De flesta kvinnor uttrycker en önskan att amma sitt barn. Amningsfrekvensen är dock sjunkande både i Sverige och internationellt. WHO rekommenderar helamning i sex månader och delamning tills dess att barnet är två år eller äldre. Amningssvårigheter är vanligt förekommande och påverkar kvinnans upplevelser samt deras beslut att avbryta eller fortsätta amningen. Amning ingår i barnmorskans kompetensområde, vilket betonar vikten av att öka förståelsen för kvinnors upplevelser av amningssvårigheter. Syftet var att belysa kvinnors upplevelser av amningssvårigheter. Vald metod var en litteraturöversikt med systematisk metod. Databassökningen utfördes i databaserna PubMed och CINAHL där 15 artiklar inkluderades. Artiklarna genomgick en kvalitetsgranskning och det tillämpades en integrerad analysmetod i kombination med en induktiv ansats. Artiklar ifrån olika delar av världen inkluderades i resultatet. Identifierade huvudteman var Bristande kunskaper kring amning, Erfarenheter av stöd samt Upplevda känslor och hantering av amningssvårigheter. Underteman var Betydelsen av stöd, Avsaknad och negativt upplevt stöd, Strategier och hjälpmedel för fortsatt amning, Konfrontation av känslor vid avbruten amning samt Psykologisk påverkan. Slutsatsen berörde vikten av förberedelse samt tillgången till information och kunskap kring amning. Svårigheter med amning kunde uppstå när kvinnor kände sig oförberedda och saknade tillräcklig kunskap. Resultaten indikerade att kvinnornas upplevelse av amning och dess utfall påverkades av hur de upplevde stödet som de erbjöds samt sin tilltro till den egna förmågan att amma. Både vårdpersonalens stöd och det sociala stödet spelade en betydande roll. Barnmorskan har möjlighet att främja amning vid amningssvårigheter genom att erbjuda stöd och rådgivning på ett sätt som upplevs positivt av kvinnan. / The majority of women express a desire to breastfeed their infants. However, breastfeeding rates are declining both in Sweden and internationally. WHO recommends exclusive breastfeeding for the first six months and continued breastfeeding with complementary foods for two years or older. Breastfeeding difficulties are prevalent and significantly impact women's experiences, influencing their decisions to discontinue or persevere with breastfeeding. Given that breastfeeding falls within the realm of midwifery competence, it underscores the importance of enhancing understanding regarding women's experiences with breastfeeding challenges. The aim was to illustrate women´s experiences of breastfeeding difficulties. The chosen methodology was a literature review with a systematic method. Database searches were conducted in PubMed and CINAHL, resulting in the inclusion of 15 articles. The articles underwent quality assessment, and an integrated analysis method was applied in conjunction with an inductive approach. Articles from various parts of the world were included in the results. Identified main themes were Insufficient knowledge about breastfeeding, Experiences of support and Perceived emotions and coping with breastfeeding difficulties. Subthemes included the Significance of support, Absence and negatively perceived support, Strategies and tools for continued breastfeeding, Confrontation of emotions during interrupted breastfeeding and Psychological impact. Conclusion addressed the significance of preparation and access to information and knowledge regarding breastfeeding. Difficulties with breastfeeding could arise when women felt unprepared and lacked sufficient knowledge. The results indicated that women's experience of breastfeeding and its outcomes were influenced by how they perceived the support offered to them and their confidence in their ability to breastfeed. Both healthcare professionals' support and social support played an important role. The midwife has the opportunity to promote breastfeeding in cases of breastfeeding difficulties by providing support and guidance in a manner perceived positively by the woman.

