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INTRODUCTION: Poor sleep quality is a significant risk factor for the development of postpartum depression. This thesis examined the impact of a post-delivery intervention which promoted and protected sleep during the immediate postpartum period on maternal mood, sleep quality, and anxiety. METHODS: 41 women with lifetime or current mood and/or anxiety disorders (12 receiving the intervention) were enrolled in this prospective naturalistic cohort study from the third trimester of pregnancy until 24 weeks postpartum. Depression, the primary outcome, was measured using the Edinburgh Postnatal Depression Scale at 12 weeks postpartum. Remaining outcomes (sleep quality and anxiety) were measured using self-report questionnaires (Insomnia Severity Index and State-Trait Anxiety Inventory, respectfully), and objective measures (i.e., actigraphy for sleep quality). RESULTS: There were no significant differences between the comparison and intervention group in depressive symptomatology at postpartum week 12 (primary outcome). On our secondary outcomes, we found that there were no significant differences in subjective and objective sleep quality at postpartum week two, or anxiety symptomatology at postpartum week eight between the two groups. There were also no significant differences in breastfeeding rates between the two groups at postpartum week 24. CONCLUSION AND FUTURE DIRECTIONS: Floor effects, specialized perinatal psychiatric treatment for a specific population, and low statistical power offer explanations for the observed null results. Strengths of our study include diagnosis of mood/anxiety disorders using the gold-standard (i.e., clinician diagnosis), and use of objective sleep measures. Future studies may benefit from implementing this intervention in resource-poor settings, using adequately powered research designs. / Thesis / Master of Science (MSc) / While the arrival of a child is a celebrated and joyous occasion, it can also be a source of duress and anguish, particularly for the mother. Postpartum depression is a mood disorder experienced by 10-15% of mothers after childbirth. One of the strongest risk factors for the development of postpartum depression is disrupted postpartum sleep quality. This thesis examined the impact of an intervention designed to protect and promote sleep of mothers during the postpartum period in an effort to improve mood, sleep quality, and anxiety symptomatology. By improving maternal mental health, not only do women benefit, but their children, their partners, and the healthcare system.

Yes / Though many women may be dissatisfied with their bodies, maternity represents a period when the body deviates significantly from Western beauty ideals. However, the developing corpus of literature is contradictory and there is limited knowledge about the longer-term implications of maternity. Further, much of the early postpartum literature focuses on body image, precluding consideration of broader embodiment and other potential issues. Taking account of recent feminist critiques about acknowledging women’s reproductive capacities, the study reported here explores the embodied subjectivity of longer-term bodily changes resulting from pregnancy, childbirth and early mothering. The data explored are from three focus groups. Mothers were recruited from two universities in the North of England, UK. Data were transcribed and analysed thematically and discursively using a feminist and poststructuralist approach, while also taking account of where language was elusive. A number of contradictory, yet interrelated embodied constructions were identified including the aesthetic, the maternal, the suffering/sentient, the strong and the embarrassing body. New insights are offered, in that, not only are the postpartum body and the ‘work of mothering’ inextricably linked, but also that maternal embodied identities are in continuous process across the life course and may have implications for health and well-being.

Dairy cows are increasingly predisposed to diseases in the periparturient time period due in part to immunosuppression. Dystocia amplifies the disease risk due to the increased tissue trauma and stress the animal endures during the lengthened parturition. To decrease the increased inflammatory response seen in dystocic animals and improve their well-being in the postpartum period, we administered either a potent steroid, dexamethasone (DEX), or a saline control (CON) to cows within 12 hours after a dystocic parturition. The inflammatory marker haptoglobin was measured as well as behavioral and production measures. We observed that primiparous DEX cows exhibited a greater haptoglobin concentration on d 3 and d 7 postpartum compared to primiparous CON cows. Behavior was seen to be altered between the treatments, with DEX cows having reduced locomotion and increased lying times in the week following parturition. These measures could indicate pain reduction, suggesting improved comfort. Milk yield was affected, with a reduction of 7.3 kg/d in multiparous DEX cows in comparison to CON cows for almost the entirety of the first month following dexamethasone treatment. No treatment effects were seen for milk production of primiparous cows. Additional research is needed for further investigation of the immunological and production effects of steroids on postpartum dairy cows, especially between parities. / Master of Science in Life Sciences / Dairy cows are most likely to develop metabolic diseases in the weeks leading up and following calving. This risk can be heightened in cows that experience a difficult calving process, most likely due to an increased inflammatory response. A potent steroid, dexamethasone, was assessed after a difficult calving to see if postpartum animal recovery is accelerated through dampening of the inflammatory response. Dairy cows were given either dexamethasone (DEX) or saline control (CON) within 12 hours after a difficult birth to counter the inflammatory response. Our study found that primiparous cows that received dexamethasone, exhibited a greater concentration of the inflammatory marker, haptoglobin, on d 3 and d 7 postpartum than in CON cows. This may be attributed to increased tissue trauma in first time calvings since there was no treatment difference in multiparous cows. Cows that received dexamethasone also had a reduction in locomotion and an increased amount of total lying time in the days following calving. Additionally, multiparous cows that received dexamethasone exhibited a reduction in milk production by 7.3 kg/d for almost the entirety of the first month following treatment. Future research needs to examine the long-term effects of dexamethasone on the mammary gland and the inflammatory response in different parity cows postpartum.

