In comparison to other high-income nations, the U.S. maintains the highest maternal mortality rate, especially among Black women. Factors like the growing maternal age and restricted family planning clinics have been noted to contribute to this phenomenon. However, the impact of health literacy on maternal has yet to be reviewed. Health literacy in the U.S. has long been determined to be a social determinant of health more broadly, and it may likely play a role in maternal health as well. Consequently, a systematic review of health literacy and its association with maternal health outcomes is warranted. The goal of this study is to examine research that has been conducted over the past ten years to determine the state of evidence on the association of health literacy and maternal health outcomes. I will utilize the research databases of PubMed, CINAHL, and PsycINFO alongside a carefully curated search hedge to find articles that best align with pre-determined inclusion criteria. After articles have been screened at title/abstract and full-text levels, all remaining articles will be appraised for quality. Articles strictly pertaining to health literacy and its relationship to maternal health outcomes will be evaluated. I expect this systematic review to shed light on the role of health literacy as a potential strategy to improve maternal health outcomes.

This study examined pregnancy risk and protective factors for developing postpartum depression from a structural family theory lens. The purpose of this study was to (1) examine previously identified pregnancy stressors to learn which stressors put women more at risk for postpartum depression and (2) to identify possible buffers for women who are at risk for developing postpartum depression. In this paper, two analyses were proposed. Analysis I, uses a hierarchal regression analysis to examine the impact of couple related stress on postpartum depression. Analysis II uses moderated multiple regression to test factors during pregnancy which may protect at-risk women from postpartum depression symptoms. Three post-hoc exploratory analyses were conducted following the originally proposed analyses. Secondary data was used in this study. The data was collected in four large urban hospitals in Utah from 2005-2007 and included 1568 women. The results of these analyses illustrate the importance of conceptualizing postpartum depression from a family systems perceptive. Specifically, this study shows that a couple’s relationship, depending on the stress level experienced in the relationship, can be both a risk and protective factor for pregnant women. / Ph. D.

Introduktion: Mellan åtta och femton procent av nyförlösta kvinnor i Sverige drabbas av Postpartum depression (PPD). Många vet inte om att de är sjuka och söker inte vård. Hälso- och sjukvården ska tidigt uppmärksamma symtom, samt ha kunskap om vilka faktorer som kan bidra till PPD för att ge vård, hjälp och stöd. Syfte: Syftet var att utforska kvinnors upplevelse av förlossningsdepression samt stöd från vårdpersonal. Metod: En systematisk deskriptiv litteraturöversikt baserad på elva originalartiklar med kvalitativ design utfördes. Resultat: Resultatanalysen visade att kvinnorna upplevde fysiska och psykiska symtom, kände rädsla och hade svårigheter att prata om sina känslor vilket bidrog till isolering. En del kvinnor hade anknytningsproblem till barnet och vissa påverkades i sin relation till partnern. Kvinnor hade suicidtankar eller tankar på att skada sig själva eller sitt barn. Positiva eller negativa egenskaper hos vårdpersonalen var avgörande för mödrarnas önskan om stöd. När stödet i vården var bristande eller otillräckligt upplevdes fysisk aktivitet vara hjälpande faktorer. Slutsats: Kvinnor med PPD upplever ett onödigt lidande och känner skuld och skam. I många fall skulle dessa individer kunna upptäckas och få behandling tidigare genom att sjukvården arbetar proaktivt och ger kvinnor information i ett tidigt stadium. Det kan hjälpa kvinnor att uppmärksamma symtom själva och att söka vård i tid. Att göra information och vård lättillgängligt, att öka kunskapen i samhället och bland professionerna i vården samt att normalisera och bryta stigmat skulle kunna underlätta för många drabbade. / Introduction: Between eight and fifteen percent of women who have just given birth in Sweden suffer from postpartum depression (PPD). Many do not know that they are ill and do not seek treatment. The healthcare system must pay attention to symptoms early on, and have knowledge of which factors can contribute to PPD in order to provide care, help and support. Purpose: The purpose was to explore women's experience of postpartum depression and support provided by healthcare professionals. Method: A systematic descriptive literature review based on eleven original articles with a qualitative design was performed. Result: The results analysis showed that the women experienced physical and psychological symptoms, felt fear and had difficulty talking about their feelings, which contributed to isolation. Some women had attachment problems with the child and some were affected in their relationship with the partner. Women had suicidal thoughts or thoughts of harming themselves or their child. Positive or negative characteristics of the healthcare professionals were decisive for the mothers' desire for support. When support in care was lacking or insufficient, physical activity was perceived to be a helping factor. Conclusion: Women with PPD experience unnecessary suffering and feel guilt and shame. In many cases, these individuals could be detected and treated earlier by the healthcare system working proactively and providing women with information at an early stage. It can help women to notice symptoms themselves and to seek care in time. Making information and care easily accessible, increasing knowledge in society and among the healthcare professions, and normalizing and breaking the stigma could make things easier for many sufferers.

