by Dominic Tak-Shing Lee. / "December 2000." / Thesis (M.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. 222-245). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Postpartum depression (PPD) is a significant public health issue. Up to 20% of women are affected by depression following childbirth. PPD is associated with anxiety, poor adjustment and health-related quality of life (HRQOL), and may lead to a woman's personal suffering, conflict with family members (especially in the relationship with partner) and developmental delays in children. Given the high prevalence of PPD and deleterious effects on both women and their families, adequate treatment is critical. While existing PPD treatments have strong efficacy data, the treatment literature suggests that many depressed postpartum women either do not receive treatment or receive suboptimal care. Further, barriers to care including medication side effects for breastfeeding women, stigma, and treatment preferences influence treatment decision-making. Thus, it may be worthwhile to examine the efficacy of a complementary and alternative medicine (CAM) treatment option for PPD that is associated with minimal risk and consistent with maternal preferences. The current investigation examined the efficacy of a Gentle Vinyasa Flow yoga intervention for PPD. Fifty-seven postpartum women with a score of ≥12 on the Hamilton Depression Rating Scale (HDRS) were randomly assigned to 1 of 2 groups − yoga n = 28) or wait-list control (WLC) ((italic)n(/italic) = 29). The yoga intervention lasted 8 weeks, and consisted of 16 classes taught by a certified yoga instructor in a studio and the recommendation to practice once a week at home with the use of a DVD that included a 30 minute yoga sequence. The primary outcome, depression, was assessed using the clinician-rated HDRS and self-report measures. The HDRS was administered over the telephone by blinded raters at baseline and after 2, 4, 6, and 8 weeks of treatment. Secondary outcomes were anxiety, postpartum adjustment, and HRQOL, with exploratory outcomes including mindfulness and physical activity. These outcomes were assessed using self-report measures completed on the same schedule as that for the HDRS. Growth curve modeling was used to test the hypotheses that women in the yoga group would experience a significantly greater rate of change over the course of the 8-week intervention on primary and secondary outcome measures, relative to the WLC group. As predicted, controlling for age and social anxiety at baseline, women in the yoga group experienced a greater rate of change in depression and well-being scores over the course of the 8-week intervention. The yoga group also experienced a significantly greater rate of improvement on scores of anxiety, postpartum adjustment, HRQOL, and mindfulness over the 8-week intervention, relative to the control group. These findings support yoga as a promising CAM intervention for PPD; large-scale replication studies are warranted. The findings also shed light on potential mediator and intervention-relevant variables for future research. Yoga is an acceptable and low-risk treatment option that may have broader clinical implications for the PPD treatment literature, and the field of CAM more generally.

Bakgrund: Det har funnits en uppfattning att nyblivna mammor ska ta det lugnt efter förlossningen. På senare tid har dock forskning visat att det är viktigt att träna framförallt sina magmuskler med anpassade övningar. Syfte: Att undersöka nyblivna mammors uppfattningar om träning av magmusklerna efter graviditeten och hur dessa uppfattningar omsätts i faktisk träning. Metod: En kvalitativ forskningsansats användes och semi-strukturerade intervjuer genomfördes med åtta nyblivna mammor. Data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Fem huvudkategorier skapades och dessa var tankar om att träna magmusklerna, att träna sina magmuskler, att tillägna sig information om träning, faktorer som underlättar träningen samt att inte få till träning. Konklusion: De mammor som uppgav att de inte hade några kunskaper om träning av magmusklerna tränade inte heller. De som tränade gjorde det med hjälp av appar eller böcker anpassade för nyblivna mammor eller på mamma-barn pass. Den vanligaste informationskällan var Internet, dock ifrågasatte mammorna tillförlitligheten. Faktorer som främjade att mammorna tränade var organiserad träning, att gymmen erbjuder olika träningslösningar samt möjligheten till egentid. Barriärer var vardagen, brist på barnpassning och kroppsliga besvär. / Background: Previous recommendations said that new mothers should rest after giving birth. But more recently research has stated that it is important to do exercises for your abs postpartum. Aim: The aim of this study was to examine new mothers views of abtraining postpartum and how these views are turned into actual practice. Method: A qualitative research approach was used and semi-structured interviews was performed with eight new mothers. Data were analyzed by using content analysis. Results: Five main categories were formed. These were views of abtraining, to exercise your abs, assimilating information on exercise, things that facilitates training and not get into the workout. Conclusion: The mothers that expressed that they didn´t know much about exercises did not actually do exercises for their abs. Those who trained used apps or books appropiate for new mothers or went to mother-child classes. The most common source of information was the Internet. However mothers questioned its reliability. Facilitators were the possibility to attend organized training, gyms offering different solutions and the opportunity to childfree time. Barriers were everyday life, lack of childcare, as well as physical problems.

