Att bilda familj är en stor del av livet och innebär många förändringar för de blivande föräldrarna. För kvinnorna som drabbas av postpartumdepression (PPD) blir vardagen väldigt annorlunda. PPD förekommer alltmer i världen och idag förväntas 10 – 15 % av mammorna utveckla sjukdomen. Mammans tidigare livserfarenheter samt det stöd hon får av sin närmsta omgivning avgör hur hon tar sig an den nya rollen som mamma. De flesta kvinnor som har PPD upplever en känsla av oro, ilska och skuld. Den nyblivna mamman kan känna sig rädd och överväldigad över ansvaret att ha ett nyfött barn. Det råder brist i kunskapen om PPD hos mammor vilket innebär att de inte vill eller vågar söka hjälp. Syftet med studien är att belysa mammans upplevelser av PPD. I denna litteraturstudie har åtta kvalitativa artiklar analyserats där en intervjumetodik har varit central. Resultatet består av huvudteman där fokus ligger på vad mamman upplever. Studiens resultat visar att de nyblivna mammor som drabbas av PPD upplever ett lidande. Känslor av skuld och rädsla är centrala och påverkar relationen mellan mamman och barnet. Sjukdomen påverkar även mammans andra relationer i livet och leder ofta till att hon väljer att vara isolerad. Rädsla för att stigmatiseras av omgivningen är ytterligare en anledning till att mamman många gånger väljer ett liv i ensamhet. I resultatdiskussionen lyfts sjukdomens påverkan på mammans relation till barnet, upplevelser av stigma i samband med PPD, kulturella aspekter och dess påverkan på mammans sociala liv samt sjuksköterskans ansvar i vården av dessa patienter. / Program: Sjuksköterskeutbildning

Under första vakenhetsperioden efter förlossningen visar de flesta nyfödda barn tecken på att vilja amma och ska då få möjlighet till det. Amning har en lugnande effekt och den underlättar anknytningen mellan mor och barn. Barn som ammas under denna period ammas i större utsträckning fyra månader efter förlossning än barn som inte ammats. Vid förlossning är barnets behov av värme, närhet och mat primära för barnets fortsatta utveckling och välbefinnande. Om det nyfödda barnet får stanna hos sin mamma finns inga hinder för barnmorskan att stödja det nyfödda barnets kompetens och medverka till en lyckad första amning. För att stödet skall bli optimalt behövs både god kunskap och en positiv attityd till amning hos barnmorskan. Syftet med studien är att beskriva förlösande barnmorskors upplevelse av deras stödjande roll i samband med den första amningen. Sex barnmorskor intervjuades och materialet tolkades genom kvalitativ innehållsanalys. Resultatet visar att barnmorskor upplever krav från både kollegor och patienter på att den första amningen skall fungera,. De känner att kvinnorna behöver dem och att de kan bidra mycket genom sin kunskap och genom att vara närvarande. Vidare ser barnmorskan sig som en assistent till kvinnan, vars uppgift är att hjälpa till att skapa förutsättningar för en lyckad första amning. / <p>Program: Barnmorskeutbildning</p><p>Uppsatsnivå: D</p>

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal death worldwide. For every woman that dies, 20 or 30 more will experience morbidity. Severe PPH is increasing and is the leading cause of severe maternal morbidity in the UK. Rapid recognition of PPH is essential, but concealed bleeding, underestimation of blood loss and a failure to appreciate the physiological effects of blood loss, lead to delays in recognition and treatment. Experts believe that most deaths from PPH could be avoided by earlier diagnosis, but there is a lack of evidence on how to achieve this. Aims: To explore the experiences of those involved in evaluating blood loss during childbirth; and to develop and test a theory of blood loss evaluation and PPH recognition, as a prerequisite to developing strategies to support earlier diagnosis. Study Design: A sequential, exploratory mixed methods design was used. Methods: Qualitative methods included 8 focus groups and 19 one-to-one semi-structured interviews, conducted with 50 participants. These included: women and their birth partners (recruited from Liverpool Women's Hospital); and health professionals (midwives and obstetricians recruited from Saint Mary's Hospital, Manchester). A purposive sampling strategy was used to recruit women, who had experienced vaginal birth with or without