Bakgrund: Förlossningsskador och andra besvär postpartum är vanligt förekommande. Fysioterapi har visat sig ha stark evidens för att hjälpa med smärta och funktion för dessa besvär. Trots detta används fysioterapeuter i mycket liten utsträckning inom förlossningsvården. Syfte: Syftet var att kartlägga prevalensen och omfattningen av förlossningsskador och andra besvär samt att ta reda på hur rehabiliteringsprocessen såg ut. Metod: En kvantitativ ansats med empiristisk-atomistisk design användes. Kartläggningen gjordes med hjälp av en digital enkät som delades i allmänna facebookgrupper riktade till mammor och kvinnor. Den insamlade datan analyserades med hjälp av frekvenstabeller, Pearsons korrelationskoefficient samt Chi2-test. Resultat: Över 80% av deltagarna hade fått en bristningsskada vid förlossning, där majoriteten fått grad 2. Av deltagarna uppgav 63% att de haft besvär efter förlossningen och 50% uppgav att de hade kvarstående besvär idag. Majoriteten uppgav att de haft multipla besvär, där inkontinens var vanligast förekommande. Efter återbesök hos barnmorska uppgav 54% att de inte fått någon information om sina besvär och 72% fick ingen information om rehabilitering för dem. Hälften av alla deltagare hade utfört någon form av rehabilitering efter sin förlossning, där bäckenbottenträning var det absolut vanligaste. 62% visste inte om att man kan söka hjälp hos en fysioterapeut för förlossningsrelaterade besvär.  Konklusion: Utbredningen av förlossningsrelaterade besvär är stor och många lever med kvarstående besvär långt efter sin förlossning. Fysioterapi är en outnyttjad resurs och fysioterapeuter bör med fördel kunna användas som en del av den standardiserade förlossningsvården i Sverige idag. Fler högkvalitativa studier behövs för att öka kunskapen inom ämnet. / Background: Childbirth injuries and other postpartum complications are common. Physiotherapy has shown strong evidence for helping with pain and function related to these complications. Despite this, physiotherapists are rarely used in standard maternity care.  Objective: The objective was to map the prevalence and extent of childbirth injuries and other complications, as well as to understand the rehabilitation process.  Method: A quantitative approach with an empiricist-atomistic design was used. The mapping was conducted using a digital survey shared in general Facebook groups targeted at mothers and women. The collected data were analyzed using frequency tables, Pearson’s correlation coefficient, and Chi-square tests.  Results: Over 80% of participants had suffered a perineal tear during childbirth, with the majority experiencing a second-degree tear. Of the participants, 63% reported complications after childbirth, and 50% reported having ongoing issues today. The majority reported multiple complications, with incontinence being the most common. After follow-up visits with a midwife, 54% stated they received no information about their complications, and 72% received no information about rehabilitation for them. Half of all participants had undergone some form of rehabilitation after childbirth, with pelvic floor exercises being the most common. Additionally, 62% did not know that they could seek help from a physiotherapist for childbirth-related complications.  Conclusion: The prevalence of childbirth-related complications is high, and many live with persistent issues long after childbirth. Physiotherapy is an underutilized resource, and physiotherapists should be integrated into the standardized maternity care in Sweden today. More high-quality studies are needed to increase knowledge in this field.

