Postpartum depression affects some 10% to 20% of mothers. Its impact on the health and well-being of mothers and their infants is well documented. If not identified and addressed early, it can result in emotional burden, costly hospitalization and treatment, and, at worst, suicide and or infanticide. Empowerment theory was the conceptual framework for this hermeneutic phenomenological study. The purpose was to understand the lived experiences of the screening and treatment processes of 10 women from New York City experiencing postpartum depression and their perceived adequacy of the treatment received. In-depth interviews were used to investigate participants' lived experiences of the screening and treatment processes for their postpartum depression and to explore the extent to which they percieved that their emotional needs were met. From the responses to the interview questions, 6 themes emerged: crying and stress during and after pregnancy, inadequate assessment, feeling bad or unlike oneself, lack of understanding, needing to cope, and prayer was essential for recovery. Participants had tearfulness that began during pregnancy and intensified during the postpartum period, were ineffectively assessed, exhibited bizarre behaviors that could not be explained, had little understanding of what they were experiencing, and were sometimes misunderstood by others. Further, participants at times sought treatment on their own in order to cope. Some reported that prayer was central to the restoration of their mental health. Insights gained through this study can be utilized to foster positive social change by heightening awareness and assisting health care providers in planning appropriate screening and treatment to meet the individual needs of women with postpartum depression.

<p>This study was undertaken to investigate the involutional changes of the uterus and uterine cavity by ultrasound (US), gray-scale and Doppler, after normal delivery, and to compare with the corresponding findings from women with puerperal complications, particularly retained placental tissue (RPT). The overall design was exploratory and prospective, with the use of descriptive statistics for analysis. </p><p>Forty-two women with uncomplicated vaginal term delivery were examined on post-partum days 1, 3, 7, 14, 28 and 56. The AP diameters of the uterus and uterine cavity and morphological findings were recorded. The maximum AP diameters of the uterus and uterine cavity diminished from 92.0 mm on day 1 to 38.9 mm at day 56 and from 15.8 mm at day 1 to 4.0 mm at day 56, respectively. The uterus was most often empty in the early and late puerperium while a mixed echo pattern over the whole cavity was found during mid puerperium (I).</p><p>Seventy-nine women with secondary post partum hemorrhage (SPH) were examined on the day they presented with clinical symptoms. US revealed an echogenic mass in the uterine cavity in 17 of 18 patients treated surgically and histology confirmed placental tissue in 14 of these. Sixty-one patients with either an empty cavity or mixed echo pattern had an uneventful puerperal course after conservative treatment (II).</p><p>AP diameters and morphological findings for 55 women with endometritis, 28 after caesarean section and 20 after manual evacuation of the placenta overlapped extensively with normal references (III).</p><p>The physiological vascular involution studied in 45 women after normal delivery showed that PI and RI indices did not change significantly until day 28 postpartum. The presence of at least one uterine artery notch was found in 13.3% of the women at day 1 and in 90.6% at day 56 postpartum (IV).</p><p>PI and RI values were measured and compared with reference values in 20 women with clinical suspicion of RPT who were to undergo surgical evacuation. Mean resistance indices were below the 10th percentile for eight of these 20 women, but overlapping was considerable. Doppler US has limited value as a diagnostic tool for RPT. The absence of a hyper-vascular area in the myometrium does not exclude RPT but an echogenic mass in the cavity is a sign of RPT (V).</p>

