Bakgrund: Under BB-tiden ska barnets och föräldrars hälsa och välbefinnande främjas och tillgodoses efter familjens behov. Barnmorskan ska stärka föräldraparet i föräldrarollen, samt stödja och främja amningen. Syfte: Att beskriva föräldrars förväntningar och upplevelser av BB-tiden. Metod: En kvalitativ metod användes och datainsamlingen utfördes med hjälp av semistrukturerade intervjuer. Urvalet bestod av föräldrapar som rekryterats från BB genom ett bekvämlighetsurval. Intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Förväntningar hos föräldrapar inför BB-tiden kan utebli eftersom de fokuserar och samlar tankarna inför förlossning. De förväntningar föräldraparen hade var att få praktisk hjälp av vårdpersonalen för att kunna ta hand om sitt barn och känna sig trygga inför hemgång. Majoriteten av föräldraparen upplevde att de fick stöd från vårdpersonalen och att vårdpersonalen var närvarande. Trots det fanns det en önskan från föräldraparen att vårdpersonalen skulle kunna vara ännu mer närvarande. En positiv upplevelse var också att båda föräldrarna hade möjlighet till ett gemensamt ansvar för barnet under de första dygnen och att de upplevde delaktighet. Slutsats: Föräldrapars upplevelse av BB-tiden tyder på att vården är bra gällande vårdpersonalens kompetens och engagemang. När föräldrar ses som unika individer leder det till att vården blir mer familjecentrerad och individanpassad, vilket kan leda till att föräldrapar känner en ökad trygghet i sitt föräldraskap. / Background: During the postnatal care, the health and well-being of the child and parents shall be promoted and catered for according to the needs of the family. The midwife will strengthen the parent in the parenting role, as well as support and promote breastfeeding. The Aim: To describe parents' expectations and experiences of postnatal care. Method: A qualitative method was used, and the data collection was conducted using semi structured interviews. The selection consisted of parents recruited from postnatal care through a comfort check. Interview material was analyzed using a qualitative content analysis. Results: Expectations of parents in the postnatal care can be lost because they focus and collect the thoughts of childbirth. The expectations that the parents had where to get practical help from the healthcare staff to take care of their child and feel safe before returning home. Most of the parents experiences that they were supported by healthcare professionals and that the healthcare staff where present. Nevertheless, there was a wish from the parents that healthcare staff could be even more present. A positive experience was also that both parents had the opportunity to share responsibility for the child during the first few days and that they experienced participation. Conclusion: Parents experience of postnatal care indicates that healthcare is good in terms of the health and safety of the healthcare staff. When parents are seen as unique individuals, care is becoming more family-centered and individual-adapted, which can result in that parents feel more secure in their parenthood.

Whilst previous research has explored women's experiences of disclosing symptoms of postnatal depression (PND) to health professionals, very little qualitative research exists on women's experiences of disclosing to people in their personal support networks. Research has shown that some mothers with PND find it difficult to disclose to professionals and prefer to seek support from partners, family and friends. Aim: The current study aimed to explore the overall process mothers go through to disclose PND - to people with whom they have personal relationships, as well as health professionals. Method: Five women who experienced and disclosed PND participated in semi-structured interviews. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis. Results: The analysis produced four super-ordinate themes: 'Trying to cope whilst making sense of experiences', 'Deciding whether to disclose: Facilitative and inhibiting factors', 'The two-way interpersonal nature of disclosure', 'Disclosure as part of a transformative process'. Conclusions: This study highlighted the influence of internalised expectations of motherhood and stigma surrounding PND on how mothers try to cope with their initial symptoms and on their decisions about whether or not to disclose. The participants described a cautious approach to disclosure in which they had to deal with setbacks. Consequences of disclosing were considered alongside how the disclosure process was influenced by recovery from PND.