Having a newborn can be a big change for families, especially for first-time parents. At hospital discharge, parents are often provided with a lot of information, which can be difficult to retain. Due to shortened postnatal lengths of stay, nurses typically have less time to educate parents, which often results in families feeling overwhelmed. After hospital discharge, it is recommended for families to see a health care provider (i.e., physician, nurse practitioner, or registered midwife) within 72 hours for a follow-up appointment. This follow-up appointment is meant to assess both the mother and newborn to ensure they are both in good health and to provide any needed support. Unfortunately, completing the appointment within this timeframe may not be possible for every family or they may not be aware of its importance. Depending on the family’s model of care, completing the follow-up appointment within 72 hours after hospital discharge can be challenging. Families that have a physician as their health care provider may experience delays in scheduling the follow-up appointment. This can be due to the physician’s lack of availability, as there is a physician shortage in most communities. Furthermore, some families do not have access to a health care provider and, therefore, do not see a care provider after hospital discharge. Completing the follow-up appointment later than when it is recommended, or not at all, can result in negative health consequences for the mother and newborn and can also increase re-admission hospital rates and related costs (Cargill et al., 2007). At the moment, postnatal lengths of stay are shortening but the service delivery has not changed to accommodate this trend (Lemyre et al., 2018). This means that the services typically provided to families in the hospital now need to be provided in the community. The follow-up appointment after hospital discharge is an opportunity to provide these services; however, timely access to a health care provider, specifically a physician, can be challenging. Thus, this thesis explores the development of a general design methodology for a postpartum nurse practitioner-led clinic. The aim of the clinic is to provide timely access to any family that needs to complete the necessary postpartum services after hospital discharge within a community. An analytical model was developed to explore the characteristics of a postpartum nurse practitioner-led clinic and how it would operate (i.e., what services would be offered, the amount of time needed for these services, what is needed to offer these services, etc.). The model conducts a simulation of the appointment scheduling process based on the input values entered into it and evaluates a number of performance metrics (e.g., number of diversions, patient wait times, resource idle time, clinic overtime, number of appointments provided within 72 hours and number of appointments provided beyond 72 hours). The findings from the model can support the potential implementation of a postpartum nurse practitioner-led clinic in any community. Implementing such clinics could increase awareness, further educate parents and increase access to postpartum services.

Flera studier visar amningens fysiska och psykiska hälsofördelar för mor och barn, dock avvänjer kvinnor som lider av postpartum depression amning tidigt om de presenteras med utmaningar under amningen. Syfte med denna studie är därför att beskriva hur kvinnor som lider av postpartum depression upplever amning. Nio kvinnor deltog i studien, fem förstföderskor och fyra omföderskor, varav 5 intervjuades och 4 erhöll semistrukturerade frågeformulär med öppna svarsalternativ. En reflekterande livsvärldsansats som baserar på fenomenologi användes under datainsamling och dataanalys. Resultatet visar att amningen som fenomen är komplex och innebär en utmaning för kvinnan. Den essentiella innebörden av fenomenet beskrivs som ”amning som en kraftkälla, där den har potential att vara både kraftgivande och stärkande samt riskerar vara kraftdränerande”. Detta beskrivs vidare utifrån fyra innebördselement: ”att knyta kontakt med och lära känna sitt barn”, amning som återhämtning”, ”amning som energikrävande” och ”att känna sig ömtålig och utsatt”. Vårdande av kvinnor som lider av postpartum depression under amning innebär att assistera kvinna att möta sin osäkerhet och stärka hennes förtroende för att lita på sin förmåga att amma sitt barn. När amningen fungerar bra har den potentialen att inge kraft och stärka kvinnan i moderskapet. Fungerar amningen däremot inte bra riskerar den att dränera kraft och strävan efter samhörighet och bekräftelse sätts på spel vilket späder på kvinnans redan sköra situation och gör henne ännu mer sårbar i förhållande till barnet och sig själv.

The risk of breast cancer transiently increases immediately following pregnancy. Hispanic women have one of the highest rates of postpartum breast cancers of all racial/ethnic minority groups in the US. The biology that underlies this risk window and the effect on the natural history of the disease is unknown. MicroRNAs (miRNAs) are small non-coding RNAs that have been shown to be dysregulated in breast cancer. In this study, we measured the miRNA expression of 56 tumors from a case series of multiparous Hispanic women and assessed the pattern of expression by time since last full-term pregnancy. A data-driven splitting analysis on the pattern of 355 miRNAs separated the case series into two groups: a) an early group representing women diagnosed with breast cancer ≤ 5.2 years postpartum (n=12), and b) a late group representing women diagnosed with breast cancer ≥ 5.3 years postpartum (n=44). We identified 15 miRNAs that are differentially expressed between the early and late postpartum groups; 60% of these miRNAs are encoded on the X chromosome. Ten miRNAs had a two-fold or higher difference in expression; miR-138, miR-660, miR-31, miR-135b, miR-17, miR-454, and miR-934 were overexpressed in the early versus the late group; while miR-892a, miR-199a-5p, and miR-542-5p were under expressed in the early versus the late postpartum group. The DNA methylation of three out of five tested miRNAs (miR-31, miR-135b, and miR-138) was lower in the early versus late postpartum group, and negatively correlated with miRNA expression. Taken together, the results of this study show that miRNAs are differentially expressed and differentially methylated between tumors of the early versus late postpartum, suggesting that potential differences in epigenetic dysfunction may be operative in postpartum breast cancers.