One of the most common complications for mothers after childbirth is postpartum depression (PPD). This illness can occur in women who have given birth, who have miscarried or who have had a stillbirth. The American College of Obstetricians and Gynecologists (2010) indicate that PPD affects 1 in 8 women. These statistics are disturbing especially when 51 % of women may not be willing to seek treatment for PPD (Beck & Gable, 2001 ). Therefore, the number of women who are experiencing PPD is of national concern. The literature reveals that there is not a standard or protocol for the assessment of PPD symptoms, education delivery, or referral and treatment. With an absence of a standard or protocol, this devastating disorder will continue to go undiagnosed in thousands of women affecting not only their wellbeing but the wellbeing of their families. Nurses are in an optimal position to help prevent and identify women suffering from PPD. Establishing the nurse's role in assessing, educating and referring women and families suffering from PPD will assist in reducing the prevalence of this illness and identifying afflicted women for early intervention. Implementing a standard of practice in PPD assessment, education, and referral will assist healthcare providers in achieving the Healthy People 2010 objective of reducing mental illness and complications due to pregnancy.

Every year, over 3.5 million women give birth in the United States, with about 67.9% delivering vaginally. Over 80% of postpartum (PP) women experience chronic pain in the pelvis, lower back, hip, and legs at 24 weeks after birth, and 20% continue to experience these issues 3 years later. PP women often face pelvic instability and weakness, which disturb balance and lead to asymmetric loading in the pelvis and legs. This imbalance makes daily tasks, such as lifting and carrying a car seat during childcare, more difficult, and increases the risk of chronic pain and injury. This study aimed to explore how different groups – PP and nulliparous (NP) women – and different ways of holding a car seat while standing – no holding, symmetrical holding with two hands in front, and asymmetrical holding with one arm by the side – affect balance and limb loading symmetry. Results showed that postpartum women struggled more with balance as the task became more challenging, with asymmetrical holding showing large differences between groups. PP women also exhibited greater asymmetric limb loading compared to NP women with asymmetrical holding creating the greatest level of asymmetric limb loading. The study also aimed to explore how the two groups – PP and NP – and the different ways of lifting a car seat – symmetrically and asymmetrically – affect balance and limb loading. Both groups had more asymmetric limb loading and worse balance with asymmetrical lifting, though NP women showed larger movements during asymmetrical lifting, likely reflecting the movement of the body during the condition. These results highlight the importance to further research balance and limb loading in PP compared to NP women. Understanding whether pelvic instability and weakness may contribute to differences in balance and limb loading is crucial as it may help explain how and why postpartum women face higher risk of injury and chronic pain. Ultimately, such work may find ways to improve postpartum health during daily activities. / VT Engineering Faculty Organization-Opportunity (EFO-O) Seed Investment / Master of Science / Every year, over 3.5 million women give birth in the United States, with about 67.9% delivering vaginally. Over 80% of postpartum (PP) women experience chronic pain in the pelvis, lower back, hip, and legs at 24 weeks after birth, and 20% continue to experience these issues 3 years later. PP women often face pelvic instability and weakness, which disturb balance and lead to asymmetric loading in the pelvis and legs. This imbalance makes daily tasks, such as lifting and carrying a car seat during childcare, more difficult, and increase the risk of chronic pain and injury. This study aimed to explore how different groups – PP and nulliparous (NP) women – and different ways of holding a car seat while standing – no holding, symmetrical holding with two hands in front, and asymmetrical holding with one arm by the side – affect balance and limb loading symmetry. Results showed that postpartum women struggled more with balance as the task became more challenging, with asymmetrical holding showing large differences between groups. PP women also exhibited greater asymmetric limb loading compared to NP women with asymmetrical holding creating the greatest level asymmetric limb loading. The study also aimed to explore how the two groups – PP and NP – and the different ways of lifting a car seat – symmetrically and asymmetrically – affect balance and limb loading. Both groups had more asymmetric limb loading and worse balance with asymmetrical lifting, though NP women showed larger movements during asymmetrical lifting, likely reflecting the movement of the body during the condition. These results highlight the importance to further research balance and limb loading in PP compared to NP women. Understanding whether pelvic instability and weakness may contribute to differences in balance and limb loading is crucial as it may help explain how and why postpartum women face higher risk of injury and chronic pain. Ultimately, such work may find ways to improve postpartum health during daily activities.

