Obesity is a widespread problem in the United States that has profound health implications. Obesity rates also differ across different racial and ethnic groups. Among women, an important time period in their lives is the pregnancy period as gestational weight gain and postpartum weight retention may influence and contribute to noticeable differences in weight gain and retention. Maternal weight retention has implications for future health related problems and therefore needs to be addressed. One such group that is of specific interest is African Americans as data shows that obesity is more prevalent among African American adults, with the highest rates occurring in African-American women. Weight loss intervention programs for postpartum women may be useful in helping new mothers lose weight. This study was aimed at observing changes in areas such as weight loss and body image perception from a pilot-tested randomized controlled culturally tailored weight loss intervention program.

Magister Public Health - MPH / Ensuring a good performance of health workers is one of the key components for provision of quality health care services in order to progress toward one of the priorities of MDGs namely improving maternal health care. In 2005, Rwanda adopted the “Performance Based Financing (PBF)” program to remunerate and motivate health professional based on their job performance. This lead to increase in the number of health workers by 62% between 2005 and 2008 and public subsidies for health worker remuneration tripled. Despite promotion of this motivation mechanism to enhance job performance in maternal health care, recent data in Rwanda show that MMR is still high with 383 per 100,000 live births and high rates of postpartum complications. All these problems have been attributed to poor performance of staff. To date, little research has been conducted on the factors that affect job performance among health care providers in low income countries and particularly in Rwanda. The present study assesses factors that influence job performance of health care providers working in postpartum care in two public hospitals of Rwanda. Ninety six nurses and midwives were observed providing early and late postpartum care and interviewed about the presence or absence of the performance factors within their work environment. Data were analyzed to determine if there is an association between observed providers performance and variables of interest. Observation revealed that staff performed poorly in the use of guidelines for the management in the postpartum care. The bivariate analysis showed that (a) receiving feedback about job performance (b) receiving training in postpartum care management, (c) training in the use of the tools for the daily work, (d) being satisfied with the way the work is organized, and (e) finding the organization interested in the staff creativity in general, are factors associated with good performance. In conclusion, the study identified important factors that need to be taken into consideration when planning strategies to improve the quality of care and reducing morbidity and mortality in the postpartum wards of the two hospitals.

Master of Public Health - MPH / Access to appropriate health care service during childbirth is a great challenge to many women in Africa and Namibia is no exception. More than 70% of women in Otjozondjupa region experienced some form of delay during childbirth, and while maternal mortality continued to rise over the years in Namibia it is currently at about 265/100 000, which is too high for a middle-income country. Hence, this study aimed to get a deeper understanding of the perceptions of women who experienced any of the three delays in accessing appropriate health care during childbirth in Otjiwarongo hospital.

Progestins are synthetic progestogens that prevent pregnancy by thickening the mucous of the cervix to prevent sperm entry and by disrupting implantation via alteration of the timing of endometrial changes occurring during a normal menstrual cycle. Various hormonal birth control methods utilize progestins, with some of the most effective types of birth control methods being long-acting reversible contraceptives. These include hormonal injections such as depot medroxyprogesterone acetate (DMPA), hormonal implants such as Nexplanon, and hormone-releasing intrauterine devices (IUDs) such as Mirena. Although there have been many studies on the safety and effectiveness of these methods, fewer studies have examined how these hormonal methods may impact the bacterial environment of the vagina, better known as the vaginal microbiome. The health of the vagina relies heavily on the bacteria composing the microbiome. Changes in species composition correlate with higher risk of sexually transmitted infections (STIs) and adverse pregnancy outcomes. When women select their preferred hormonal contraceptive method, they should know if it will impact their vaginal microbiome and increase susceptibility to disease. Twenty-one patients enrolled in this study, with one patient initiating DMPA, 14 initiating levonorgestrel (LNG) IUD, and 6 initiating the etonogestrel subdermal implant (ESI). At initiation, 3 months post initiation, and 6 months post initiation, no differences were seen in the vaginal microbiomes of each of the women enrolled in the study. Some differences in the vaginal microbiota of postpartum women and those who were not postpartum were seen. More specifically, enrichment of three families, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae, was seen in women who were more than 12 weeks postpartum, but the effects of those differences remain unclear. Although our sample size was small, the lack of changes in the vaginal microbiome in women initiating long-acting progestin contraception is reassuring; further study in this area is needed.