Bakgrund: Postpartumdepression (PPD) drabbar mellan 8-15% av alla kvinnor som föder barn och innebär stora påfrestningar för både modern, partnern och spädbarnet. Utvecklandet av PPD har multifaktoriella orsaker som tidigare psykiatrisk sjukdom, dåligt parförhållande och brist på socialt stöd. Syfte: Studiens syfte var att undersöka kvinnors upplevelser av postpartumdepression. Metod: Studien är en litteraturöversikt där vetenskapliga artiklar motsvarande studiens syfte granskades. Samtliga artiklar hade kvalitativ ansats och söktes i databaserna Cinahl och Pubmed. Resultat: Studiens resultat indelades i tre övergripande teman: moderskap, diagnostisering - samt stöd. Kvinnor som drabbas av PPD uppfattar sig vara misslyckade mödrar samt upplever känslor av hopplöshet och utmattning. Stigmatiseringen kring PPD samt att bli diagnostiserad med psykiatrisk sjukdom, och rädslan av att bli uppfattad som en otillräcklig mor, leder till motvilja att uppsöka vård. Vårdpersonalen uppfattas ofta normalisera kvinnornas depressionssymptom vilket leder till att dessa kvinnor tappar förtroende för vården och inte känner sig sedda eller tagna på allvar. Partnerns och den närmaste omgivningens stöd spelar en betydande roll för att identifiera symptom, söka hjälp och tillfriskna. Slutsats: PPD upplevs av drabbade kvinnor både som ett personligt och socialt stigma, där den egna förmågan till moderskap och lämplighet ifrågasätts. Resultaten indikerar behov av förbättrat bemötande från vården, samt nytänkande inom tillgänglighet och prevention. / Background: Postpartum depression (PPD) affects between 8-15% of all women who give birth to children and poses major new challenges for the mother, partner and baby. The causes behind the development of postpartum depression are multifactorial; a previous psychiatric illness, poor partner relationship and a lack of social support. Aim: The aim of the study was to explore women's experiences of postpartum depression. Method: The study is a literature review in which scientific papers corresponding to the study's aim were reviewed. All reviewed articles had a qualitative approach and was searched in the databases CINAHL and Pubmed. Results: The results of the study were divided into three overarching themes: maternity, diagnosis and support. Women who suffer from PPD perceive themselves to be a failure as mothers and experience feelings of hopelessness and exhaustion. The stigma surrounding PPD and beeing diagnosed with a mental illness, as well as the fear of being perceived as an inadequate mother, are leading to reluctance to seek care. Health care workers are often perceived to normalize women's depressive symptoms which leads to that these women lose trust in the health care system and do not feel they are seen or taken seriously. Support from partner and the immediate surrounding plays a significant role in identifying symptoms, helpseeking and the process of recovery. Conclusion: PPD was experienced by the affected women as both a personal and a social stigma, where their ability to motherhood and suitability was questioned. The results indicate the need for improved treatment of health care, as well as innovation in availability and prevention.

The current study examined the psychometric properties of the Physical Activity and Nutrition Self-Efficacy (PANSE) scale. If proven a valid and reliable measure of self-efficacy for weight-loss behaviors, the PANSE scale may be useful in future research involving activity and nutrition for weight loss. This is particularly important given today’s high prevalence of overweight and obesity, which may be curtailed with increased levels of activity and/or improved food-related behaviors. Initial reliability and validity testing was performed using a sample of 71 women low-income in central Texas. The average age of the participants was 24.5 ± 4.75 years; 35.2% were African American, 32.4% were Hispanic, and 32.4% were White. The women completed the 11-item PANSE questionnaire at baseline and at a 7-week follow-up data collection. Test-retest results provided reliability evidence, and there was sufficient evidence of internal consistency (Cronbach alpha = 0.89). Construct validity was established with significant correlations in expected directions with the Self Care Inventory, Perceived Stress Scale, and Decisional Balance Inventory. The predictive validity of the PANSE scale for weight-loss at 7-week follow-up and program drop out was not established. Exploratory factor analyses revealed a 2-factor model for the 11 items. Initial examination provided evidence for the reliability and construct validity of the PANSE scale. Future testing of the scale should to be conducted with other populations to assess the generalizability of the PANSE scale outside of the population studied in the current report. / text

