Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2008. / LICL has E-Thesis 0043 ; please contact computer services.

abstract: Postpartum depression (PPD) is a significant public health concern affecting up to half a million U.S. women annually. Mexican-American women experience substantially higher rates of PPD, and represent an underserved population with significant health disparities that put these women and their infants at greater risk for substantial psychological and developmental difficulties. The current study utilized data on perceived stress, depression, maternal parenting behavior, and infant social-emotional and cognitive development from 214 Mexican-American mother-infant dyads. The first analysis approach utilized a latent intercept (LI) model to examine how overall mean levels and within-person deviations of perceived stress, depressive symptoms, and maternal parenting behavior are related across the postpartum period. Results indicated large, positive between- and within-person correlations between perceived stress and depression. Neither perceived stress nor depressive symptoms were found to have significant between- or within-person associations with the parenting variables. The second analysis approach utilized an autoregressive cross-lagged model with tests of mediation to identify underlying mechanisms among perceived stress, postpartum depressive symptoms, and maternal parenting behavior in the prediction of infant social-emotional and cognitive development. Results indicated that increased depressive symptoms at 12- and 18-weeks were associated with subsequent reports of increased perceived stress at 18- and 24-weeks, respectively. Perceived stress at 12-weeks was found to be negatively associated with subsequent non-hostility at 18-weeks, and both sensitivity and non-hostility were found to be associated with infant cognitive development and social-emotional competencies at 12 months of age (52-weeks), but not with social-emotional problems. The results of the mediation analyses showed that non-hostility at 18- and 24-weeks significantly mediated the association between perceived stress at 12-weeks and infant cognitive development and social-emotional competencies at 52-weeks. The findings extend research that sensitive parenting in early childhood is as important to the development of cognitive ability, social behavior, and emotion regulation in ethnic minority cultures as it is in majority culture families; that maternal perceptions of stress may spillover into parenting behavior, resulting in increased hostility and negatively influencing infant cognitive and social-emotional development; and that symptoms of depressed mood may influence the experience of stress. / Dissertation/Thesis / Doctoral Dissertation Psychology 2014

Background: Postpartum depression is a common complication after birth and affects approximately 13-19% of women each year. Many women currently have antidepressant drugs prescribed and would therefore benefit from a treatment option without adverse side effects, in this case physical activity. Physical activity is considered to have an effect on mental health in general as exercise breaks down the destructive and negative thoughts you have by distracting. Aim: The aim of this study was to determine whether physical activity can affect the mental well-being of women with postpartum depression. Method: A descriptive literature study based on 10 quantitative original articles with different study designs. Nine out of the 10 articles included were intervention studies. The databases Pubmed, CINAHL, Google Scholar and psycINFO were used to gather information for this literature study. Quality review was carried out using review templates. Results: Eight out of ten articles showed that physical activity had a positive effect and reduced depressive postpartum symptoms. What kind of physical activity the different studies chose for their intervention were varied, as well as the measuring instruments used to measure depression symptoms in postpartum women. The result was divided and presented in three categories; group training, home-based training and group training with home-based training as a complement. Conclusion: The result of our study show that physical activity has an effect on the mental well-being of women with postpartum depression. The degree of depression decreases in points and one could also see an elevated quality of life after interventions in the form of physical activity. However, to strengthen this result and to get enough evidence, more research is needed on the subject. / Bakgrund: Postpartum depression är en vanlig komplikation och drabbar cirka 13-19% av kvinnor som föder barn varje år. Många kvinnor får i nuläget antidepressiva mediciner utskrivet och skulle därmed gynnas av ett behandlingsalternativ utan negativa biverkningar, i det här fallet fysisk aktivitet. Fysisk aktivitet anses ha effekt på psykisk ohälsa generellt i och med att motion bryter ner de destruktiva och negativa tankarna man har genom att man blir distraherad.  Syfte: Syftet var attundersöka om fysisk aktivitet kan påverka det psykiska välmåendet hos kvinnor med postpartum depression.  Metod: En deskriptiv litteraturstudie baserad på 10 kvantitativa originalartiklar med olika studiedesign. Nio av de 10 artiklarna som inkluderades var interventionsstudier. Databaserna Pubmed, CINAHL, Google Scholar och psycINFO användes för att samla information för denna litteraturstudie. Kvalitetsgranskning gjordes med hjälp av granskningsmallar.  Resultat: Åtta avtio artiklar visade att fysisk aktivitet hade en positiv effekt och reducerade depressiva postpartum symptom. Vilken fysisk aktivitet som de olika studierna valt att använda sig av var varierande, samt vilka mätningsinstrument som användes för att mäta depressionssymtom hos postpartum kvinnorna. Resultatet delades upp och presenterades i tre kategorier; gruppträning, hembaserad träning och gruppträning med hembaserad träning som komplement.  Slutsats: Resultatet av litteraturstudien visar att fysisk aktivitet har påverkan på det psykiska välmåendet hos kvinnor med postpartum depression. Graden av depression minskades i poäng och man kunde även se en förhöjd livskvalité efter interventioner i form av fysisk aktivitet. För att styrka detta resultat och få tillräckligt med evidens behövs dock mer forskning kring ämnet.