Psychiatric morbidity in the postpartum period has been a subject of research for years that has been plagued by much controversy. Most of the studies have come from Western countries. Studies that were done in Africa have concentrated on psychotic disorders in in-patients. A pilot study done by Cheetham et al (1981) at King Edward VIII Hospital found a high incidence of 'transient situational disturbances', which required further investigation. AIMS AND OBJECTIVES: 1. To document the spectrum of psychiatric morbidity in an out-patient population of postpartum Zulu women; 2. To define predictive factors which would identify women 'at risk'; 3. To assess the feasibility of 'Western' screening instruments; 4. To investigate whether 'postpartum blues' occurs in Zulu women. RESEARCH DESIGN A prospective, descriptive study was undertaken. Sample Selection: 177 postpartum Zulu women attending the ' Well-Baby' Clinic at King Edward VIII Hospital were randomly selected for inclusion in the study. Methodology: Three questionnaires: The General Health Questionnaire- 30, Pitt's Questionnaire of Anxiety and Depression and The Kennerley Blues Questionnaire were administered to the subjects. A Structured Clinical Interview DSM-III (SCID) was conducted in those women with symptoms. FINDINGS: 1. The majority of the sample were between the ages of 20 and 30 years, unmarried, with a Senior Primary education and a baby of 20 weeks. 2. 45.76% of the sample had a psychiatric diagnosis, with 18.07% having major depression. Other disorders included: adjustment disorders, schizophrenia and dysthymia. 3. Significant variables using Chi-square analysis were: inadequate antenatal care, a negative response from the partner and the absence of cultural rituals. No association was found with demographic and obstetric variables. 4. T-test analysis showed a correlation between the questionnaires and the SCID. 5. 37.3% had experienced 'postpartum blues'. CONCLUSIONS: 1. The spectrum of psychiatric morbidity is affective in nature and similar to other studies. 2. 'Postpartum blues' does occur in Zulu women. 3. Antenatal screening with 'Western' instruments could reduce psychiatric morbidity. 4. The nomenclature of puerperal disorders is inadequate and needs review. 5. More prospective, community-based research is needed, especially in rural Zulu women. / Thesis (M.Med.)-University of Natal, Durban, 1992.

Bakgrund: Att bli förälder är en omvälvande och stor förändring i livet och det är vanligt att bli nedstämd den första tiden som förälder. Oftast går det över ganska snabbt efter förloss-ningen men 10-20 procent av alla nyblivna mödrar mår fortsatt dåligt en längre tid och drab-bas av en förlossningsdepression. På grund av känslor som skam och skuld undviker många mödrar att söka vård och därför blir förlossningsdepression ofta oupptäckt och odiagnostise-rat.Syfte: Att beskriva mödrars upplevelser vid förlossningsdepression samt att beskriva upple-velsen av stödet från sjuksköterskan. Syftet var vidare att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp.Metod: En beskrivande litteraturstudie baserad på 15 vetenskapliga artiklar med kvalitativ ansats. Databaserna PsycINFO och Cinahl användes till litteratursökningen.Huvudresultat: Vanliga upplevelser hos mödrar med förlossningsdepression var rädsla, skuld och ökad sårbarhet för att hantera förändringar. Mödrarna beskrev en frustration kring stödet och rådgivningen som gavs från sjuksköterskan samt deras attityder. Mödrarna beskrev en önskan om att sjuksköterskan skulle lyfta fram och synliggöra förlossningsdepression.Slutsats: Mödrar med förlossningsdepression lever i en känslomässig berg- och dalbana. På grund av skam och dåligt bemötande från sjuksköterskan undviker många mödrar att söka hjälp och de som försöker söka hjälp vet oftast inte var de kan vända sig. Sjuksköterskan ska enligt mödrarna ha ett empatiskt bemötande och vårda relationen mellan dem för att skapa trygghet i vården. / Background: Becoming a parent is revolutionary and a huge change in life and it is normal to become depressed the first time as a parent. The feelings often disappear after giving birth, but 10-20 percent of all new mothers continues to feel depressed for a long time and can result in a postpartum depression. Because of feelings such as shame and guilt many mothers avoid seeking care and therefore postpartum depression often become undiscovered and under-diagnosed. Aim: To describe mothers' experiences at postpartum depression and to describe the experi-ence of support from the nurse. The aim was also to describe the included articles selection method and study group. Method: A descriptive literature study based on 15 scientific articles with qualitative approach. The databases PsycInfo and Cinahl were used for the literature research. Main Results: The most common experiences of mothers with postpartum depression were fear, sense of guilt, increased vulnerability to manage change. The mothers described the frus-tration surrounding the support and advice given by the nurse. What created the most frustra-tion were the poor availability and the nurse's condescending attitude. The mothers described a desire that the nurse would highlight and make postpartum depression more visible. Conclusion: Mothers with postpartum depression lives in an emotional rollercoaster. Because of the feeling of shame and poor treatment from the nurse many mothers avoid to seek help and those who try to seek help often do not know where to turn. According to the mothers the nurse should have an empathetic approach and cherish the relationship between them to create safety in care.