In 2021, over three and a half million women entered the postpartum period in the United States [1]. Despite their prevalence, postpartum health is a largely overlooked area. After delivery, 25% of women within this population experience lumbopelvic or pelvic pain during the typical postpartum period [3], up to 8 weeks post-delivery, and research has found these women may continue to experience pain years after delivery [4]. Persistent pelvic region pain in postpartum women may result in lower limb load asymmetry. Additionally, external loading from carrying a child may alter the degree of asymmetric loading that exists in the lower limbs. Therefore, the first purpose of this study was to investigate the effect of daily tasks on lower extremity load symmetry using metrics that have successfully identified load asymmetry in other populations. Load symmetry was found to differ between task, with the largest asymmetry occurring between limbs during the sit-to-stand task for the peak impact force (PIF = 9.08% symmetry) and during the stair descent task for the average loading rate (ALR = 15.43% symmetry). The increase in asymmetry during these tasks may be attributed to increased muscle activation and force production. The second purpose of this study was to investigate the effect of an external child load on lower extremity load asymmetry during a 14-meter level walking task. A significant increase was found between the no load and both child load conditions for PIF and ALR (p <0.001 for both metrics). No statistically significant differences in symmetry were found between carrying the child centrally in a carrier and carrying on one side of the body without a carrier. The lack of difference in asymmetry during child carrying conditions may indicate mothers naturally compensate for the external child load as both ALR and PIF values increased during these conditions, but asymmetry was not impacted. Our results indicate the need to continue to examine different carrying conditions in postpartum women to better understand risk factors for pain or injury and provide evidence-based recommendations for postpartum activity progression. / Master of Science / In 2021, over three and a half million women entered the postpartum period in the United States [1]. Despite their prevalence, postpartum health is a largely overlooked area and 25% of women experience low back or pelvic pain past the typical postpartum period of 8 weeks post delivery [3]. Research has found women may continue to experience this pain years after delivery and result from the lower limbs being loaded unequally. The extra weight from carrying a child may also impact the amount of unequal loading placed onto the lower limbs. The first purpose of this study was to investigate the effect of daily tasks on load symmetry in the lower limbs using measures that have successfully identified unequal load distribution in non-pregnant individuals. Load symmetry was found to differ between task, with the largest asymmetry occurring between limbs during the sit-to-stand task for the force applied to lower limbs during initial contact of the feet and during the stair descent task for the rate that force was applied to lower limbs. The second purpose of this study was to investigate the effect of an external child load on lower extremity load asymmetry during a 14-meter level walking task. A significant increase was found between the no load and both baby load conditions for force applied during initial contact of the feet and rate this force was applied. No difference was found between child carrying external loading condition when evaluating asymmetry. Our results indicate the need to continue to investigate the unique loading patterns of postpartum women to better understand the specific risk factors for pain or injury development within this population.