Background: Postnatal PTSD affects between 1 and 6% of women, whereas 30% are partially symptomatic. The mental health of new mothers is of public health concern as it could affect the marital relationship and the behavioural and emotional health of children. Little research has explored emotional regulation difficulties as predictors for postnatal PTSD. Treatments such as Cognitive Behavioural Therapy (CBT) have long waiting list times and may be hard to access for new mothers. Aim: The relationship between key predictors especially those associated with emotional regulation and PTSD in postnatal women was investigated. The feasibility of using internet based writing therapy for women with postnatal PTSD was assessed. Exploration of women's views about writing therapy as a therapeutic tool and their lived experience of PTSD was undertaken. Methods: Two literature reviews were conducted; firstly to identify the types of therapy previously used for women with postnatal PTSD, secondly to identify necessary conditions for effective writing therapy. The quantitative phase used measures for key predictors of PTSD and incorporated a feasibility study for a writing intervention. Regression analysis for a variety of predictors and PTSD and general and psychological health was conducted on data from 211 women. In the qualitative phase narrative analysis was used on interview transcripts from seven non-writers exploring access to writing and their experience of PTSD. An in depth case study was conducted on a woman who participated in the intervention and who was interviewed. Findings: The quantitative phase showed that planning the pregnancy; whether the baby slept or fed as expected; maternal confidence; past trauma; attachment patterns; self-efficacy; social support and partner support correlated with PTSD. However, the pain component of the birth experience mediated the effect of affects and alexithymia on general and psychological health. Most women did not access writing therapy. The qualitative phase showed that complicating factors and relationships with staff and mothers affect women's experience of PTSD and their view of themselves. Social media was used by women for support. Conclusion: Emotion regulation difficulties could impact postnatal mental health. Antenatal screening for alexithymia may be useful. Women value good relationships with staff during labour. The role of social media for postnatal mental health support should be investigated.

Il est désormais clairement établi que la vélocité de croissance dans les premiers mois de la vie influence le risque d’apparition de maladies métaboliques, telles que l’obésité à l’âge adulte. L’un des mécanismes sous-jacents à cette programmation néonatale pourrait mettre en jeu des perturbations de l’environnement hormonal périnatal pendant des périodes critiques du développement. Cette hypothèse repose sur des travaux réalisés au laboratoire montrant que pendant le développement postnatal, des hormones telles que la ghréline et la leptine peuvent influencer le développement des circuits neuronaux impliqués dans la régulation de la prise alimentaire à l’âge adulte. Dans ce contexte, l’objectif général de ce travail de thèse a été de définir les médiateurs hormonaux par lesquels l’environnement nutritionnel périnatal peut influencer le développement de maladies métaboliques à l’âge adulte. Une attention particulière a été portée à la contribution de la ghréline et de la leptine.Pour induire une surnutrition postnatale, nous avons utilisé un modèle murin de surnutrition postnatale induit par la réduction de la taille de portées. Au troisième jour de vie post-natale, les portées ont été réduites à 3 petits (SL) pour induire une suralimentation et les portées contrôles ont conservé 7 petits. Comparées aux souris NL, les souris SL présentent un gain de poids rapide pendant la lactation, et présentent un surpoids à l'âge adulte même sous régime de nourriture standard. A l’âge adulte, les souris SL ont une adiposité et une glycémie à jeun plus élevée. Sous régime « obésogène » les souris SL présentent également une prise de poids et de graisse plus importante que les souris NL. La première partie de ces travaux a été dédiée à l’étude de la nutrition périnatale sur le développement du système ghrélinergique. Les souris SL présentent des taux réduits de ghréline total et active pedant la troisième semaine de vie post-natale. Ces diminutions des taux de ghréline sont associées à une diminution de l’expression de ghreline dans l'estomac. La normalisation de la ghrélinémie ne parvient pas à restaurer un phénotype métabolique normale chez les souris SL ce qui suggère que les souriceaux SL présenteraient une résistance