Obesity-related diseases account for the majority of morbidity and mortality in U.S. adults. An estimated 4 million women in the United States deliver an infant annually, of which approximately 34% are overweight/obese prior to pregnancy. More than 30% of these women gain weight that exceeds the IOM’s recommendations; increasing their risk of postpartum weight retention and possibly increasing their risk of greater weight gain and retention over time. This research sought to test the efficacy of a traditional MED diet for 4-months on weight loss/control and biomarkers of inflammation in breastfeeding women compared to women randomized to the USDA’s MyPyramid diet for Pregnancy and Breastfeeding (control diet). At baseline, the women (N=129) were 29.7±4.6 years, overweight (BMI: 27.2±4.9 kg/m2), and primarily non-Hispanic white (75.2%). The majority of women were exclusively breastfeeding (73.6%) and a mean 17.5 weeks postpartum. Adherence to the MED diet was evaluated via calculation of the MED diet score from validated FFQs administered pre- and post- the diet intervention. Anthropometric measurements (body weight, body fat, and waist and hip circumference) and biosamples (blood, urine, and breast milk) were collected at baseline and 4-months (diet completion). Biomarkers of inflammation (IL-6 and TNF-α) were assessed via standard ELISA kits. The MED diet score was increased by 0.68±2.74 and 0.27±1.57 for the MED and control group, respectively. Increases in fish and dairy intake and a decrease in meat/poultry intake were significantly different between diet groups (P<0.05). Participants in both diet groups demonstrated significant (P=0.002) reductions in all anthropometric measurements; no significant between group differences were shown. A significant decrease in TNF-α, but not IL-6, was demonstrated in both diet groups. There were no significant between group differences. Both the MED diet and the USDA’s MyPyramid diet were effective in reducing anthropometric measurements and inflammation in postpartum breastfeeding women.

Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants&rsquo / lives. The purpose of this study was to explore adolescent mothers&rsquo / experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women&rsquo / s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women&rsquo / s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women&rsquo / s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents&rsquo / disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies.

According to the World Health Organization, mental health problems, particularly depression and anxiety, are increasing worldwide; this places a huge burden on individuals, families, and society. Maternal depression has drawn a lot of attention during the last two decades because maternal depression affects not only the women, but also their unborn children and/or newborns. However, the majority of women who suffer from maternal depression do not seek help. When the women seek help, they are often under-diagnosed or under-treated by their family physicians. The shared care model has been implemented in a variety of health care settings including mental health. Shared care enhances collaboration between family physicians and specialists in delivering patient care. The Maternal Mental Health Program (MMHP) is a shared care program, and was developed to improve the mental health of pregnant and postpartum women in the Saskatoon Health Region. In comparison to other shared care programs reported in the literature, the MMHP is focused exclusively on maternal mental health. To evaluate the MMHP, a quantitative evaluation was conducted to examine the implementation and maintenance of the program. Based on the findings, there was a significant reduction of depression and anxiety symptoms among women who completed the program. This study revealed that social determinants of health are associated with the level of symptoms. Overall, the program met women’s and physician’s expectations, with 75 women (75.8%) and 75 physicians (76.5%) being satisfied or very satisfied with the program. This evaluation study suggests that implementation and maintenance of a shared care maternal mental health program are possible and effective in a local setting, and, in order to improve maternal mental health, social determinants of health have to be addressed.