The postpartum period, also know as postpartum, is a time of great physical and psychological changes, increasing the risk for onset of musculoskeletal discomfort, postural changes and depressive symptoms, which are directly related to muscle and physiological functions and may affect function and the musculoskeletal control, reflecting the postural pattern. In clinical practice, postural changes are frequently observed among the mothers, both either due to biomechanical compensations during pregnancy or the tensions and burdens generated by baby care. In the literature, there are few studies that relate postural alignment and depressive symptoms. This relationship will add up to knowledge that helps identify the obstacles to recovery and lead to the development of strategies and targeted interventions for postpartum women. The objective of the study is to investigate depressive symptoms in postpartum women, and the influence of this posture. Eighty women were evaluated; with postpartum time of two to 30 weeks; pregnancy with resolution between 34 and 42 weeks and calving and healthy live baby. Depressive symptoms were screened through Depression Scale Edinburgh Postnatal (EPDS). Postural assessment was conducted through computerized photogrammetry and visual. Approximately 33% (n = 26) of evaluated postpartum women had scores indicating postpartum depression. Postpartum women showed distinct global postural patterns in relation to depressive symptoms and these compensation patterns generated in the body segments, more significantly in the pelvis. / Submitted by Ramon Santana (ramon.souza@ufpe.br) on 2015-03-10T18:15:57Z No. of bitstreams: 2 Alterações posturais e sintomas depressivos em puérperas.pdf: 1368202 bytes, checksum: b6e598bc074a49361d58ae8cf28c0f12 (MD5) license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) / Made available in DSpace on 2015-03-10T18:15:57Z (GMT). No. of bitstreams: 2 Alterações posturais e sintomas depressivos em puérperas.pdf: 1368202 bytes, checksum: b6e598bc074a49361d58ae8cf28c0f12 (MD5) license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Previous issue date: 2014-09-04 / O puerpério, também chamado de pós-parto, é um período de grandes mudanças físicas e psicológicas, aumentando os riscos para desencadeamento de desconfortos musculoesquelético, alterações posturais e sintomas depressivos, os quais estão diretamente relacionados às funções musculares e fisiológicas e podem afetar a função e o controle musculoesquelético refletindo no padrão postural. Na prática clínica, as alterações posturais são frequentemente observadas entre as puérperas, tanto pelas compensações biomecânicas durante a gestação, como pelas tensões e sobrecargas geradas com os cuidados com o bebê. Na literatura, são escassos os estudos que relacionam alinhamento postural e sintomas depressivos. Tal relação será um conhecimento a mais para ajudar a identificar os obstáculos para a recuperação e levar ao desenvolvimento de estratégias e intervenções direcionadas às puérperas. O objetivo do estudo foi rastrear a sintomatologia depressiva em puérperas e verificar a influência desta na postura. Foram avaliadas 80 mulheres, com tempo de pós-parto entre duas e 30 semanas; gestação com resolução entre 34 e 42 semanas e parição de bebê saudável e vivo. Os sintomas depressivos foram rastreados através da Escala de Depressão Pós-natal de Edimburgo (EDPE). A avaliação postural foi efetuada através de fotogrametria computadorizada e visual. Aproximadamente, 33% (n=26) das puérperas avaliadas apresentaram escores indicativos de depressão pós-parto. As puérperas apresentaram padrões posturais globais distintos em relação à sintomatologia depressiva e estes padrões geraram compensações nos segmentos corporais, de modo mais significativo na pelve.