a la ghréline. En accord avec cette hypothèse, les souriceaux SL présente une atténuation de la réponse centrale suite à l’injection périphérique de ghréline. Les mécanismes sous-jacents à cette résistance à la ghréline semblent mettre en jeu un défaut de transport de l’hormone via les tanycytes de l’éminence médiane. La seconde partie de mon travail de thèse a consisté à étudier l’importance de la leptine dans la programmation nutritionnelle. Etant connu que les souris SL présent des taux anormalement élevés de leptine pendant la deuxième semaine de vie postnatale, nous avons émis l’hypothèse que le blocage partiel de la leptine chez les souris SL pourrait avoir des effets bénéfiques sur le métabolisme de ces souris. Les animaux injectés néonatalement avec l’antagoniste de la leptine ne présentent pas de différences de poids par rapport aux animaux contrôles. En revanche, l’injection de l’antagoniste de la leptine chez les souriceaux SL induit une amélioration de leur masse grasse et une normalisation de leur glycémie. Cette amélioration du phénotype métabolique des souris SL est associée à un rétablissement de la sensibilité centrale à l’hormone leptine.Ainsi, les travaux réalisés au cours de ce doctorat confortent l’importance de l’environnement hormonal périnatal, en particulier de la ghéline et de la leptine, dans la programmation nutritionnelle. / Rapid weight gain after birth is associated with increased risk of metabolic disease in adulthood. This metabolic malprogramming may be mediated by endocrine disturbances during critical periods of development. Several hormones that act on hypothalamic feeding circuits in adulthood to regulate energy homeostasis, such as leptin and ghrelin, are also involved in the postnatal development of these circuits. Previous studies have shown that leptin promotes the growth of axons from the arcuate nucleus of the hypothalamus(ARH), whereas ghrelin inhibits arcuate axon growth. The aim of this thesis was to study whether accelerated growth during early postnatal life is associated with alterations in the ghrelin and leptin systems during postnatal development. Our general objective was also to examine the relative contribution of ghrelin and leptin in the metabolic malprogramming associated with neonatal overnutrition. To manipulate nutrient intake specifically during postnatal (pre-weaning) life, we manipulated litter size on postnatal day 3 by randomly distributing pups among mothers such that small litters (overfed) had 3 pups and normal litters (normal fed) had 7 pups. SL pups gained substantially more weight than NL pups during lactation, and remained overweight throughout adulthood on a standard chow diet. Adult SL mice displayed increased adiposity and and elevated fasting glucose levels. Adult SL mice also gained more weight and fat when exposed to an obesogenic diet. During postnatal development, SL pups displayed reduced total and active circulating ghrelin levels compared to NL pups, particularly during the third week postnatal week. This was associated with decreased stomach expression of ghrelin in the third postnatal week. Normalization of hypoghrelinemia in overnourished pups is relatively ineffective in ameliorating metabolic outcomes, suggesting that SL pups may present ghrelin resistance. Consistent with this idea, pups raised in small litters displayed an impaired central response to peripheral ghrelin. The mechanisms underlying this ghrelin resistance include diminished ghrelin transport into the brain.In addition to marked changes in ghrelin levels, neonatally overnourished pups also display a marked increase in circulating leptin levels during early postnatal life. To investigate whether these abnormally high levels in circulating leptin levels might be causally involved in the central leptin resistance and metabolic programming, we used a competitive leptin antagonist to partially block leptin action in SL and NL mice between P6 and 16, i.e. when when endogenous leptin levels are high in SL mice. Neonatal injection of the leptin antagonist had no effect on postnatal growth or adult body weight. However, SL pups treated with the leptin antagonist displayed a marked reduction in adult fat mass and normalized glucose tolerance and insulin sensitivity. Previous studies reported that SL exhibit early central leptin resistance. Remarkably, pretreatment with leptin antagonist significantly increased leptin-induced pSTAT3 levels in the ARH of SL pups, suggesting that neonatal leptin antagonism may normalize metabolic programming in neonatally overnourished mice by enhancing central leptin sensitivity. Together our data show that early postnatal nutrition influence the pattern of secretion of metabolic hormones and their ability to act on hypothalamic regions involved in appetite regulation. These hormonal alterations may contribute to the metabolic defects observed in subject exposed to overnutrition during early life.