Sammanfattning                                 Bakgrund:Tiden efter förlossning benämns som den mest kritiska men också mest försummade perioden i en nybliven moders liv. Det är barnmorskans uppgift att bl. a. handlägga postnatal period samt bedöma behov av uppföljning. Det har framkommit att det finns brister och behov av utveckling i eftervården. Det finns få eller inga studier som visar styrkorna som finns i eftervården i Sverige. Syfte:Att undersöka hur mödrar och barnmorskor erfar eftervården.  Metod:Kvalitativa intervjuer med induktiv ansats har utförts. Analysen av insamlat datamaterial är genomförd med kvalitativ innehållsanalys. Fyra nyförlösta mödrar och fyra barnmorskor i en region i södra Sverige har intervjuats.  Resultat:Mödrarna var överlag nöjda med eftervården men det fanns en önskan om tidigare uppföljning och bättre amningsstöd. Barnmorskorna beskrev hur de flesta mödrar är välmående och att de inte anser att det finns några större brister i dagens eftervård. De har dock önskemål om tidigare uppföljning för möjligheten att kunna utforma en individuell plan för varje familj, mer utbildning och bättre samarbete mellan olika instanser. Konklusion: Eftervården har länge sett likadan ut och är i dagsläget icke flexibel med begränsade resurser. Det finns behov av förbättring och utveckling samt en önskan om en mer individanpassad vård. / Background:The time after childbirth is known as the most critical but also the most neglected time in every new mothers life. It is part of the midwifes’ task to care for the mother during the postnatal period and assess the need for follow-up. It has been shown that there are shortcomings and a need for development in the postpartum care. There are few or no studies which examines the strengths of the Swedish postpartum care. Purpose:To examine the experiences of postpartum care among midwifes and mothers. Method:Qualitative interviews with an inductive approach, which were analyzed with a qualitative content analysis. Four new mothers and four midwifes in a region in the south of Sweden were interviewed. Results:The mothers were mostly satisfied with the postpartum care but there was a wish for an earlier follow-up after birth and better breastfeeding support. The midwifes described that most mothers are feeling well and that there are no serious shortcomings with the postpartum care today. They do however wish for an earlier follow-up after birth in order to establish an individual plan of care for every family, more education and a better cooperation between different instances. Conclusion:The postpartum care has been designed in the same way for a long time and is inflexible with few resources. There is a need for improvement and development as well as a wish for more individualized care.