SAMMANFATTNING Bakgrund: Postpartumdepression (PPD) är en depression som uppkommer omkring fyra veckor efter förlossningen och drabbar cirka 10 - 15 % av kvinnorna. Det finns många olika faktorer som bidrar till att PPD utvecklas som t.ex. prenatal depression, premenstruella spänningar, ångest, instabilt partnerskap, låg inkomst, stressad livssituation, lågutbildade, arbetslöshet och brist på socialt stöd. Syfte: Syftet med denna studie var att utforska kvinnors upplevelser av att ha drabbats av postpartumdepression. Metod: En litteraturstudie av tio kvalitativa studier som granskat kvinnors upplevelser av postpartumdepression genomfördes. Resultaten har sammanställts efter att studierna kvalitetsgranskats och analyserats. Samtliga artiklar hade kvalitativ ansats och söktes i databaserna PubMed och PsychINFO. Som teoretisk referensram användes Joyce Travelbees omvårdnadsteori. Resultat: Tre övergripande kategorier av kvinnors upplevelser framkom vid granskningen av artiklarnas resultat: Upplevelser av förändringar, Upplevelser av stigmatisering och Upplevelser av återhämtning. Kvinnors berättelser beskriver deras individuella känslor och förväntningar över att bli föräldrar och när verkligheten inte stämmer överens med förväntningarna uppstår känslor som skuld och skam. Det finns en stigmatisering runt PPD som är svår för kvinnor att komma över. De upplever att det är svårt att söka vård för psykiatrisk sjukdom och det finns en rädsla och oro över att uppfattas som en dålig förälder. Omgivningen och partnern spelar en stor roll när det kommer till att identifiera symtomen och att ta första steget mot tillfrisknande genom att de har möjligheten att uppmärksamma och uppmuntra kvinnor till att söka hjälp och får det stöd som är nödvändigt. Slutsats: PPD upplevs av många kvinnor som ett stigma. Kvinnor kan uppleva sig misslyckade och känna skam och skuld när tiden efter förlossningen inte blev som de förväntat sig. Att uppmärksamma dessa kvinnor i ett tidigt stadie är en av sjuksköterskans många ansvarsområden. För att kunna göra det krävs det att sjuksköterskan har en förståelse för och kunskap om PPD. / ABSTRACT  Background: Postpartumdepression (PPD) is a mental disorder that occurs in about four weeks after delivery and affects approximately 10 - 15% of the new mothers. There are many different factors that contribute to develop PPD such as prenatal depression, premenstrual tension, anxiety, unstable partnerships, low income, stressful life situation, unskilled, unemployment and lack of social support. Aim: The aim of this study was to explore women's experiences of having suffered from postpartumdepression. Method: A literature review was conducted on ten qualitative studies that examined women's experiences of postpartumdepression. The results were compiled after the studies had been qualityreviewed and analyzed. All reviewed articles had a qualitative approach and was searched in the databases PubMed and PsychINFO. Joyce Travelbee's nursing theory was used as a theoretical framework. Results: Three categories of women’s experiences emerged after analysis: Experiences of changes, Experiences of stigma and Experiences of recovery. The women's stories describe individual feelings and expectations related to becoming a parent, and when reality does not match expectations feelings of guilt and shame arise. There is a stigma associated with the PPD that is difficult for women to handle. They may experience difficulties to seek treatment for mental illness and there is a fear and concern about being perceived as an insufficient parent. The environment and the partner plays an important role when it comes to identifying the symptoms and to take the first step toward recovery by having the ability to recognize and encourage women to seek help and get necessary support. Conclusion: PPD is experienced by many women as a stigma. Women see themselves as failures and feel shame and guilt when the time after childbirth did not turn out as expected. Paying attention to these women at an early stage is a nursing responsibility. To do so requires that nurses have an understanding and knowledge of PPD.

Bakgrund: Postpartum depression (PPD) drabbar 12 % av alla nyblivna mammor i Sverige och förekomsten av PPD i världen är 13 till 19%. PPD påminner om depression men med ytterligare symtom så som överdriven ångest och oro för barnet. PPD hos mammor kan ha långtgående negativ inverkan på barnens utveckling och psykiska välmående, vilket gör PPD till en angelägen fråga för Barnhälsovården. Barnhälsovårdsjuksköterskorna har vanligtvis tät och regelbunden kontakt med mammorna den första tiden efter barnets födelse vilket ger dem goda förutsättningar för att i ett tidigt skede identifiera PPD hos nyblivna mammor. Syfte och metod: Syftet med studien var att beskriva riskfaktorer för PPD hos nyblivna mammor. Studien genomfördes som en integrativ litteraturstudie. Resultat: Studien resulterade i fem kategorier: 1) ouppfyllda förväntningar, 2) förändrade levnadsvanor, 3) krav, 4) brist på stöd samt 5) psykosociala omständigheter. Ökad kunskap kring riskfaktorer för PPD ökar chansen att BHV-sjuksköterskorna tar tidiga symtom på PPD på allvar. / Background: Postpartum depression (PPD) affects 12% of all new mothers in Sweden and the prevalence of PPD in the world is 13-19%. PPD is similar to depression but with further symptoms such as excessive anxiety and concern about the child. PPD in mothers may have far-reaching negative impact on children´s development and mental well-being, witch makes PPD to a concern for Child health care. Maternal-and child health nurses (MCH-nurses) usually have close and regular contact with the mothers during the first period after childbirth witch gives them a particularly important role in efforts to find the mothers at increased risk of PPD. Aim and methods: The aim of the study was to describe risk factors for PPD in new mothers. The study was conducted as an integrative litterature review. Results: The study resulted in five categories: 1) unmet expectations, 2) changing lifestyles, 3) demands, 4) lack of suppot, 5) psychosocial circumstances. Increased knowledge about the risk factors for PPD increases the chance that MCH-nurses take early symptoms of PPD seriously.