This study was undertaken to investigate the involutional changes of the uterus and uterine cavity by ultrasound (US), gray-scale and Doppler, after normal delivery, and to compare with the corresponding findings from women with puerperal complications, particularly retained placental tissue (RPT). The overall design was exploratory and prospective, with the use of descriptive statistics for analysis. Forty-two women with uncomplicated vaginal term delivery were examined on post-partum days 1, 3, 7, 14, 28 and 56. The AP diameters of the uterus and uterine cavity and morphological findings were recorded. The maximum AP diameters of the uterus and uterine cavity diminished from 92.0 mm on day 1 to 38.9 mm at day 56 and from 15.8 mm at day 1 to 4.0 mm at day 56, respectively. The uterus was most often empty in the early and late puerperium while a mixed echo pattern over the whole cavity was found during mid puerperium (I). Seventy-nine women with secondary post partum hemorrhage (SPH) were examined on the day they presented with clinical symptoms. US revealed an echogenic mass in the uterine cavity in 17 of 18 patients treated surgically and histology confirmed placental tissue in 14 of these. Sixty-one patients with either an empty cavity or mixed echo pattern had an uneventful puerperal course after conservative treatment (II). AP diameters and morphological findings for 55 women with endometritis, 28 after caesarean section and 20 after manual evacuation of the placenta overlapped extensively with normal references (III). The physiological vascular involution studied in 45 women after normal delivery showed that PI and RI indices did not change significantly until day 28 postpartum. The presence of at least one uterine artery notch was found in 13.3% of the women at day 1 and in 90.6% at day 56 postpartum (IV). PI and RI values were measured and compared with reference values in 20 women with clinical suspicion of RPT who were to undergo surgical evacuation. Mean resistance indices were below the 10th percentile for eight of these 20 women, but overlapping was considerable. Doppler US has limited value as a diagnostic tool for RPT. The absence of a hyper-vascular area in the myometrium does not exclude RPT but an echogenic mass in the cavity is a sign of RPT (V).

The purpose of this research was to examine psychosocial and body weight correlates of dietary behavior in low-income tri-ethnic women. In Study 1, a semi-quantitative food frequency questionnaire (FFQ) was developed and validated against diet records in 95 college women and 50 low-income postpartum women. Pearson's correlations were 0.42 among college women and 0.45 among low-income women. Cross-classification of participants into quartiles resulted in 76% of college women and 79% of low-income women being classified correctly. These results suggested that the FFQ was valid for dietary assessment among young women in the southwestern United States. In Study 2, approximately 160 mothers were recruited in the hospital 0-1 days following childbirth, and prepregnancy weight and demographic information were obtained. Weight was measured at 6 months and 1 year postpartum; psychosocial factors were assessed at 1 year. Diet during pregnancy and postpartum was assessed via food frequency questionnaires administered at 1.5 months, and at 6 and 12 months postpartum, respectively. From pregnancy to postpartum, % calories from fat (delta = +1.1%, p<0.05) and added sugar (delta = +2.0%, p<0.05) increased. A greater percentage of lactating than non-lactating women (64% vs. 38%, p<0.05) met recommendations for fruits during pregnancy. Mean intakes of calcium, vitamin A and dairy foods were higher in women who had retained <10% of their prepregnancy weight at 1 year postpartum than in those who had gained [greater-than or equal to] 10%. During late postpartum, women in the highest tertile of compliance with dietary recommendations had a more positive body image (p<0.041) than those in the lowest tertile, and less neglect of self-care (p<0.001), weight-related distress (p<0.006), stress (p<0.009), depressive symptoms (p<0.020), and perceived barriers to weight loss (p<0.039). These findings suggest that the transition from pregnancy to postpartum is associated with a negative impact on dietary behavior in low-income women. Intakes of calcium, vitamin A and dairy foods may be associated with lower weight retention in postpartum. Furthermore, psychosocial variables may influence adherence to dietary guidelines during this time. / text

Postpartal adaptation and vulnerability to depression was assessed in a sample of eighty women during the third and eighth weeks after childbirth. A questionnaire (IPA) was developed to assess postpartal adaptation in five areas: activities of daily living, labor-delivery events, mother-infant interactions, social supports, and construal of self and future. Other questionnaires included a psychological screening inventory (PSI), two depression measurements (Beck's Inventory and Pitt's Questionnaire), and a maternal assessment scale (MAS). Data were processed through the Statistical Package for Social Sciences, developed by Nie and Associates, Version 7 procedure, Northwestern University, Vogelback Computing Center, to obtain correlation analyses. Results suggested several areas of postpartal adaptation to be correlated with depression reactions after childbirth: moods, sleep, eating schedule, energy level, negative emotions toward infant, and items assessing social supports and self-construal.