PPH, and health professionals, with varying levels of experience in blood loss evaluation and PPH management. A snowball sampling strategy was used to recruit the birth partners of women participants. Phase one was completed from June to September 2014. All discussions were audio-recorded and transcribed verbatim. Data were managed using NVivo 10 qualitative data analysis software, which also supported the Framework approach to analysis and interpretation. Quantitative methods were used in phase two and involved 10 midwives and 11 obstetricians, recruited from Liverpool Women's Hospital, during February and March 2015. Two scenarios, one of fast and one of slow blood loss, were presented to the sample using clinical simulation with the NOELLE® childbirth simulator, in a pilot, randomised, cross-over study. Participants also completed three questions about the use of the NOELLE® mannequin for these types of scenarios. IBM SPSS Statistics version 23 software was used for quantitative data management and to estimate descriptive statistics. Numerical crossover data were copied into StatsDirect software, to perform the crossover analyses. Results: Women and birth partners were very perceptive to blood loss but felt ill-prepared for the reality of bleeding, with many experiencing negative emotional responses to both PPH and the lochia. Non-verbal communication from staff was used by women and their birth partners to interpret the seriousness of their blood loss. Health professionals: Recognition of PPH mainly occurs as an automatic response to the speed of blood flow. Volume of blood loss is often ascertained and used retrospectively after a PPH diagnosis, to validate the intuitive response and to guide and justify on-going decisions. This was confirmed by the simulation studies, where treatment was initiated at 100ml or less in all blood loss scenarios. Fast blood loss was more likely than slow blood loss to elicit a PPH response, despite volumes in the two groups being similar. Formal quantification of blood loss is not used routinely in practice. When it is used, values are often unofficially normalised to reflect health professionals' perceptions of the woman's clinical condition. Tools introduced to aid diagnosis, such as blood collection bags, routine weighing and the use of early warning scores, are not routinely used in the immediate post-birth period, especially if the woman and her blood loss are perceived to be normal. The tools are again used to validate intuitive feelings about blood loss and maternal condition. When they are used, the values are often modified if they contradict professional judgement. Conclusions: Women and birth partners want more information, open communication, and on-going support, to minimise the emotional impact of blood loss. For health professionals, the speed of blood loss is the crucial factor in PPH recognition rather than an accurate assessment of the volume of blood loss. The amount of visible blood is generally not initially interpreted as a volume, but is used to compare current blood losses to those previously witnessed. Experience therefore plays a crucial role in the decisions of whether blood loss is considered normal or excessive. Formal quantification of blood loss and regular recording of physiological observations do not occur routinely in the immediate post-birth period. Therefore, women with insidious blood loss can have delayed PPH diagnosis because they have a normal blood flow and exhibit minimal physiological changes, due to the compensatory mechanisms of shock. Often such women need to exhibit outward signs of physiological compromise, such as fainting or feeling unwell, before their physiological observations and blood loss are formally re-evaluated. Education of health professionals should highlight the common errors of judgement made during blood loss evaluation and provide feedback on cases of delayed recognition. Future research should examine normal postnatal bleeding in the hours following birth, and create visual aids for women to self-diagnose insidious blood loss. Training should focus on the skills of PPH recognition, particularly those with insidious blood loss and postnatal physiological assessments. Novel tools such as the shock index should be considered and evaluated as tools of assessment.