Postpartum depression is a serious mental illness with onset of symptoms appearing anytime within the first four months after delivery (e.g. irritability, severe sadness, profound feelings of hopelessness, etc.). Environmental toxicants are synthetic (i.e. manufactured) or naturally found chemicals that are not produced by organisms as a result of cellular metabolism (e.g. tobacco smoke, pesticides, etc.). There is limited consideration for how exposure to environmental toxicants can create adverse psychological health effects, specifically postpartum depression. The purpose of this systematic review was to determine if the literature supports a link between exposure to environmental toxicants during the prenatal/perinatal period and postpartum depression and if so, to identify whether there are specific classes of toxicants that provide a higher risk for postpartum depression. Several databases were used to search the online literature, with the following inclusion criteria: articles published in English, publication years between 1995-2018, and with women of reproductive age (15-49 years old). The article selection process comprised of screening each article by title/abstract, followed by screening those articles based on full-text. Six categories of toxicants were identified among the thirty included articles. Active/passive smoke exposure was largely found to increase the risk of developing postpartum depression; dietary supplements provided mixed results; antidepressants demonstrated preventative effects; particulate air pollution was found to be associated with postpartum depression; oral contraceptives (DMPA) exhibited an increase in postpartum depressive symptoms; and organochlorine pesticides had no associative risk. Quality assessments were performed for all of the included articles, with the majority being assessed as satisfactory. This systematic review presents as a foundation for encouraging future research to investigate the link between environment and mental health, in order to attain a greater perspective.

Postpartum depression can be defined as a major depressive disorder which usually occurs during the postpartum period within one month or more after giving birth. Literature shows that 35 to 47 per cent of South African women have been diagnosed with major depressive disorder during pregnancy and the postpartum period. Studies stated that the challenges in the South African context regarding the postpartum period includes detachment from care and lack of a support system. Emotions are typically present in the context of relationships, in this case a mother and child relationship. However, research on early childhood has emphasised that the impact of the first five years of a child’s life on his/her social and emotional development is crucial, since children must learn to communicate with emotional language. The role of the mother in a young child’s emotional development is crucial, as the mother models certain behaviour to be imitated by the infant. A phenomenological and multiple case studies research design were followed throughout this qualitative research study. As the aim of the study was to provide information and guidelines for mothers who suffer from postpartum depression, the sample selection focused on participants (mothers) who had experienced postpartum depression and who, in retrospect, could give information about their experience and their perceptions of the effect this syndrome had on the emotional development of their children. Three mothers who were diagnosed with postpartum depression were the participants of this study. In order to get rich in-depth data, they were each interviewed and had to compile a narrative describing their experience with postpartum depression and the effect it had on their child’s emotional development. The three case studies provided a unique insight into the effect of postpartum depression on a young child’s emotional development according to the mother’s experience of postpartum depression. The empirical part of the study revealed that postpartum depression has a severe effect on a child’s emotional regulation and that support was an integral part in overcoming depression. / Dissertation (MEd)--University of Pretoria, 2017. / Early Childhood Education / MEd / Unrestricted

Postpartum hemorrhage is a leading cause of maternal death, yet many deaths related to hemorrhage might be prevented with early recognition and intervention. The birthing unit of a U.S. community hospital formed an interprofessional task force to plan and implement a postpartum hemorrhage protocol that would provide the obstetric team with the knowledge, skills, and tools needed for early identification and quick action when hemorrhage occurred. Lewin's model of change provided a framework for protocol implementation. The purpose of this doctoral project was to evaluate this quality improvement project. Secondary data internal to the organization were collected and analyzed to answer the practice-focused question, Is there a relationship between implementation of a postpartum hemorrhage protocol and the incidence of postpartum hemorrhage? To determine the incidence of postpartum hemorrhage, the number of hemorrhages with and without blood transfusion was divided by the number of deliveries and recorded monthly. The chi-square test was used to analyze the rates of hemorrhage pre- and post-implementation. A statistically significant decrease in hemorrhage was noted post-implementation, suggesting that there was a relationship between implementation of a protocol and the incidence of postpartum hemorrhage. This project supported the Walden University mission by working towards optimal health outcomes for women. Eliminating preventable harm related to hemorrhage benefits women, families, and communities. Lessons learned from the implementation and evaluation of this quality improvement project are expected to be utilized by nursing leaders to address other challenges identified in the obstetric setting.