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Maternal and child-health and health education are three major concerns of public health organisations and researchers throughout the world. Health education for mothers is a strategy many countries have adopted to improve maternal and child-health. The present study was carried out in Uganda with the objective of exploring the factors influencing the utilisation of postnatal services at Mulago and Mengo hospitals, a government and private hospital. Both hospitals are located in Kampala district in Uganda. The survey, was completed by 330 women who responded to a structured questionnaire that was given to them six to eight weeks after delivery. Questions that were asked generated demographic information about the mothers; mothers’ knowledge about postnatal services; mothers’ socio-economic status and barriers to utilisation of the postnatal services. The participants included all women who delivered in Mulago and Mengo hospitals in November 2003 except for those who had had a neonatal death. The data was analysed using descriptive and inferential statistics. Some of the key findings of the study were that most women lacked awareness about postnatal services and those who knew about these services only knew about immunisation and family planning services. The majority of the mothers did not know about other services, such as physiotherapy, counselling, growth monitoring, and physical examination. Lack of money for transport or service costs, distance from the health care facility, not being aware of the services, lack of somebody to take care of the child at home were some of the main barriers to utilisation of postnatal services. Others included, lack of education, lack of employment, lack of decision-making powers, and lack of time to go back for the service. The ministry of health should educate women and communities about the importance of postnatal care, its availability, and the importance of women having decision-making power over their own health. The health service organization should improve on the quality of care by ensuring that services are provided at convenient hours with privacy, confidentiality and respect and it should evaluate the services periodically from the users perspective to maintain the quality of service. / South Africa

Background: Young childbearing women have an increased risk of experiencing perinatal depression when compared to adult childbearing women. Perinatal depression has been associated with adverse life events in the literature and conceptually, in frameworks such as the Lifecycle Approach to Risk Factors for Mental Disorders Model. Purpose: The purpose of this manuscript-based thesis was to (1) determine the prevalence of: (i) adverse life events that have been associated with depression and (ii) depressive symptoms among the young pregnant and parenting women who access specialized services in an urban centre in Ontario, Canada; (2) determine which adverse life events are predictive of depression during the perinatal period, in this population; and (3) examine the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) for use in a population of young childbearing women who access specialized services in an urban centre in Ontario, Canada. Methods: A survey was conducted with 102 young women from two agencies that provide specialized services to young parents. The interviewer-administered questionnaire included demographic questions, the Edinburgh Postnatal Depression Scale, the Antenatal Psychosocial Health Assessment, the Centers for Epidemologic Studies Depression Scale, Brown’s Support Behaviour Inventory. Results: 31.4% of the sample screened positive for perinatal depression. The only adverse life events found to predict perinatal depression were satisfaction with support from ‘others’ and intimate partner violence. Another predictor was very young maternal age (14 – 17 years). The EPDS was found to be psychometrically sound when used in this population of young childbearing women. Conclusion: In this study of young childbearing women in Ontario, Canada, we found a high prevalence rate of perinatal depression and adverse life events. Furthermore, we identified specific factors that predict the development of perinatal depression in this group. Nurses can use these findings to help prioritize perinatal screening efforts to identify this condition early on in order to lessen the adversities related to perinatal depression.