<p> </p><p><strong>Background:</strong> The birth of an infant can represent additional, financial and emotional stress. Lack of social support negatively impacts these women’s ability to cope with already difficult circumstances after childbirth. Poorer health care for the postpartum women may be the consequence of deficient understanding. It is thus interesting to know how stress and lack of social support affects the health status among postpartum women.</p><p><strong>Aim:</strong> The aim was to describe stress, social support and health status among postpartum women, and also to compare the situations between women in an urban and a rural area of Thailand.</p><p><strong>Method:</strong> A descriptive comparative cross sectional study with a quantitative method was used. 160 women from Bangkok and Ayutthaya, Thailand answered a questionnaire, which was divided into four parts; background, postpartum stress, health status and social support.</p><p><strong>Result:</strong> The perceived stress was in general low. They had a large amount of social support; the most important support was received by partners and parents. They perceived a good postpartum health status. No significant difference was shown between the two areas regarding the total score of stress, social support and health status.</p><p><strong>Conclusion: </strong>In total the Thai postpartum women were exposed to a low amount of stressors. They had a good postpartum wellbeing and received a high level of social support.</p><p><strong>Clinical Implications:</strong> To enable care in a more holistic approach, improvement in detecting postpartum stressors and to encourage social support in the postpartum period, will reduce postpartum stress and  prevent a better health status.</p><p> </p> / <p> </p><p><strong>Bakgrund:</strong> Ett nyfött barn kan innebära en ekonomisk och emotionell stress. Bristande socialt stöd har en negativ påverkan på dessa kvinnors möjlighet att hantera redan svåra omständigheter efter barnafödandet. En bristande förståelse från sjukvårdspersonal kan orsaka en sämre hälso- och sjukvård för postpartum kvinnor. Det är därför intressant att veta hur stress och bristande socialt stöd påverkar hälsan bland kvinnor postpartum.</p><p><strong>Syfte:</strong> Syftet var att beskriva stress, socialt stöd och hälsa bland kvinnor  postpartum, samt att jämföra situationen mellan kvinnor i ett urbant och ett ruralt område i Thailand.</p><p><strong>Metod:</strong> En kvantitativ jämförande tvärsnitts metod användes. 160 deltagare fyllde i frågeformular, som var indelade i fyra delar; bakgrund, postpartum stress, hälso status och social stöd.</p><p><strong>Resultat:</strong> Den upplevda stressen var genrellt sett låg. De hade ett stort socialt stöd, det viktigaste stödet gavs fran partners och föräldrar. De upplevde en god postpartum hälsa. Ingen signifikant skillnad visades mellan det två områdena vad det gäller den totala rankningen av stress, hälso status och social stöd.</p><p><strong>Slutsats: </strong>Totalt sett verkade thai postpartum kvinnorna uppleva lite stress. De hade en god hälsa och upplevde i hög usträckning ett bra socialt stöd.</p><p><strong>Kliniska implikationer:</strong> För att möjliggöra ett mer holistisk vårdperspektiv, kommer förbättringar i att upptäcka postpartusmstressorer samt uppmuntran till socialt stöd tiden postpartum, leda till en  minskad postpartum stress och förebygga en bättre hälsa.</p><p> </p>