Background: Within the Stockholm County Council returned in 2013 around 68 percent of the women to the antenatal clinic for a check-up after childbirth. Earlier studies show that new mothers want greater support from maternal health care and do not always know where to seek care. Aim: The aim of this work was to investigate whether the use of a standard model describing midwifery care and procedures for the postpartum check-up could affect the number of women who return to Södermalms clinic. A further aim was to compare the midwife and the patient's perspective, about what were included and discussed at this postpartum check-up. Method: This study had a descriptive quantitative research approach. How and when the woman contacted, and what topic the midwife discussed with the woman during the postpartum visit, was well described in a flowchart. 112 women were enrolled in the study and the project could be evaluated on the basis of data from the Pregnancy Registry and a control group corresponding to the intervention group was appointed. Results: Registered data showed an increased number of women who returned to Södermalms clinic postpartum, in the control group, there was no increase in the percentage of women who came to postpartum visits. There was a difference between the midwife and the woman's perception of what was discussed at the postpartum visit, particularly around the   information about the ruptures and the pelvic floor muscle, there was a discrepancy.  The midwives participating in the study preferred after completion of the study a more structured working model, where the postpartum visits were clarified. Conclusion: There may be advantages to use a standard model describing the midwifery care and procedures for the postpartum visits. The midwives preferred to book in the woman's postpartum check-up during her last pregnancy visit and were more satisfied with the new approach.

Research shows that maternal depression has adverse effects on mother-infant attachment and subsequent infant development (Cogill, Caplan, Alexandra, Robson & Kumar, 1986). The mechanisms through which this comes about are unclear. Murray & Cooper (1997) suggest an impaired pattern of mother-infant communication is responsible. Within this, Murray proposes that maternal speech may be a key factor. This study constitutes a preliminary exploration into the mechanisms through which maternal depression effects mother-infant interaction in South Africa. 147 predominantly Xhosa-speaking mother-infant dyads that took part in a broader epidemiological study on post-partum depression in Khayelitsha (Cooper, Tomlinson, Swartz, Woolgar, Murray & Molteno, 1999) made up the subjects. Maternal depression was assessed according to the Structured Clinical Interview for DSMIV (SCID). Maternal speech recorded from standard, five-minute, face-to -face mother-infant interactions was translated and analysed according to a coding system developed by Murray (Murray, Kempton, Woolgar & Hooper, 1993). The speech of depressed mothers to their two month old infants was compared to the speech of non-depressed mothers on dimensions of focus, affect and agency, and the role of infant gender was assessed. Results revealed no significant group differences for depression. Maternal speech to male infants was found to hold significantly less ascription of agency than to female infants. Findings suggest that maternal speech may be too narrow a marker of maternal depression in this context and that broader indices are needed. It is recommended that future research control for measures of social adversity, factor in cultural and language particularities, and consider contextual aspects of mother-infant interaction / attachment processes, in investigating the mechanisms through which post-partum depression leads to negative infant outcome in the developing world.

Cette recherche vise à donner une approche des troubles psychiques de la puerpéralité à partir de la psychanalyse d’orientation lacanienne. Ce travail se forge aussi comme une réponse aux idéaux de notre époque d’effacer toute la subjectivité des êtres parlants. Le pari de ce travail est donc d’élaborer une clinique prête à accueillir la subjectivité de chacune, tout en s’éloignant des théories valables pour toutes. Au-delà de la dialectique cause-effet et des conceptualisations des maladies puerpérales très définies et tranchées, on cherche à élucider les effets divers que l’événement de la maternité peut susciter et la façon dont chaque sujet peut renouer la déstabilisation provoqué par cet événement ; dès symptômes les plus anodins jusqu’aux déclenchements psychotiques les plus ravageants. Une telle orientation nous permet d’aborder ces diverses réponses à l’événement de la maternité d’une manière qui rend compte de l’unicité du sujet en question. / This investigation aims to provide a Lacanian approach to postpartum mental disorders. As such, our work responds to the dominant ideals of our epoch – that of erasing the unique subjectivity of each speaking being. The establishment of our clinical approach is based around a central wager, that of being able to welcome the subjectivity of everyone, all the while renouncing universal theories, which would be equally valid for all. Beyond the dialectic of cause-effect and conceptualizations of well defined and differentiated postpartum disorders, we seek to elucidate the diverse effects of the event of maternity; to elucidate the diverse ways in which each subject might come together again in the aftermath provoked by this event, from the most innocent symptoms to the most ravaging psychotic breaks. Such an orientation permits us to conceive of these diverse responses the event of maternity in a manner that takes into account the uniqueness of the subject in question.

