Bakgrund: Varje år dör flera 100 000 kvinnor i världen på grund av graviditet, förlossning och abort. Länder världen över arbetar ständigt med FN:s globala mål till att minska mödradödligheten. I Sverige får kvinnor som fött sina barn ofta kvarstanna allt från ett dygn till några dygn för postnatal vård relaterat till komplikationer med mamman eller barnet. Kvinnor med okomplicerade och komplicerade graviditeter och förlossningar är en patientgrupp som barnmorskan möter dagligen i sitt yrkesutövande. Postnatal vård är därför en central del i barnmorskeyrket. Syfte: Syftet med den här studien var att beskriva kvinnors upplevelser av postnatal vård efter en komplicerad graviditet eller förlossning vid ett svenskt sjukhus. Metod: Studiens design var en kvantitativ och kvalitativ enkätstudie där författarna fick ta del av tidigare insamlade data. Sammanställning av enkäterna gjordes i SPSS och analys av kvalitativa data skedde genom en textanalys. Resultat: Majoriteten av kvinnorna var nöjda med den postnatala vården. Kvinnorna upplevde att de fick bra stöd från personalen. Ingen skillnad i nöjdhet mellan de olika vårdenheterna hittades. Kvinnor som hade sin partner med sig postnatalt var nöjdare än de som inte haft möjlighet att ha sin partner med. Förbättringsområden inom postnatal vård hittades. Slutsats: Trots det begränsade urvalet med kvinnor som haft komplikationer under graviditet och förlossning, så visade resultatet att de flesta kvinnorna var nöjda med den vård och stöd från personalen som de fått. Vissa områden kan dock förbättras, så som information gällande rutiner, barnläkarundersökningen och olika delar inom amningsstödet. Klinisk tillämpbarhet: Det är viktigt även för kvinnor med en komplicerad graviditet och förlossning att få en individualiserad vård. Den postnatala vården är viktig för kvinnans helhetsupplevelse. Därför är det av vikt att barnmorskan ha kunskap kring detta och kan utveckla sin yrkeskunskap. / Background: More than 100 000 women worldwide dies every year due to pregnancy, childbirth or abortion. Countries worldwide are continuously working towards the global goals to prevent maternal mortality. In Sweden, many women who give birth get to stay at a postnatal care unit for a few days after childbirth due to complications to the mother or the baby. Every day, midwives meet women who have a normal or a complicated pregnancy and childbirth. Postnatal care is a central part in midwifery practice. Aim: The aim of this study was to describe women's experience of postnatal care after having a complicated pregnancy or labor in a Swedish hospital. Method: The study design was a quantitive and qualitive survey study where the authors used previously collected data. Questionnaires were compiled in SPSS and the qualitative data was analysed with a text analysis. Result: The majority of women were satisfied with the postnatal care they received. They experienced that they got great support from the medical staff during their stay at the hospital. No significance was found in satisfaction between the care units at the hospital. Women who had their partner with them at the postnatal care unit were more satisfied than women who didn´t. Areas for improvement in postnatal care were identified. Conclusion: Despite the limited selection with women who had complications during pregnancy or childbirth, the result showed that most women were satisfied with the postnatal care they received. Quality of care improvement in some areas can be done, such as, routine information on each unit, pediatric examination and breastfeeding support. Clinical applicability: It is essential for women with complications during pregnancy or labor to have an individualized care. Postnatal care is very important for the woman's holistic experience. Therefore, it is vital that the midwife has knowledge and can further develop her professional knowledge.