Li Siu-yan Susan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 156-168). / Abstracts in English and Chinese. / Abstract (English version) --- p.i / Abstract (Chinese version) --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of figures --- p.ix / Chapter I. --- INTRODUCTION --- p.1 / Background of the study --- p.1 / Chapter II. --- LITERATURE REVIEW --- p.5 / Maternal role attainment --- p.6 / Transitional theory --- p.16 / Feminist approaches to transition to motherhood --- p.23 / Local research on transition to motherhood --- p.26 / The rationale of the study --- p.30 / Chapter III. --- METHODS --- p.34 / Design --- p.34 / Setting --- p.39 / Sample --- p.39 / Ethical issues --- p.41 / Data collection --- p.42 / Data analysis --- p.46 / Trustworthiness of the study --- p.53 / Summary --- p.57 / Chapter IV. --- FINDINGS AND DISCUSSION --- p.59 / Conceptual categories --- p.61 / Keeping harmony --- p.62 / Giving of self --- p.63 / Discontinuity of self --- p.64 / Caring for (m)other --- p.75 / Replenishing --- p.91 / Daydreaming --- p.92 / Fortifying support --- p.98 / Developing self --- p.117 / Rewards of mothering --- p.118 / Achieving maternal competency --- p.121 / Renegotiating relationships --- p.127 / With mother-in-law --- p.130 / With husband --- p.135 / With work --- p.137 / The storyline --- p.139 / Chapter V. --- CONCLUSIONS AND RECOMMENDATIONS --- p.141 / Summary of the study --- p.141 / Implications for midwifery practice --- p.146 / Limitations and recommendations for further study --- p.152 / Personal reflections on study --- p.153 / References --- p.156 / Appendix / Chapter A. --- Letters of approval - The Chinese University of Hong Kong --- p.169 / Chapter B. --- Letters of approval - general hospital --- p.170 / Chapter C. --- Subject information sheet for the participants (English and Chinese version) --- p.171 / Chapter D. --- Consent form from the participant (English and Chinese version) --- p.173 / Chapter E. --- Transcripts in Chinese language --- p.175 / Chapter F. --- Translation of transcripts in English --- p.195 / Chapter G. --- Demographic summary of interview participants --- p.214

nÃo hà / Embora a importÃncia da morbidade pÃs-natal tenha sido posta em pauta nos Ãltimos anos, informaÃÃes sobre a sua repercussÃo para a vivÃncia das puÃrperas ainda à limitada, o que leva a crer que a qualidade de vida (QV) da mulher neste perÃodo seja um aspecto que mereÃa maior atenÃÃo. Neste sentido, a mensuraÃÃo da qualidade de vida mediante a percepÃÃo do paciente tem sido recomendada. Objetivou-se adaptar transculturalmente a Maternal Postpartum Quality of Life Questionnaire para a LÃngua Portuguesa no contexto brasileiro, verificar as propriedades psicomÃtricas da Maternal Postpartum Quality of Life Questionnaire no Brasil, analisar a relaÃÃo entre os Ãndices da Maternal Postpartum Quality of Life Questionnaire e as variÃveis maternas, e identificar os preditores de Qualidade de Vida entre as mÃes brasileiras estudadas. Trata-se de um estudo metodolÃgico, com abordagem quantitativa, realizado em uma maternidade-escola pÃblica de Fortaleza-CearÃ. O estudo foi iniciado apÃs consentimento da autora da escala e cumpriu duas etapas: adaptaÃÃo transcultural, segundo protocolo de Beaton et al. (2007) e verificaÃÃo das propriedades psicomÃtricas (validade e confiabilidade). A amostra foi composta por 210 mulheres, entre 7 e 10 dias de pÃs-parto. A coleta de dados ocorreu entre abril e julho de 2012 e foi subsidiada pela tÃcnica de entrevista, com aplicaÃÃo da MAPP-QOL e de um formulÃrio com informaÃÃes sociodemogrÃficas e obstÃtricas das participantes. As anÃlises dos dados maternos, Ãndices de Qualidade de Vida e propriedades psicomÃtricas foram realizadas utilizando o programa Statistical Package for Social Sciences, versÃo 21.0. O processo de adaptaÃÃo transcultural resultou em uma escala com 39 itens, reavaliados seis itens por discordÃncia entre o comità de juÃzes e acrescentadas modificaÃÃes em dois destes, em resposta à validaÃÃo de face. Sendo assim, a Maternal Postpartum Quality of Life Questionnaire obteve um Ãndice de ConcordÃncia entre os juÃzes de 0,97. A anÃlise fatorial foi o meio escolhido para a validaÃÃo de construto do instrumento. Foi mantido o mesmo nÃmero de domÃnios da versÃo original, diferindo apenas na relocaÃÃo de 20 itens ao longo de todos os domÃnios, segundo rotaÃÃo varimax. O alfa de Cronbach total foi de 0,89, denotando a confiabilidade do instrumento. A validade discriminante foi confirmada atravÃs das diferenÃas nos escores da Maternal Postpartum Quality of Life Questionnaire entre os grupos contrastados. O escore mÃdio obtido da Maternal Postpartum Quality of Life Questionnaire foi 15,24 e houve relaÃÃo estatÃstica significativa entre estado civil (p = 0,01), raÃa (p = 0,04) e nÃvel educacional (p = 0,01), com os escores totais da escala. Segundo a anÃlise de regressÃo mÃltipla das variÃveis e os escores da escala, apenas o estado civil e a raÃa puderam ser considerados preditores para qualidade de vida. Conclui-se que a versÃo brasileira da Maternal Postpartum Quality of Life Questionnaire pode ser considerada um instrumento especÃfico confiÃvel e vÃlido de aferiÃÃo da qualidade de vida, de fÃcil compreensÃo e aplicaÃÃo durante o perÃodo pÃs-parto. A utilizaÃÃo da MAPP-QOL no Brasil poderà nortear pesquisadores e/ou profissionais da Ãrea da saÃde da mulher rumo ao planejamento, à implementaÃÃo e à avaliaÃÃo de intervenÃÃes prÃ-qualidade de vida, tornando-os, assim, promotores da saÃde materna.