Bakgrund: Att föda barn är en unik händelse och upplevelsen kan följa kvinnan genom hela livet. En negativ förlossningsupplevelse kan leda till psykisk ohälsa och förlossningsrädsla. Barnmorskor har en viktig roll i att ge professionellt stöd vid bearbetning av en negativ förlossningsupplevelse. Syfte: Att belysa omföderskors upplevelse av professionellt stöd i relation till tidigare negativ förlossningsupplevelse som resulterat i sekundär förlossningsrädsla. Metod: Kvalitativ innehållsanalys med induktiv ansats användes. Semistrukturerade intervjuer med sju omföderskor med sekundär förlossningsrädsla utfördes. Resultat: Kvinnorna beskrev vikten av att bli sedd och att barnmorskan tog deras rädsla på allvar. Att inte få gehör försvårade möjligheten till bearbetning av förlossningsupplevelsen och det upplevdes negativt att inte följas av samma barnmorska genom vårdkedjan. Att få stöd i rätt tid uttrycktes vara en viktig faktor för bearbetningen. Konklusion: Att som barnmorska visa intresse och se varje kvinnas unika behov av stöd främjar möjligheten till bearbetning. När i tiden stöd ges har stor betydelse och för att kunna ge mer individanpassad eftervård som utgår från varje enskild kvinnas behov av bearbetning, är det viktigt att barnmorskor är lyhörda. Kontinuitet i vårdkedjan bidrar till en trygg relation mellan kvinnan och barnmorskan och främjar en positiv förlossningsupplevelse. / Background: To give birth is an unique life event and the experience follow women throughout life. A negative birth experience can lead to mental illness and fear of childbirth. Midwives have an important role in providing professional support in processing a negative birth experience. Aim: To illuminate multiparas' experiences of professional support in relation to previous negative birth experience which has resulted in secondary fear of childbirth. Method: Qualitative content analysis with inductive approach was used. Seven semi-structured interviews were performed with multiparas having secondary fear of childbirth.   Result: The women described the importance of being seen and that the midwives took their fear seriously. Not being heard and lack of continuity reduced their capability to process their negative birth experience. Getting support at the right time was an important factor for processing. Conclusion: To promote women's capability to process their negative birth experience midwives need to show an interest in every woman's unique need of support. Timing of support is important and in order to provide more personalized postpartum care midwives needs to be responsive to women's needs. Continuity of care contributes to a good relationship between the woman and the midwife and promotes a positive birth experience.