Background: The birth of an infant can represent additional, financial and emotional stress. Lack of social support negatively impacts these women’s ability to cope with already difficult circumstances after childbirth. Poorer health care for the postpartum women may be the consequence of deficient understanding. It is thus interesting to know how stress and lack of social support affects the health status among postpartum women. Aim: The aim was to describe stress, social support and health status among postpartum women, and also to compare the situations between women in an urban and a rural area of Thailand. Method: A descriptive comparative cross sectional study with a quantitative method was used. 160 women from Bangkok and Ayutthaya, Thailand answered a questionnaire, which was divided into four parts; background, postpartum stress, health status and social support. Result: The perceived stress was in general low. They had a large amount of social support; the most important support was received by partners and parents. They perceived a good postpartum health status. No significant difference was shown between the two areas regarding the total score of stress, social support and health status. Conclusion: In total the Thai postpartum women were exposed to a low amount of stressors. They had a good postpartum wellbeing and received a high level of social support. Clinical Implications: To enable care in a more holistic approach, improvement in detecting postpartum stressors and to encourage social support in the postpartum period, will reduce postpartum stress and  prevent a better health status. / Bakgrund: Ett nyfött barn kan innebära en ekonomisk och emotionell stress. Bristande socialt stöd har en negativ påverkan på dessa kvinnors möjlighet att hantera redan svåra omständigheter efter barnafödandet. En bristande förståelse från sjukvårdspersonal kan orsaka en sämre hälso- och sjukvård för postpartum kvinnor. Det är därför intressant att veta hur stress och bristande socialt stöd påverkar hälsan bland kvinnor postpartum. Syfte: Syftet var att beskriva stress, socialt stöd och hälsa bland kvinnor  postpartum, samt att jämföra situationen mellan kvinnor i ett urbant och ett ruralt område i Thailand. Metod: En kvantitativ jämförande tvärsnitts metod användes. 160 deltagare fyllde i frågeformular, som var indelade i fyra delar; bakgrund, postpartum stress, hälso status och social stöd. Resultat: Den upplevda stressen var genrellt sett låg. De hade ett stort socialt stöd, det viktigaste stödet gavs fran partners och föräldrar. De upplevde en god postpartum hälsa. Ingen signifikant skillnad visades mellan det två områdena vad det gäller den totala rankningen av stress, hälso status och social stöd. Slutsats: Totalt sett verkade thai postpartum kvinnorna uppleva lite stress. De hade en god hälsa och upplevde i hög usträckning ett bra socialt stöd. Kliniska implikationer: För att möjliggöra ett mer holistisk vårdperspektiv, kommer förbättringar i att upptäcka postpartusmstressorer samt uppmuntran till socialt stöd tiden postpartum, leda till en  minskad postpartum stress och förebygga en bättre hälsa.

Bakgrund: Postpartum depression har länge förknippats med moderskap, men drygt 10 % av papporna drabbas också av depression efter barnets födelse. Syfte. Belysa begreppet postpartum depression hos fäder. Metod: Systematisk litteraturstudie som bearbetat och analyserat kvantitativ samt kvalitativ forskning genom en innehållsanalys. Resultat: Orsakerna till postpartum depression hos fäder var främst psykologiska och sociala faktorer där mammans eventuella depression, pappans arbetslöshet och en ansträngd ekonomi samt pappans upplevelse av bristande socialt stöd utgjorde de viktigaste orsakerna. Depressionen påverkade pappans anknytning till barnet, hela familjen och föräldraskapet samt barnets emotionella, kognitiva och sociala utveckling negativt. Slutsats: Postpartum depression hos pappan orsakas av sociodemografiska, psykiska och sociala faktorer. Depressionen påverkar familjen, parrelationen, föräldraskapet samt barnets kognitiva och sociala utveckling negativt. Den kunskap litteraturstudien bidrar till ger ökade möjligheter att uppmärksamma postpartum depression hos pappan, stödja familjen samt bidra till en fördelaktig utveckling för barnet. Framtida forskning bör ske med syfte att hitta lämpliga metoder och bedömningsinstrument utformade för att identifiera pappor med risk att utveckla en depression. / Background: Postpartum depression have for a long time been associated with motherhood, but more than 10 % of fathers also get a depression after their child's birth. Aim: Elucidate the concept of paternal postpartum depression. Method: A systematic literature study who processed both quantitative and qualitative research, analyzed with a content analysis. Results: The causes of paternal postpartum depression where mostly psychological and social factors were the mother´s depression, the father’s unemployment and a strained economy together with the father´s experience of lack of social support seemed to be the most important risk factors. Paternal postpartum depression affected the father’s attachment to his child, family, parenthood and the child's emotional, cognitive and social development negatively. Conclusion: Paternal postpartum depressions are caused of socio-demographic, psychological and social factors. The depression affects the whole family, partners, parenting and the child's cognitive and social development negatively. The literature study increases the knowledge and opportunities to identify postpartum depression in fathers, support the family and to contribute to a favorable development for the child. Future research should be done in order to find appropriate methods and assessment instruments designed to find the fathers at risk for developing depression.

University of Macau / Faculty of Social Sciences and Humanities / Department of Psychology