O consumo de álcool durante a gestação tem sido associado na literatura científica a uma maior intensidade de sofrimento psiquiátrico durante a gestação e no pós-parto. Este estudo teve como objetivo principal verificar se o consumo de álcool em gestantes está relacionado a um aumento de sintomas depressivos e/ou ao diagnóstico de depressão no pós-parto. Para tal foi realizado um estudo prospectivo, com dois tempos de coleta de dados. Foram convidadas a participar gestantes da rede pública de saúde da cidade de Juiz de Fora/MG. Inicialmente foram entrevistadas 260 mulheres no terceiro trimestre gestacional, das quais 177 foram entrevistadas entre 15 dias a 3 meses após o parto. Para avaliação do uso de álcool durante a gestação foram utilizados os instrumentos T-ACE (Tolerance, Annoyed, Cut down, Eye opener) e AUDIT C (Alcohol Use Disorders Identification Test C), além do relato das gestantes sobre a quantidade de álcool ingerida durante toda a gestação. Para avaliação de sintomas depressivos no pós-parto foi utilizado o instrumento EPDS (Edinburgh Postnatal Depression Scale) e para o diagnóstico de Episódio Depressivo Maior foi utilizada a entrevista diagnóstica MINI (Mini International Neuropsychiatric Interview). Os resultados obtidos apontaram para um aumento de sintomas depressivos no pós-parto proporcional ao aumento do consumo de álcool durante a gestação medido pelo total do AUDIT C (Spearman Correlation, r=0,251; p<0,001) e pelo total em gramas de álcool consumido durante toda a gestação (Spearman Correlation, r=0,185; p=0,01). Além disso, foi observado uma maior prevalência de depressão pós-parto entre as mulheres que tiveram pelo menos um binge alcoólico durante a gestação (Non-parametric Chi-Square, value=88,28, p< 0,001). Os dados apresentados permitem concluir que existe um aumento de sintomatologia depressiva no pós-parto à medida que aumenta o consumo de álcool na gestação e aumento de diagnóstico para aquelas que tiveram pelo menos um binge alcoólico durante a gestação. / Alcohol consumption during pregnancy, according to the scientific literature, has been associated to a higher intensity of psychiatric problems during the gestational period as well in the postpartum period. This study aimed to verify whether alcohol consumption in pregnancy is related to an increase of depressive symptoms and/or the diagnosis of depression in the postpartum period. For this purpose a prospective study was carried out, with two phases of data collection. Pregnant women assisted by public health services of the city of Juiz de Fora /MG were invited to participate. Initially 260 women in the third gestational trimester have been interviewed. For the second phase 177 were interviewed between 15 days to three months after childbirth. To assess alcohol use during the gestational period the research instruments T-ACE (Tolerance, Annoyed, Cut down, Eye-opener) and AUDIT C (Alcohol Use Disorders Identification Test C) have been used, besides of direct reports of the pregnant women about the amount of alcohol ingested during all the gestation. To evaluate postpartum depressive symptoms the instrument EPDS (Edinburgh Postnatal Depression Scale) was used and to determine the presence of a diagnosis of Major Depressive Episode the diagnostic interview MINI (Mini International Neuropsychiatric Interview) was used. The results pointed out to an increase of postpartum depressive symptoms proportional to the increase of alcohol consumption during the gestation measured by the total score of the AUDIT C (Spearman Correlation, r=0,251; p<0,001) and by the total amount (in grams) of alcohol ingested during all the gestational period (Spearman Correlation, r=0,185; p=0,01). Further, a higher prevalence of postpartum depression was found among the pregnant women who reported at least once a binge episode during the gestational period (Nonparametric Chi-Square, value=88,28; p< 0,001). The presented data allow concluding about the occurrence of an increase of depressive symptoms in the postpartum period related to higher alcohol consumption in pregnancy as well an increase of diagnosis among those pregnant women who have had at least one binge episode during all the gestational period.

