograph evoked differing emotions in midwives.  Theme 4. Midwives` knowledge and skills in the utilization of the partograph should be updated regularly. By describing the lived experienced of midwives in the maternity ward on the use of the partograph, the midwives had a positive attitude to using the partograph, but they also found it difficult to utilize the instrument as was directed by the (WHO) due to challenges experienced such as: unrealistic staff/patient ratio, shortage of staff, time consuming, insufficient knowledge and skills among midwives and lack of appropriate equipment. There is a specific need to prevent further negative emotions by addressing the challenges experienced. Based on the findings, guidelines for partograph utilization which aimed at improving the midwifery care were developed. Recommendations were made regarding midwifery education, clinical midwifery care and midwifery research.

BACKGROUND: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality, affecting 2-8% of pregnancies worldwide. It is estimated that 76,000 women and 500,000 babies die from this disease each year globally. Preeclampsia is characterized as hypertension associated with the onset of proteinuria, maternal organ dysfunction or uteroplacental dysfunction occurring at or after 20 weeks of gestation. In addition to its effects on pregnancy, preeclampsia may also have long-term adverse effects on women who experience the disorder and their children later on in life. Currently, the only cure for preeclampsia is delivery, which is often associated with preterm birth, increasing the risk of neonatal death. Daily low-dose aspirin (81mg) has been shown to have a preventive effect on preeclampsia in women at high risk of developing the disorder. OBJECTIVE: To analyze patient data collected at Boston Medical Center to determine the effects of prescribed low dose prenatal aspirin (81 mg) on pregnancy outcomes. METHODS: There were 2648 obstetric deliveries at Boston Medical Center in the two-year span of 2017-2018. Using R, statistical analyses were performed to determine the difference in birth outcomes between the prenatal aspirin prescribed group and the non-aspirin prescribed group as well as the effect of prenatal aspirin on pregnancy outcomes. Logarithmic and linear models as well as basic statistical methods were employed for the analyses. RESULTS: The prenatal aspirin prescribed population had higher major and moderate risk factors as well as worse birth outcomes, Apgar scores and birthweight as compared with the non-prescribed population. However, prenatal aspirin may reduce the adverse effects of both major and moderate risk factors on birth outcomes. CONCLUSIONS: Prenatal aspirin may have beneficial effects on birth outcomes, and the pregnant population at Boston Medical Center may benefit from taking low-dose aspirin. This study was carried out retrospectively with a cohort that was not randomized, so this conclusion needs to be verified by future studies.

Thesis (M.S.)--Boston University

Phosphoinositide-3-kinase (PI3K)/Akt dependent signaling has been shown to improve outcome in sepsis/septic shock. There is also ample evidence that PI3K/Akt dependent signaling plays a crucial role in maintaining normal cardiac function. We hypothesized that PI3K/Akt signaling may ameliorate septic shock by attenuating sepsis-induced cardiac dysfunction. Cardiac function and survival were evaluated in transgenic mice with cardiac myocyte specific expression of constitutively active PI3K isoform, p110α (caPI3K Tg). caPI3K Tg and wild type (WT) mice were subjected to cecal ligation/puncture (CLP) induced sepsis. Wild type CLP mice showed dramatic cardiac dysfunction at 6 hrs. Septic cardiomyopathy was significantly attenuated in caPI3K CLP mice. The time to 100% mortality was 46 hrs in WT CLP mice. In contrast, 80% of the caPI3K mice survived at 46 hrs after CLP (p30 days (p