SAMMANFATTNING  Syfte: Att kartlägga kvinnor och partners sexuella hälsa och parrelation efter barnafödande. Metod: En webbaserad prospektiv tvärsnittsstudie med kvantitativ ansats.Resultat: Enkäten besvarades av 134 deltagare. Deltagarna ansåg att relationen hade förändrats till det bättre efter barnafödandet. Trötthet var den övervägande orsaken till förändrad sexlust. Cirka 70% av deltagarna rapporterade att sexlivet inte var lika prioriterat som tidigare. Partners önskade sex tidigare än kvinnorna efter barnafödande. Cirka 90% av deltagarna hade haft sex efter förlossningen och lusten kom vanligtvis tillbaka inom sex månader. Majoriteten rapporterade att informationen från barnmorskan angående sexuell hälsa var otillräcklig.  Slutsats: Trötthet var den främsta orsaken till förändrat sexliv för både kvinnor och partners. Sexlivet var inte lika prioriterat som tidigare dock ansåg majoriteten av deltagarna att relationen förändrats till det bättre efter barnafödande. Barnmorskans information om sexuell hälsa ansågs otillräcklig.Kliniska implikationer: Genom att informera om sexuell hälsa och hur relationen kan förändras efter barnafödande på föräldragrupper, barnmorskemottagningar och barnavårdscentraler kan både kvinnan och partnern få en ökad kunskap samt förberedelse på förändringarna som väntar. / ABSTRACT  Aim: To map women's and partners' sexual health and relationship after childbirth. Method: A web-based prospective cross-sectional study with a quantitative approach. Results: The survey was answered by 134 participants. The participants felt that the relationship had changed for the better after the delivery. Fatigue was the predominant cause of altered sex drive. About 70% of the participants reported that sex life was not as prioritized as before. The partners wanted sex earlier than the women after delivery. About 90% of the participants had had sex after delivery and the desire usually returned within six months. The majority reported that the information provided by the midwife regarding sexual health was insufficient.  Conclusion: Fatigue was the main cause of altered sex life. Sex life was not as prioritized as before, however, the majority of participants felt that the relationship changed for the better after childbirth. The midwife's information about sexual health was considered insufficient. Clinical implications: By addressing about sexual health and how the relationship can change after childbirth in parent groups, midwife clinics and the childcare center, both the woman and the partner can gain increased knowledge and preparation for the changes that await.

La France se démarque par un ratio de mortalité maternelle par hémorragie du postpartum (HPP) élevé.Les objectifs de cette thèse étaient: 1/comparer les caractéristiques épidémiologiques de l'HPP entre la France et le Canada 2/décrire les pratiques d'anesthésie-réanimation dans l'HPP et évaluer leur adéquation par rapport aux recommandations chez les femmes décédées d'HPP et dans une population de femmes avec HPP.Les sources de données utilisées étaient: La base nationale canadienne de données hospitalières sur les séjours des patients, l'essai Pithagore6 et l'Enquête nationale confidentielle sur les morts maternelles.La comparaison du profil épidémiologique de l'HPP entre la France et le Canada montre que l'HPP n'est pas plus fréquente en France. Le recours plus fréquent à des traitements de seconde ligne suggère une incidence plus élevée de l'HPP sévère en France. Dans les décès maternels par HPP, certaines pratiques d'anesthésie-réanimation apparaissent comme inadéquates: le monitorage clinique et la mise en condition des patientes, la surveillance paraclinique, le protocole d'anesthésie générale et la stratégie transfusionnelle. La description en population des pratiques transfusionnelles dans l'HPP montre un recours insuffisant à la transfusion. Inversement des stratégies transfusionnelles dont l'efficacité n'est pas prouvée sont fréquemment appliquées.Ce travail suggère une sévérité importante de l'HPP en France, pouvant expliquer l'importance de la mortalité par HPP. Certaines pratiques d'anesthésie-réanimation apparaissant comme non-optimales pourraient être impliquées dans cette sévérité. L'association entre pratiques et sévérité de l'HPP reste à être étudiée. / In France, the maternal mortality ratio due to postpartum hemorrhage (PPH) is higher than in other high resources countries. This situation remains partially unexplained. The objectives of this PhD thesis were: 1/ to compare PPH epidemiological characteristics between France and Canada, 2/ to describe anesthesia and intensive care practices in PPH and to compare them with guidelines, first in cases of maternal deaths from PPH and secondly in a large population of women with PPH. The data sources were: the Discharge Abstract Database from the Canadian Institute for Health Information, the Pithagore6 trial and the French Confidential Enquiry into Maternal Deaths. The comparison of PPH epidemiological profiles between France and Canada shows that PPH incidence is not higher in France. Second-line treatments in PPH management are more frequently performed, suggesting a higher incidence of severe PPH in France. Among maternal deaths from PPH, some practices in anesthesia and critical care management appear to be inadequate: clinical monitoring and laboratory assessment, protocol for general anesthesia and transfusion strategy. The description on transfusion practices in a large population of women with PPH shows that the use of blood products is not sufficient. Conversely, transfusion strategies with unproved efficacy are frequently used. These results suggest a higher rate of severe PPH in France, that may result in the higher maternal mortality due to PPH. Inadequate practices in anesthesia and critical care could be involved in this severity. But the association between specific components of anesthesia and critical care management and PPH severity remains to be explored