Bakgrund: Obstetriska bristningar sker i olika grad där grad III-IV involverar analsfinktern. Detta kallas för sfinkterruptur och incidensen är cirka 3,6%. Sfinkterrupturer kan ge fekal inkontinens och påverka livskvaliteten. Behandlingen vid obstetrisk sfinkterruptur inkluderar fysioterapi där fysioterapeuten ger information och instruktioner om bäckenbottenträning. Det är oklart hur kvinnorna upplever informationen som ges ut. Upplevelsen av hinder och möjligheter för att följa ett beteende kan förklaras av den transteoretiska modellen. Syfte: Att undersöka hur kvinnor upplever information och träningsanvisningar postpartum vid obstetrisk sfinkterruptur samt hinder och möjligheter att följa dessa enligt den transteoretiska modellen Metod: Kvalitativ deskriptiv intervjustudie med semistrukturerade intervjufrågor. Ett lämplighetsurval användes. Informanterna var kvinnor diagnostiserade med en obstetrisk sfinkterruptur. Fyra intervjuer genomfördes cirka åtta veckor postpartum, transkriberades och analyserades med induktiv ansats. Resultat: Analysen formade fyra kategorier som representerade kvinnors uppfattade hinder och möjligheter till bäckenbottenträning. Kategorierna behandlade tid, den nya upplevelsen av att vara mamma, upplevelse av ovisshet och påminnelsernas betydelse för hur och om träningen bedrevs. Slutsats: En diskussion mellan vårdgivarna bör ske angående när information ska ges och möjligheten för uppföljning och återbesök. Individanpassade påminnelser och ökad information till partnern kan vara viktigt för att öka följsamheten till bäckenbottenträningen. / Background: Obstetrical lacerations occur in different grades, where grade III-IV involves the anal sphincter. That kind of laceration is described as an anal sphincter rupture and the incidence is about 3.6%. An anal sphincter rupture can lead to faecal incontinence and affect the quality of life. The treatment for an anal sphincter rupture includes physical therapy where the physiotherapist gives information and instructions about pelvic floor training. It is unknown how the women experience the information. The experience of difficulties and facilities for compliance can be described by the transtheoretical model.  Objective: To investigate how women experience information and instructions regarding postpartum pelvic floor training after an obstetric sphincter rupture and difficulties and facilities to follow these instructions according to the transtheoretical model. Methods: A qualitative, descriptive interview study with semi structured questions. A convenience sampling was used. The informants were women diagnosed with an obstetric sphincter rupture. Four interviews were being held approximately eight weeks postpartum, transcribed and analysed with an inductive approach. Results: The analysis formed four different categories that represented the women’s experienced difficulties and facilities for pelvic floor training. The categories processed time, the new experience of being a mother, the experience of uncertainty and how reminders affected if and how the training was pursued. Conclusions: A discussion between the caregivers about the time when information should be given and the opportunity for a follow up and revisits should be done. Individually adjusted reminders and increased information to the partner could be important to increase the compliance to pelvic floor training.