Research suggests that the relationship between caregivers and their infants has a significant effect on development and well-being across the lifespan. There is a significant body of research into psychological interventions which focus on this relationship. However, there is only limited research into the impact of antenatal interventions which aim to promote the caregiver-foetus relationship, thus preventing later difficulties in the caregiver-infant relationship. Findings so far suggest that such interventions could be effective, and recommendations have been made for further studies exploring the effect antenatal interventions on the caregiver-foetus relationship. This pilot study explored the impact of a newly developed psychoeducational intervention entitled “Baby World” on the caregiver-foetal relationship. Seventy-nine females and 26 males who were expecting their first child were recruited from an NHS midwife service in London. They were randomly allocated to experimental or control groups. All participants completed questionnaires measuring antenatal attachment, mental health and childhood experiences of caregiving at baseline. Those in the experimental group then attended the Baby World class. All participants then completed the questionnaires for a second time, and then attended the standard antenatal classes. Following attendance at these classes, participants completed the questionnaires for a third time and gave anonymous responses to qualitative questions. Statistical analyses of the quantitative data indicated that the intervention did not have an impact on antenatal attachment. Results did show that antenatal attachment increased over time, whilst anxiety decreased. A significant correlation was found between recollections of maternal caring and antenatal attachment. Qualitative analysis suggested that the intervention did have an impact on aspects of the relationship. In the qualitative responses, the majority of participants wrote that the class had been a positive experience for them, and that it had increased their confidence about being a caregiver. Many of the responses indicated that the class had positively affected their skills in reflective functioning, caregiver sensitivity and attunement, and changed their perspective on how to interact with their infant. The results add to the literature regarding the impact of antenatal interventions on the caregiver-foetus relationship. Further research is needed to explore the impact of the intervention on the relationship more closely, in particular to understand which aspects of the relationship may be affected. There are several limitations of the study, in particular the small sample size and the limited number of expectant fathers who participated. Reasons for these limitations are discussed.

The purpose of this study was to investigate the utilization of Postnatal Services at St. Joseph's Clinic. Sixty women of child- bearing age participated in the study. Convenience sampling was utilised. An integration of Qualitative and Quantitative approaches were used for collection and analysis of data. The results of the study showed that women had high knowledge about the sixth week PNC. Women's attitudes regarding attendance at the sixth week PNC were both positive and negative. The relationship between knowledge and attitude was significant (r = .2999, p = .044) The study concluded that, the attitudes of women towards attendance at the sixth week PNC were mostly negative. Four themes emerged from the study. Some of the recommendations of the study included a need for review of information given to mothers regarding its relevance and appropriateness; a need to foster more positive attitudes in women towards attendance at the sixth week PNC. / Health Studies / M.A. (Nursing Science)

La présente étude vérifie l’existence de relations significatives entre la consommation maternelle pré et postnatale de psychotropes (nicotine, alcool et drogues) et deux dimensions importantes du tempérament de l’enfant âgé entre 0 et 3 ans (Gartstein et Rothbart, 2003), soit la détresse face aux limitations (DL; prédisposition à l’irritabilité, à la frustration et à la colère) et la détresse face à la nouveauté (DN; crainte, peur, inhibition). De plus, elle examine les contributions relatives de la consommation maternelle de psychotropes pré et postnatale au tempérament de l’enfant ainsi que l’effet modérateur potentiel du sexe de l’enfant dans ces relations. L’échantillon comprenait 90 dyades mère-enfant issues d’un projet plus vaste s’intéressant au développement d’enfants nés de jeunes mères considérées à risque sur le plan psychosocial. La consommation maternelle a été évaluée à l’aide de questionnaires à trois reprises, soit à environ cinq mois de grossesse et à environ trois et huit mois suite à l’accouchement. Pour le tempérament, lors des visites à trois et huit mois de vie, la mère a également complété un questionnaire élaboré par Gartstein et Rothbart (2003) qui permet d’évaluer 14 dimensions du tempérament dont celles de détresse face aux limitations et de détresse face à la nouveauté. Diverses analyses statistiques (descriptives, corrélations, tests de comparaison de moyennes et régressions multiples) ont été effectuées afin d’atteindre les objectifs à l’étude. Les résultats ne montrent aucune relation significative entre la consommation pré et postnatale d’alcool et de nicotine et les deux dimensions du tempérament de l’enfant. Cependant, l’exposition in utero à la marijuana durant les premiers mois de grossesse et après l’accouchement est associée positivement à la dimension de crainte (DN) chez l’enfant de trois mois (mais pas à la dimension de colère, DL). De plus, les résultats suggèrent parfois un poids plus important de la présence de consommation prénatale dans l’explication de la DN comparativement à la présence de consommation postnatale et parfois, le contraire. La fréquence de consommation de drogues suggèrent toutefois que la fréquence de consommation prénatale a plus d'importance dans l'explication de la DN chez l'enfant que la fréquence de consommation postnatale. En ce qui concerne la modération par le sexe de l’enfant, les résultats montrent qu’il n’existe pas d’effet modérateur du sexe de l’enfant dans la relation étudiée. Pris dans leur ensemble, les résultats font ressortir la complexité existant dans la relation entre la consommation maternelle et le tempérament du nourrisson. Tant au niveau de la recherche que de la pratique, la présente étude suggère également l’importance d’utiliser des mesures et des interventions différenciées selon le psychotrope utilisé par les mères et le moment de la consommation (pré et/ou postnatal).