Depression during the perinatal time period is the most common medical condition related to pregnancy and childbirth. Based on previous research, this condition can have negative sequelae for mothers, their offspring, families and the community. Therefore, studies are needed to better understand risk factors and health outcomes among women with depression and the health outcomes among children born to mothers with depression. We examined rurality as a risk factor for depression during the perinatal time period using data from the 2016 Pregnancy Risk Assessment Monitoring Survey (aim one). We found women who resided in rural communities, as defined by their individual states, had an increase in the odds of depression during the perinatal period by 21% (OR: 1.21; 95% CI 1.05,1.41) when compared to women who resided in urban communities. Based on the results from this study, future studies are warranted to examine mediators of this relationship to develop effective public health and clinical interventions. Next, we examined the association between perinatal mental health conditions and postpartum prescription opioid use using private insurance claims data of women who delivered a baby in the state of Iowa 2005 to 2016 (aim two). Overall 38.63% of the women in our study filled at least one opioid prescription and 5.88% filled at least two prescriptions in the first 90 days postpartum. A significant interaction of having a perinatal mental health condition and delivery mode was observed for at least one (p=.04) and at least two opioid fills (<.0001). The presence of a mental health condition among women who delivered vaginally increased their odds of filling at least one opioid fill by nearly 50% (OR: 1.48 95% CI 1.35, 1.63) and by almost 20% (OR: 1.19 95% CI: 1.00, 1.43) among women with a cesarean delivery. A mental health condition significantly increased the odds of filling at least two opioid prescriptions among women with a vaginal or cesarean delivery by 2.78 (95% CI: 2.32-3.33) and 1.66 (95% CI: 1.40,1.98). Based on findings from this study, more research is needed to improve our understanding of the relationship between perinatal mental health and prescription opioid use. Finally, the association between perinatal depression and attention deficit hyperactivity disorder (ADHD) use was examined using private insurance claims data from mother-child pairs from the state of Iowa (aim three). Children were born during years 2004 through 2015. In our study children born to mothers with perinatal depression were at an increased odds of ADHD diagnosis by 170% (OR: 2.70; 95% CI 2.06, 3.55). We also evaluated how timing of depression (during pregnancy vs. postpartum) influenced the odds of ADHD diagnosis. While we found children born to mothers with depression during pregnancy and postpartum had an increased risk of ADHD diagnosis, we observed children exposed to depression during fetal development had the greatest risk overall. Research is needed to better understand the mechanisms of risk between perinatal depression and ADHD risk in offspring. Additionally, due to low power we were not able to evaluate how treatment of depression during pregnancy or postpartum may influence childhood outcomes, therefore more studies are needed in this area. Overall, findings from each study illustrate the importance of maternal mental health and how a mental health condition during the perinatal period can influence maternal and child health outcomes. Future prospective population-based studies are needed to better understand the etiologies of perinatal mental health conditions and how such conditions can influence outcomes for maternal and child health. Results from future studies have the potential to shift clinical practice to improve prevention and intervention in turn improving overall maternal and child health outcomes.

Bröstmjölk rekommenderas för spädbarn som enda föda upp till sex månaders ålder. Globalt sett syns en nedåtgående trend gällande amning vilket sannolikt kan medföra risker för barn i låginkomstländer. I höginkomstländer är det inte säkert att detta har samma betydelse, debatten pågår. Syftet med litteraturstudien är att beskriva faktorer som kan hindra/främja amning hos kvinnor. För att besvara studiens syfte valdes en litteraturstudie med kvalitativ metod för att identifiera vilka faktorer som är viktiga för att få fler kvinnor att amma. En litteraturstudie enligt Fribergs (2006) modell för litteraturöversikt valdes för att samla in data och ge oss en översikt över varför mammor väljer att amma eller att inte amma. Det analyserade materialet resulterade i två kategorier; faktorer som främjar respektive förhindrar amning. Faktorer som bland annat främjar amning är positiva känslor kring amning, kunskap och erfarenhet, stöd från personal samt stöd från partner. Resultatet visar att stöd är viktigt samt att närståendes förhållningssätt till amning är av stor betydelse. Slutsatsen är att stöd samt utbildning för ammande kvinnor behöver prioriteras i form av mer och bättre utbildning samt emotionellt stöd både under graviditet, men också under den fösta tiden då barnet är fött.