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Postpartum psychiatric disorders include the postpartum blues (PBs), postpartum depression (PPD), and postpartum psychosis (PP). The focus of this thesis will be on PPD. PPD is a commonly unrecognized mood disorder affecting up to 15% of women. Of women with PPD, half may go untreated. Untreated PPD has shown significant potential for adverse effects in both mother and child. The reproductive hormone model attributes PPD to the rapid hormone changes following removal of the placenta at delivery. This is especially true of the withdrawal of the reproductive hormones estrogen and progesterone. A true causal pathway or causal factor in PPD depression, however, is yet to be established. Several factors must be taken into account when considering risk. These risk factors include women of low socioeconomic status (SES), women with a history of depression, women with a higher reported average of recent life stressors, women with neurotic and/or shy personalities, and women who experience past and/or present obstetric complications. Currently, the Edinburgh Postpartum Depression Scale (EPDS), the Postpartum Depression Screening Scale (PDSS), the Patient Health Questionnaire-9 (PHQ-9), as well as several other screening tools are used in clinical practice to diagnose PPD. Each screening tool utilizes its own unique method to obtain depression scores from patients. The EPDS is most commonly used, yet, no statistically significant difference has been found between the use of one screening tool over the other. PPD screening tools are seen across OB/GYN practices, family practices, health centers, and pediatric practices. Routine well-child visits represent the most regular contact that mothers have with the healthcare system postpartum, making pediatric primary care practices ideal settings for PPD screening and management. PPD management within primary care primarily involves non-pharmacological interventions such as counseling, psychoeducation, motivating help seeking, encouraging social support, and referring to others as needed. On the other hand, medication management is integrated into the stepped care treatment approach, which screens for and treats PPD in a step-wise fashion tailored to a woman’s risk assessment and responsiveness to treatment. Treatments for PPD have varying success. They may include selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), gamma aminobutyric acid receptor A positive allosteric modulators (GABAA receptor PAMs), norepinephrine and dopamine reuptake inhibitors (NDRIs), estrogen therapy, omega-3 polyunsaturated fatty acid supplementation (n-3 PUFA), cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), electroconvulsive therapy (ECT), and bright light therapy (BLT). More statistical evidence currently exists on the use of pharmacological and psychotherapeutic treatments, and less on the ECT and BLT clinical treatments. Mothers deciding on which treatment to pursue should consider the potential for psychotropic and estrogen medications to pass into their breast milk and onto their infant. New mothers should also outweigh the risks and benefits of pursuing pharmacological treatment rather than letting their depression go untreated. By conducting a thorough literature review, this thesis serves the purpose of identifying the most effective treatments to be integrated with a modified stepped care pathway, thereby creating a standardized PPD protocol that can be used across pediatric primary care practices. The aim of standardization of protocol using specific treatments in a modified stepped care approach is to effectively detect maternal PPD, minimize the potential for harm to mother and infant, as well as improve the consistency of care provided to mothers diagnosed with PPD. Implemented correctly, the protocol should show increased use of validated PPD screening tools such as the EDPS in practices managing care for postpartum mothers and/or infants up to the age of one, followed by risk assessment, and then treatment escalated from psychotherapy to antidepressants if required.

Postpartum hemorrhage is the second leading cause of maternal death in the United States. According to American College of Obstetricians and Gynecologists, postpartum hemorrhage is an obstetric emergency. Between 2012 and 2013, a medical facility reported 369 postpartum hemorrhages, a 4.7% increase from previous years. It is important to address this practice issue because postpartum hemorrhage can lead to maternal mortality. The purpose of this project was to increase staff nurses' awareness and knowledge of their role on the management of postpartum hemorrhage. The outcome of the project paper was implementation of an educational module on postpartum hemorrhage at this medical facility. The conceptual model, Academic Center for Evidence-Based Practice, was used to guide this project. The project researcher presented a postpartum hemorrhage module to a staff of 80 postpartum nurses. The module included a pre and post-test developed using Association of Women's Health, Obstetric, and Neonatal Nurses' guidelines and was reviewed by a panel of experts for content validity, content on postpartum hemorrhage, and an evaluation of the project. The panel consisted of the Director of Maternal Child unit and 3 appointed obstetricians. Nurses' knowledge of postpartum hemorrhage was evaluated by comparing mean aggregate pre and post-test scores. Results showed an increase in the staff nurses' knowledge and awareness of postpartum hemorrhage. These findings are important for nurse leaders and healthcare organizations because they demonstrate that providing staff nurses with an educational program on the importance of postpartum hemorrhage can impact the level of knowledge and thereby increase positive patient outcomes.