ETUDE 1- Le traumatisme de l’accouchement prématuré et de la césarienne, un sentiment de culpabilité, une anxiété et une ambivalence envers l’enfant et l’équipe médicale ont été rapportés. Des difficultés dans l’investissement du lien mère-enfant et dans l’accès au rôle de mère ainsi que l’importance du partage d’expérience avec des femmes ayant accouché avant-terme ont également été identifiés. Enfin, des signes de dépression postnatale et de stress posttraumatique ont été relevés. ETUDE 2- 53% des participantes ont rapporté un score à l’IES-R indiquant un probable ESPT. La présence de symptômes de dépression postnatale (ß = 0,40, p< 0,05), de difficultés pendant la grossesse (ß= 0,20, p< 0,05), la perception maternelle de l’enfant comme étant vulnérable (ß = 0,17, p< 0,05), l’insatisfaction de la grossesse (ß = -0,13; p< 0,05) et des cognitions maternelles mal-adaptées (ß = -0,12, p< 0,05) étaient indépendamment associés à l’intensité des symptômes d’ESPT. ETUDE 3- 3 profils de femmes ont été identifiés: les parturientes au profil « dépressif », « faible niveau de symptômes » et les mères du groupe « dépressif anxieux traumatisé ». Nos résultats démontrent également une forte comorbidité entre troubles anxieux et dépression postnatale ainsi que l’influence négative des symptômes de dépression postnatale sur le lien mère-enfant. ETUDE 4- 64,3% des femmes de l’échantillon ont rapporté un score à l’EPDS indiquant une possible dépression postnatale. Le placement de l’enfant sous assistance respiratoire (ß = 0,23, p< 0,05), le type de prématurité (ß= 0,16, p< 0,05), et la baisse de la qualité de la relation conjugale (ß = -0,39, p< 0,05) étaient indépendamment associés à l’intensité des symptômes de dépression postnatale. / STUDY 1- Trauma of premature birth and c-section, feelings of guilt, anxiety, ambivalence towards the infant, the medical staff and the infant’s hospital discharge, were all part of their perception. Furthermore, difficulties for mothers to define themselves as such and the importance of sharing with women who have been through the same experience were evidenced. Postpartum depression and PTSD symptoms were also highlighted. STUDY 2- 53% of participants scored above the cut-off for probable PTSD. Increased postpartum depressive symptoms (ß = 0.40, p< .05), difficulties during pregnancy (ß= 0.20, p< .05), maternal perception of infant vulnerability (ß = 0.17, p< .05), decreased satisfaction with delivery (ß = -0.13; p< .05) and cognitions relating to role change (ß = -0.12, p< .05) were independently associated with PTSD symptoms. STUDY 3- 3 profiles were highlighted: “depressive”, “low level of symptoms” and “anxious-depressive-traumatized” mothers. Our findings also evidenced a high comorbidity between anxious and depressive symptoms as well as a negative impact of postpartum depression on mother-infant bond. STUDY 4- 64.3% of our sample reported a score on the EPDS highlighting a probable postpartum depression. Having an infant who experienced ventilator support (ß = 0.23, p< 0,05), type of prematurity (ß= 0.16, p< 0,05), and decreased quality of marital relationship (ß = -0.39, p< 0,05) were independently associated with the intensity of postpartum depressive symptoms.

Background: The prevalence of anxiety postpartum is high. Physical activity has shown positive effects for depressive symptoms and anxiety in pregnant women. The risk of anxiety postpartum can increase with a high and low Body Mass Index (BMI), no studies have been found to investigate the correlation between muscle mass and anxiety. Aim: To investigate the correlation between level of anxiety, BMI and proportion of muscle mass postpartum and see if there were any differences in level of self-reported anxiety between two independents groups: those who reported regular exercise and those who didn’t report regular exercise during pregnancy. Method: A quantitative correlative and comparative cross-sectional study. Data was collected using Beck Anxiety Inventory (BAI) questionnaire and one question about training answered by 2599 participants. Bioimpedance was used to calculate the proportion of muscle mass and BMI and included 164 participants. Results: There was a correlation between higher level of anxiety and higher proportion of muscle mass (r=0.25 p=&lt;0.05) and between higher level of anxiety and higher BMI (r=0.23 p=&lt;0.05). There was a difference (p=&lt;0.05) in level of anxiety between two groups: those who reported regular exercise: Md 4 (Q=6) self-reported a lower level of anxiety than those who didn´t report regular exercise: Md 4 (Q=8). Conclusion: High BMI and high proportion of muscle mass correlate with higher level of anxiety postpartum. There was a correlation between exercise during pregnancy and a decreased level of anxiety.