The aim was to explore the possibility to diagnose retained placental tissue and other placental complications with 3D ultrasound and to investigate the impact of previous caesarean section on placentation in forthcoming pregnancies. 3D ultrasound was used to measure the volumes of the uterine body and cavity in 50 women with uncomplicated deliveries throughout the postpartum period. These volumes were then used as reference, to diagnose retained placental tissue in 25 women with secondary postpartum haemorrhage. All but three of the 25 women had retained placental tissue confirmed at histopathology. The volume of the uterine cavity in women with retained placental tissue was larger than the reference in most cases, but even cavities with no retained placental tissue were enlarged (Studies I and II). Women with their first and second birth, recorded in the Swedish medical birth register, were studied in order to find an association between previous caesarean section and retained placenta. The risk of retained placenta with heavy bleeding (>1,000 mL) and normal bleeding (≤1,000 mL) was estimated for 19,459 women with first caesarean section delivery, using 239,150 women with first vaginal delivery as controls. There was an increased risk of retained placenta with heavy bleeding in women with previous caesarean section (adjusted OR 1.61; 95% CI 1.44-1.79). There was no increased risk of retained placenta with normal bleeding (Study III). Placental location, myometrial thickness and Vascularisation Index were recorded on 400 women previously delivered by caesarean section. The outcome was retained placenta and postpartum haemorrhage (≥1,000 mL). There was a trend towards increased risk of postpartum haemorrhage for women with anterior placentae. Women with placenta praevia had an increased risk of retained placenta and postpartum haemorrhage. Vascularisation Index and myometrial thickness did not associate (Study IV). In conclusion: 3D ultrasound can be used to measure the volume of the uterine body and cavity postpartum, but does not increase the diagnostic accuracy of retained placental tissue. Previous caesarean section increases the risk of retained placenta in subsequent pregnancy, and placenta praevia in women with previous caesarean section increases the risk for retained placenta and postpartum haemorrhage.

Postpartum Depression (PPD) affects approximately 15% of Canadian mothers. PPD can have negative and enduring consequences for women and their relationships with their partners and children. Women who have suffered from PPD are 50% more likely to experience depression following delivery of another child. Mindfulness-Based Cognitive Therapy (MBCT) was developed to prevent relapse in recurrent depression. MBCT has been reported to be effective in the treatment of both depression and anxiety among at risk samples from the general and clinical populations. It is not clear whether the approach is a safe and acceptable preventive option to deliver to pregnant women who are at risk for developing PPD. Objectives: The aim of my study was to explore the safety, acceptability, and effectiveness of MBCT for pregnant women who experienced difficult mood after a previous childbirth. Method: I used a mixed methods design and recruited 5 participants from the Victoria community. Participants were at least 18 years of age, native English speakers, pregnant and had experienced difficult mood for at least two consecutive weeks within the first year following the previous delivery of a healthy infant. All participants completed the slightly modified 8-week MBCT program. I administered self-report, quantitative measures at baseline (T1), before and immediately after each group, and postintervention (T2). I collected qualitative data as weekly field notes, through a semi-structured focus group one week following completion of the program, and as comments participants provided on the self-report WC-DM measure. Findings: Quantitative findings suggest program safety; speak to the acceptability of the program; and suggest that MBCT was effective in significantly decreasing anxiety symptomology, decreasing self-reported worry about difficult mood, and increasing wellbeing for pregnant women with a history of difficult postpartum mood. Field notes, focus group data, and comments participants provided on the self-report WC-DM measure contribute to and explain quantitative findings and support MBCT as a safe, acceptable, and effective approach for this population. / Graduate / 0519 / katya@uvic.ca

Licentiatavhandling (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 2 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.