Purpose: Postnatal depression has significant negative outcomes for both mother and baby. Cognitive-behavioural interventions have proven promising in its treatment, but there are a number of barriers, specific to the postnatal period, which lead to low take-up of treatment. Online interventions may circumvent some of these barriers. However, evidence of long-term follow-up is sparse, in spite of the importance of knowing how such treatments work over the longer-term. Methods: Long-term follow-up of postnatal women participating in a feasibility randomised controlled trial of NetmumsHWD, an online behavioural activation treatment with telephone support. Results: Retention rates of over 70 percent were obtained. There were small but non-significant effects of treatment on depressive symptomology and behavioural activation scores at 16 months post-randomisation. Baseline depression and behavioural activation scores predicted attrition prior to the implementation of outreach strategies for data collection; these systematic differences in attrition disappeared post-implementation. Measures of treatment adherence were not related to outcome. Conclusions: Collection of long-term follow-up data from postnatal women appears feasible. The findings demonstrate the importance of outreach in maximising retention, especially in relation to the generalizability of results. Future research should consider ways to assess treatment engagement and its relationship with outcome.

The study of the formation of new cardiac muscle cells during postnatal development is a relatively new field. During fetal development, new cells are formed as the heart grows. However, the proliferative ability of postnatal cardiomyocytes is still debated. While several studies have been made on mammals, less is known about the chicken cardiac cells and their postnatal proliferation. As almost all previous studies have used microscopy-based cell counting methods, there has been some limitations on accuracy and amounts of cells that could be counted. The aim of this study is to develop a method for using flow cytometry to analyze proliferative ability of chicken cardiomyocytes and to investigate if any postnatal proliferation exists. For this study, 4 weeks old Red Junglefowl (Gallus gallus) chickens were used for isolating cardiomyocytes. In addition, 19 days old Red Junglefowl embryos were used to asses if a longer incubation time would yield a higher number of proliferative cells. Cells were stained using a commercial EdU imaging kit and analyzed using flow cytometry and imaging flow cytometry. The produced results could not be used for determining the proliferative ability of the cardiomyocytes, but provides crucial information for possible method improvements. In conclusion, this study has laid important groundwork for future studies on the proliferative ability of chicken cardiomyocytes.