La sérotonine a été impliquée dans le processus développemental de raffinement périnatal des connections synaptiques. D’autre rôle important est joue par des cellules immunitaires du cerveau, la microglie.Pendant ma thèse j’ai teste l’hypothèse qu’une interaction entre la microglie et la sérotonine est nécessaire pour l’établissement des circuits neuronaux correct dans le cerveau de la souris.Les résultats récents du laboratoire ont montré que la microglie exprime un des récepteurs à la sérotonine: le 5-HT2B. En utilisant comme model la ségrégation des axons retiennes dans le thalamus j’ai observé que la souris invalide pour ce récepteur présente des altérations anatomiques dans les régions des projections rétiniennes du thalamus.En parallèle, j’ai testé l’effet de la sérotonine sur la microglie. La libération locale de la sérotonine sur les coupes aigue du cerveau a un effet chemoattractant sur la microglie (2-photon microscopie).En plus, les analyses d'expression d’ARN de microglie dans une culture cellulaire primaire ont montres une augmentation de certains marqueurs d'activation dans la souris invalidée pour le récepteur 5-HT2B.Afin de tester quelle(s) cellule(s) sont responsable(s) pour les altérations observées dans le thalamus j’ai teste un nombre de souris avec une invalidation conditionnelle du récepteur 5-HT2B. Les résultats que j’ai obtenus pendant mon doctorat support l’hypothèse que la sérotonine interagit avec la microglie et que cette interaction pouvait être importante dans la maturation du cerveau. / Serotonin, besides its functions as a neurotransmitter, actively participates in postnatal establishment and refinement of brain wiring in mammals. Another important role is played by the brain resident macrophages, microglia, in developmentally-regulated neuronal death as well as in synaptic maturation or elimination.During my thesis, I tested the hypothesis of cross-regulations between microglia and serotonin during postnatal brain development in a mouse model. The laboratory data show a major expression of the serotonin 5-HT2B receptor by postnatal microglia, suggesting that serotonin could participate in temporal and spatial synchronization of microglial functions. Using an in vivo model of synaptic refinement during early brain development, the maturation of retinal projections to the thalamus, I observed that Htr2B-/- mice present anatomical alterations of the projecting area of retinal axons into the thalamus.Parallelly, I tested the effects of serotonin on microglial cells. A local delivery of serotonin attracted microglial processes on acute brain slices (two-photon microscopy).Moreover, after comparing mRNA expression level in microglial primary cultures, we have found that some activation markers are upregulated in microglia from Htr2B-/-.In the second part of my PhD, by using a number of conditional Htr2B-/- mice, I investigated which cell type(s) could be responsible for the altered segregation of retinal axons in the thalamus of the total Htr2B-/- mice.Overall, my results support the hypothesis that serotonin interacts with microglial cells and that these interactions could participate in brain maturation.

Master of Public Health - MPH / PMTCT is an effective strategy in preventing paediatric HIV infection. In Zimbabwe the success of PMTCT is entirely dependent on pregnant women accessing antenatal care services and through that, getting linked to PMTCT. Failure of pregnant women to book for antenatal care through the course of pregnancy presents a missed opportunity for PMTCT and a high risk for maternal HIV transmission. It is therefore important to determine the burden of unbooked women and the factors associated with it, if elimination of maternal HIV transmission is to be achieved in the country.

Bakgrund: Barnafödande kan vara en livsomställande händelse och stödet kvinnor behöver efter en förlossning är individuellt. Stöd från vårdpersonal och närstående är en viktig resurs för kvinnors välmående och uteblivet stöd kan medföra risk för utvecklande av fysisk och psykisk ohälsa. Identifiering av kvinnors erfarenheter av stöd skulle kunna stärka barnmorskan i rollen som professionell vårdare och öka förståelsen för vikten av individanpassad vård. Syfte: Att beskriva kvinnors erfarenheter av stöd postpartum. Metod: Kvalitativ intervjustudie med induktiv ansats. Insamling av data genom semistrukturerade intervjuer med tio kvinnor. Analysmetod var kvalitativ innehållsanalys. Resultat: Kvinnorna önskade mer förberedande information om postpartumtiden under graviditeten. Under tiden på eftervårdsavdelningen fanns behov av information för att känna trygghet i handhavandet av barnet, vid amning och för möjlighet till egenvård. Stöd från vårdpersonal och närstående beskrevs viktigt för kvinnornas välmående. Efter hemkomsten från sjukhuset var tillgänglighet till vården för stöd vid behov värdefullt och kunde minska känslan av oro. Konklusion: Kvinnor har behov av individanpassat stöd från vården och informativt stöd ökar kvinnors förmåga att hantera den nya rollen som förälder. Gott omhändertagande och närvaro av personal ses som betydande faktorer för kvinnors upplevelser av stöd.

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