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

Made available in DSpace on 2016-03-22T17:26:16Z (GMT). No. of bitstreams: 1 Cristine Eliane Gomes Rodrigues.pdf: 248923 bytes, checksum: 0f2e18a14496907b79cd280de11c5c53 (MD5) Previous issue date: 2009-09-02 / Aim: Evaluating the time and problems met at resuming sexual intercourse after childbirth concerning women in Pelotas. Outlinig: Prospective Cohort Study. Sampling: Women who had their children at maternity hospitals in Pelotas, from September of 2002 to November of 2003. Population: From 2,741 parturients at perinatal period one obtained a random sample of 920 women on their 180 days after childbirth. Methods: Uni and multivaried analyses were performed and only those variables with a p<0.05 were considered as associated to the outcome with a significant statistically way. Prime Measures: Prevalence reason with a confidence interval. Results: The difficulty prevalence at resuming sexual intercourse was 25.5%, and 80% of the women resumed sexual intercourse on the first six months after deliverance. The main cause for not having sexual intercourse was for the woman not having a mate (63%); other causes were the lack of desire or time. The primiparas and women with a health problem on the prenatal or postnatal presented a higher prevalence difficulty: pelvic pains, insecurity and lack of desire. Conclusion: One found a high prevalence difficulty upon resuming sexual intercourse after deliverance. This was a study performed in a city at the south of Brazil, and that is why the findings are contextualized to the education and to the habits of these women. It is appropriate to highlight here the relevance 55 towards the need of an orientation at the prenatal, in order to soften or avoid problems which are prone to a resolution. / Objetivo: Avaliar o tempo e os problemas encontrados na retomada da atividade sexual após o parto nas mulheres de Pelotas. Delineamento: Estudo de Coorte prospectivo. Amostragem: Mulheres que tiveram seus filhos nas maternidades de Pelotas de setembro de 2002 a novembro de 2003. População: De 2741 parturientes no período perinatal, obteve-se uma amostra aleatória de 920 mulheres aos 180 dias após o nascimento. Métodos: Realizadas análise uni e multivariada e somente as variáveis com p<0,05 foram consideradas associadas ao desfecho de forma estatisticamente significativa. Principais medidas: Razão de prevalência com intervalo de confiança. Resultados: A prevalência de dificuldade no retorno à atividade sexual foi de 25,5% e 80% das mulheres retomaram a vida sexual nos primeiros dois meses após o parto. O principal motivo para não ter relação sexual foi o fato de a mulher não ter companheiro (63%); as demais causas foram a falta de vontade ou de tempo. As primigestas e as mulheres com problemas de saúde no pré ou no pós-natal, apresentaram uma prevalência mais elevada de dificuldades: dores pélvicas, insegurança ou medo e falta de desejo. Conclusão: Encontrou-se uma alta prevalência de dificuldades em retomar as atividades sexuais após o nascimento. Foi um estudo realizado numa cidade do sul do Brasil e, por isso, os achados estão contextualizados à cultura e aos hábitos destas mulheres. Cabe ressaltar a relevância da necessidade de 38 orientação no pré-natal, para amenizar ou evitar problemas passíveis de resolução

Chan Suk-mei. / "October 2000." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. [171]-188). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

The hormone withdrawal hypothesis of postpartum depression (PPD) attributes the onset of depressive symptoms to the rapid postpartum withdrawal of the ovarian hormones estradiol and progesterone that occurs during the first five days following childbirth. Although a number of human and non-human animal studies have supported the hormone withdrawal hypothesis, several studies have failed to support this hypothesis. The current research was designed to test the hormone withdrawal hypothesis of PPD using a novel translational research design that includes a series of experimental animal studies and a longitudinal human study. It was hypothesized that estradiol and progesterone withdrawal would cause increased behavioral despair, anhedonia, and anxiety in the rodent studies. In the human study, it was hypothesized that 1) decreases in estradiol would be associated with increases in negative affect and decreases in positive affect; 2) decreases in progesterone would be associated with increases in anxiety; and 3) these associations would be stronger in women with a past episode of PPD compared to those without a history of PPD. In the animal studies, rats were ovariectomized and administered ovarian hormones or placebo (i.e., hormone administration), followed by placebo only (i.e., withdrawal). Animals in these experiments were given the forced-swim test to measure behavioral despair; lateral hypothalamic self- stimulation to measure anhedonia; or the elevated plus maze to measure anxiety. In the human study, women made mood ratings and collected saliva samples daily starting in the third trimester and continuing until 10 days postpartum. In the animal studies, withdrawal from estradiol alone was associated with behavioral despair (t=2.26, p=.02) and anhedonia (t=-3.2, p=.007). In the human study, there a significant prospective association between estradiol and negative affect in women who developed PPD (r=-0.34, p<.001). This association, when combined with group status (i.e., history of PPD versus no history of depression), was used to correctly identify 100% of women who developed PPD. The results of this project contribute to evidence of a neurobiological basis for PPD. Estradiol withdrawal represents a promising candidate for further study, particularly with regard to individual differences in sensitivity to hormone withdrawal.