Syfte: Syftet med studien var att belysa barnmorskans upplevelse av att möta flyktingfamiljer på BB.Design: En intervjustudie baserad på enskilda semistrukturerade intervjuer med kvalitativ innehållsanalys.Omgivning: Två BB-enheter varav en i södra och en i norra Sverige.Deltagare: 10 barnmorskor, varav fem i södra och fem i norra Sverige intervjuades. Samtliga deltagare gav sitt muntliga och skriftliga samtycke till att delta i studien.Resultat: Barnmorskorna upplevde att de hade samma resurser som tidigare trots en ökad arbetsbelastning sedan flyktingkrisen. Vidare upplevde barnmorskorna svårigheter att kommunicera med flyktingarna trots professionell tolk vilket kunde leda till risker inom vården. Det önskades utbildning inom kulturella skillnader samt information och ett fördjupat samarbete med migrationsverket. Barnmorskorna upplevde möten med flyktingar lärorika och spännande samtidigt som det fanns en splittring inom arbetsgruppen vid vård av flyktingar som var svår att hantera. Majoriteten av barnmorskorna ansåg att de kunde ge en ändamålsenlig vård men att flyktingarna behövde få en ökad kunskap om det svenska vårdsystemet.Slutsats: Resultatet visar vikten av utbildning och samarbete. Barnmorskorna måste få bättre kunskap inom kulturella skillnader samt få redskap från arbetsgivaren för återkoppling och återhämtning. Det anses även vara av stor vikt att minska barnmorskornas ökade arbetsbelastning och fler tolkar behövs med bättre tolkkunskaper.Klinisk betydelse: Det behövs mer utbildning bland barnmorskorna för att möta kulturella skillnader på BB-enheter. Vidare anses det vara av stor vikt att barnmorskor får mer resurser i form av tid och mer personal för att minska barnmorskornas ökade arbetsbelastning. Barnmorskorna behöver en mer organiserad återkoppling på arbetsplatsen samt utbildning i hur de ska hantera familjer utsatta för traumatiska händelser. Studien skulle kunna leda till ny kunskap som kan vara ett redskap för att förbättra barnmorskornas arbetssituation samt flyktingfamiljers omhändertagande på BB. / Objective: The purpose of this study was to elucidate the midwife experience to meet refugee families in postnatal ward. Design: An interview based on individual semi-structured interviews with qualitative content analysis. Setting: Two maternity units, one in southern and one in northern Sweden. Participants: Ten midwives, five from southern Sweden and five from northern Sweden were interviewed. All participants gave their verbal and written consent to participate in the study. Findings: The midwives experienced that they worked with the same resources as before the refugee crisis despite the increased workload at the maternity unit. Furthermore, the midwives experienced difficulties in communicating with the refugees despite professional interpreter which could cause damage within the given care. The midwives request education in cultural differences and an enhanced information and cooperation with the immigration office. The midwives experienced the meetings with the refugee families as exiting and educational but they had noticed there was a split within the working group about the refugee families that was difficult to handle. The majority of the midwives felt like they could provide the appropriate care but that the refugees needed to get a better knowledge in the Swedish health care system. Key conclusion: The results show the importance of education and cooperation. The midwives must have improved knowledge of cultural differences and get improved ways of feedback and recovery from the employer. It is also considered to be of great importance to reduce the midwives increasing workloads and additional interpreters is needed to receive feasible interpreting skills. Implications for practice: We need more education among midwives to meet the cultural differences in maternity units. Furthermore, it is considered essential that midwives receive more resources in terms of time and more staff to reduce the midwives' workload. The midwives need a more organized feedback in the workplace and training in how to deal with families exposed to traumatic events. The study could generate the new knowledge that can be a tool to improve the midwives work situation and the refugee families’ disposal at prenatal ward.

Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Mental health is still the step-child of Health Services, although many studies show the serious negative impact it has on the mother, baby and the family. Knowledge about Postnatal Depression (PND) and associated risk factors which influence the development of PND is vital for early detection and intervention. Worldwide PND affects on average 10-15% of women after giving birth regardless of socio-economic status, race or education. Studies also reveal that the prevalence of PND is as high as 40-60% amongst women after giving birth. The goal of the study was to investigate the prevalence and factors influencing PND in a rural setting, in the Witzenberg Sub-district. The objectives included determining the prevalence of PND and identifying the contributing risk factors associated with PND. A descriptive explorative research design with a quantitative approach was applied. The target population was (N=1605) mothers, 18 years and older who gave birth in this Sub-district in one year, a convenience sampling method was used to select the study sample of (n=159/10%) participants who met the criteria and who gave voluntary permission to take part in the study. Validity and reliability was supported through the use of validated questionnaires EPDS and BDI including a questionnaire based on demographical, psychosocial and obstetrical data. In addition experts in statistics, nursing and psychiatry were consulted including language experts who validated the correctness of the Afrikaans and Xhosa translated questionnaires. A pilot study was conducted to test the feasibility of the study and all data was collected personally by the researcher with the support of two trained field workers. Ethics approval was obtained from Stellenbosch University and permission from the Department of Health, Provincial Government of the Western Cape, including informed written consent from each participant. The data was analysed with the assistance of a statistician and are presented with histograms and frequency tables. The relationship between continuous response variables and nominal input variables was analysed using analysis of variance (ANOVA). Various statistical tests were applied to determine statistical associations between variables such as the chi-square tests using a 95% confidence interval. Non-parametric tests such as the Mann-Whitney U–test or Kruskal-Wallis test were used for randomised design. Levene’s test was used for Homogeneity of Variance and the Bonferonni test of probability. The study revealed that 50.3% of the mothers, who participated in the study, had PND. Various risk factors were determined in this study that influences the development of PND. Results include statistical associations between PND and the following: - unplanned babies and unwelcome babies (p=<0,01) - life events (p=0.01) - partner relationship (p=<0.01) - family and social support (p=<0.1) Furthermore, the majority of the participants (53.8%) with PND (n=80) had a history of a psychiatric illness which was shown with significance (p=<0.01), the majority of the participants (63.5%) were unmarried and 23.8% were teenagers who suffered from PND. Recommendations include promoting healthy lifestyles, empowerment of women, prevention of teenage pregnancies, early and holistic assessment for symptoms of PND and approriate referral. In conclusion the prevention and promotive measures, early detection of PND and appropriate referrals and treatment are critical in managing maternal, child and family well being. / AFRIKAANSE OPSOMMING: Geestesgesondheid blyk die stiefkind van gesondheidsdienste te wees, ten spyte daarvan dat navorsing die negatiewe impak wat dit op moeder, baba en die gesin het bevestig. Kennis van postnatale depressie (PDN) en verwante risiko faktore wat die ontwikkeling van PND beïnvloed is van uiterste belang vir die vroeë opsporing en ingryping daarvan. PND affekteer gemiddeld 10%-15% van vroue wêreldwyd wat dit ervaar nadat hulle geboorte geskenk het, ongeag sosio-ekonomiese status, ras of opleiding. Navorsing dui daarop dat die voorkoms van PND so hoog is soos 40%-60% onder vrouens nadat hulle geboorte geskenk het. Die doel van hierdie studie was om die prevalensie van PND en die faktore wat PND beïnvloed in ’n landelike nedersetting in die Witzenberg Subdistrik te ondersoek. Die doelwitte sluit die bepaling van die prevalensie van PND in en die identifisering van die risiko faktore wat daartoe aanleiding gegee het. ’n Beskrywende verkennende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep was (N=1605) moeders, 18 jaar en ouer wat geboorte geskenk het in hierdie subdistrik binne een jaar. ’n Gerieflikheidssteekproef metode is gebruik om die deelnemers (n=159/10%) te selekteer wat aan die kriteria voldoen het en vrywillig toestemming gegee het om aan die studie deel te neem. Geldigheid en betroubaarheid is gerugsteun deur die gebruik van geldige vraelyste, naamlik EPDS en BDI wat ’n vraelys insluit wat gebaseer is op demografiese, psigososiale en verloskundige data. Hierbenewens is deskundiges in statistiek, verpleegkunde en psigiatrie geraadpleeg, asook taalkundiges wat die taalkorrektheid van Afrikaans en Xhosa vertaalde vraelyste nagegaan het. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die navorsing te toets en alle data is persoonlik deur die navorser met die hulp van ’n opgeleide veldwerker ingesamel. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch en toestemming van die Departement Gesondheid, die Provinsiale Regering van die Wes-Kaap, asook skriftelike toestemming van elke deelnemer. Die data is ontleed met die bystand van ’n statistikus en is deur frekwensie tabelle aangebied. Die verhouding tussen volgehoue/aaneenlopende respons veranderlikes en nominale inset/invoer veranderlikes is ontleed deur gebruik te maak van die analise van variansie (ANOVA). Verskeie statistiese toetse is toegepas om die statistiese assosiasies tussen veranderlikes vas te stel soos die chi-kwadraat toetse deur ’n 95% betroubaarheidsinterval te gebruik. Nie-parametriese toetse soos die Mann-Whitney U-toets of Kriskal-Wallis toets is gebruik vir ewekansige ontwerp. Levene se toets is gebruik vir homogeniteit van variansie en die Bonferonni toets vir waarskynlikheid. Die toets het bewys dat 50.3% van die moeders wat aan die studie deelgeneem het, het PND. Verskeie risiko faktore is in hierdie studie vasgestel wat die ontwikkeling van PND beïnvloed. Resultate sluit statistiese assosiasie tussen PND en die volgende in: - onbeplande babas en onwelkome babas (p=<0,01) - lewensgebeure (p=0.01) - lewensmaat verhoudings (p=<0.01) - familie en maatskaplike ondersteuning (p=<0.1) Vervolgens het die meeste van die deelnemers (53.8%) met PND (n=80) ’n geskiedenis van ’n psigiatriese siekte met ’n beduidenis (p=<0.01), die meeste van die deelnemers (63.5%) is ongetroud en 23.8% is tieners wat aan PND ly. Aanbevelings sluit die bevordering van gesonde leefstyle, die bemagtiging van vrouens, voorkoming van tienerswangerskappe, vroeë en holistiese assessering van simptome van PND in en die aangewese verwysing. Daar kan tot die slotsom gekom word dat voorkoming- en bevorderingsmaatstawwe, vroeë opsporing van PND en aangewese verwysings en behandeling, krities is in die hantering van moeder-, kind- en gesinswelstand.

Background: The present study considers some of the underlying mechanisms that may be acting in postnatal depression (PND). It has been suggested that rumination predicts problem solving ability and that child temperament and maternal attributions predict mother-infant bonding. This study aims to investigate the role that brooding and reflective rumination may play in predicting and mediating these relationships in postnatal women. Methods: Postnatal women were recruited to complete an online survey.190 women responded and completed the Edinburgh Postnatal Depression Scale (EPDS), Maternal Attribution Scale (MAS), Postpartum Bonding Questionnaire (PBQ), Parental Problem Solving Task (PPST), Rumination Response Scale (RRS), Infant Behaviour Questionnaire (IBQ) and a confidence in problem solving using a Visual Analogue Scale (VAS). Results: Analyses showed that reflective rumination mediated the relationship between low infant soothability and high negative attributions, on maternal problem solving. Reflective and Brooding Rumination also predicted confidence in problem solving and mother-infant bonding. Analyses showed that infant temperament (soothability and distress) and maternal attributions (positive and negative) predicted confidence in problem solving and mother-infant bonding Limitations: This study employed a correlational design and therefore all inferences regarding possible causal pathways are tentative. Limitations include the use of self report measures to assess mother-infant bonding and infant temperament. Additionally the PPST is a new measure which needs further validation. Conclusions: Reflective rumination may act as an adaptive strategy for women in the postnatal period when faced with difficult child temperaments, and for those employing negative attributions, when faced with parent specific problem solving tasks. In addition, Brooding and Reflective Rumination may be important in predicting difficulties in mother-infant bonding. Difficult Infant temperaments and less positive or more negative maternal attributions, may affect problem solving, confidence in problem solving and mother-infant bonding in the postnatal period. Future research should look to replicate these findings and explicate possible causal relationships within a postnatal population.

GABAA receptor binding is transiently increased in rat whisker barrels during the second postnatal week, at a time when neurons in the developing rat cortex are vulnerable to excitotoxic effects. To test whether these GABAA receptors might serve to protect neurons from excessive excitatory input, polymer implants containing the GABAA receptor antagonist bicuculline were placed over barrel cortex for a 4-day period in young (postnatal days 8 - 12) and adult rats. In the cortex of young, but not adult rats, the chronic blockade of GABAA receptors resulted in substantial tissue loss and neuron loss. The greater loss of neurons in young rats supports the hypothesis that a high density of GABAA receptors protects neurons from excessive excitatory input during a sensitive period in development.