Les premières semaines postnatales sont essentielles pour le développement de la sensibilité à la douleur et sont associées à une réorganisation structurelle et fonctionnelle des systèmes sensoriels. Les interneurones localisés dans la couche II interne (IIi) du sous noyau caudal du trijumeau (Sp5C), premier relais de l’information tactile et nociceptive orofaciale, sont des éléments clés des circuits responsables de l’allodynie mécanique orofaciale. L’objectif de ce travail de thèse est d’étudier le développement postnatal, à la fois morphologique (en utilisant l’immunohistochimie et l’analyse morphologique tridimensionnelle) et fonctionnel (enregistrements en patch-clamp sur tranches de Sp5C), de ces interneurones. Nous nous sommes d’abord intéressés à une population très particulière d’interneurones de la couche IIi, qui expriment l’isoforme gamma de la protéine kinase C (PKCγ). Au stade le plus précoce de notre étude (3 jours postnataux, P3), les interneurones PKCγ sont présents dans toutes les couches superficielles sauf, précisément, la couche IIi. Ce n’est qu’à P6 que les premiers interneurones PKCγ peuvent être observés dans cette couche. Leur nombre y croît ensuite progressivement jusqu’à P11-15. A cet âge, leur nombre dans la couche IIi est quasiment identique à celui observé aux âges plus tardifs. De plus, nous montrons que cette augmentation du nombre d’interneurones PKCγ dans la couche IIi n’est liée ni à une prolifération cellulaire ni à l’arrivée progressive des fibres afférentes nociceptives dans le Sp5C. Nous avons également étudié le développement des interneurones de la couche IIi dans leur ensemble. Ces neurones sont l’objet d’un grand nombre de changements morphologiques, aussi bien au niveau de leur soma (augmentation du volume) que de leurs neurites (augmentation de leur longueur combinée à une diminution de leur nombre et de leurs ramifications). Sur le plan fonctionnel, les neurones de la couche IIi, à la naissance, sont plus dépolarisés, ont une rhéobase plus basse – ils seraient donc plus excitables – et montrent plus fréquemment un profil de décharge avec un seul potentiel d’action, comparés aux mêmes interneurones chez l’adulte.Toutes ces modifications structurelles et fonctionnelles des interneurones de la couche IIi du Sp5C pourraient contribuer au développement de la sensibilité orofaciale. / The first postnatal weeks are pivotal for the development of pain sensitivity and are associated with structural and functional reorganization of sensory systems. Interneurons located in the inner part of lamina II(IIi) of the caudal trigeminal subnucleus (Sp5C), the first central node in orofacial tactile and nociceptive pathways, are key elements in circuits underlying the orofacial mechanical allodynia. The aim of this thesis is to study the morphological (by using immunohistochemistry and tridimensional morphological analysis) and functional (by using whole-cell patch-clamp recordings) postnatal development of these interneurons. First, we looked at a very specific population of lamina IIi interneurons expressing the gamma isoform of the protein kinase C (PKCγ). At the earliest stage of our study (3 postnatal days, P3), PKCγ interneurons are present in all superficial layers but PKCγ interneurons can be observed in lamina IIi only at P6. The number of PKCγ interneurons within this lamina then increases gradually up to P11-15. At this age, the number of PKCγ interneurons in lamina IIi is almost the same as that at later ages. Interestingly, we show that neither cell proliferation nor the gradual projection of nociceptive fibers within the Sp5C accounts for such increase. We also studied the development of the whole population of lamina IIi interneurons. These interneurons undergo a large number of morphological changes, in their soma (increased volume) as well as neurites (concomitant increase in length and decrease in number and branching). Furthermore, according to electrophysiological properties, lamina IIi interneurons, at birth, are more depolarized, have a lower rheobase – suggesting that they are more excitable – and exhibit more frequently a single action potential discharge profile compared with mature ones. All these structural and functional changes of lamina IIi interneurons might contribute to the development of orofacial sensitivity.

Bakgrund: Graviditetsrelaterad bäcken- och/eller ländryggssmärta kan bero på hormonella och biomekaniska förändringar som vanligen efter förlossningen. Dock kan kvinnor få ihållande smärtbesvär vilket kan påverka funktion och livskvalitet. Bäckenbottenträning, statisk bålträning och dynamisk bålstabiliserande träning har liknande effektmekanism för smärtlindring. Riktlinjer kring fysisk träning efter förlossning saknar en uppdaterad evidensbild för dess smärtlindrande effekt. Syfte: Syftet var att sammanställa evidensläget samt bedöma evidensstyrkan för den smärtlindrande effekten av bäckenbottenträning, statisk bålträning samt dynamisk bålstabiliserande träning vid smärta i bäcken- och/eller lumbalregion efter förlossning.  Metod: En systematisk litteraturöversikt genomfördes med artikelsökning på databaserna PubMed, Cinahl, PEDro och Cochrane. Varje artikel granskades enskilt av respektive författare utifrån en granskningsmall innan en gemensam sammanställning utfördes. Evidensgradering utifrån varje träningsform genomfördes med GRADE. Resultat: Nio randomiserade kontrollerade studier inkluderades med 499 kvinnor där fysisk träning visades ge en smärtlindrande effekt på postpartumsmärta i bäcken- och/eller ländrygg med genomsnittlig metodologisk kvalitet på 50 poäng. Dynamisk bålstabiliserande träning inkluderade sex studier och bäckenbottenträning två studier, samtliga med låg tillförlitlighet (⨁⨁◯◯). Statisk bålträning inkluderade en studie med mycket låg tillförlitlighet (⨁◯◯◯) enligt GRADE. Konklusion: Fysisk träning kan användas som behandling vid postpartumsmärta i bäcken- och/eller ländrygg. Evidensgraden behöver höjas genom fler studier, fler deltagare och blindad resultatuppföljning. / Background: Pregnancy-related pelvic girdle pain and/or low back pain is commonly caused by hormonal or biomechanical changes and tends to disappear after giving birth. However, some women are affected by the pain for an extended period, which will affect their functional status and quality of life. Pelvic floor exercises, static core exercises and dynamic core stabilisation exercises have a similar mechanism behind the pain-relieving effect. Guidelines for physical exercise after childbirth lack an updated picture of evidence for the pain-relieving effect. Purpose: The purpose of this review was to gather evidence and evaluate the strength of the evidence in relation to the pain-relieving effect of pelvic floor exercises, static core exercises, and dynamic core stabilisation exercises on pelvic girdle pain and/or low back pain after childbirth. Method: A systematic literature review was carried out and articles were gathered from the databases PubMed, Cinahl, PEDro and Cochrane. Each article was analysed individually by each author using a review template before a collective assessment was made. GRADE was used to rate the evidence for each form of physical exercise.  Results: Nine randomised controlled trials were included with 499 women where physical exercise was used to try and treat postpartum pelvic girdle pain and/or low back pain with a mean methodological quality of 50 points. Six studies evaluated dynamic core stabilisation exercises and two reviewed pelvic floor exercises, all with an overall low reliability (⨁⨁◯◯). Static core exercise was assessed in one study with very low reliability (⨁◯◯◯) according to GRADE. Conclusion: Physical exercise can be used as a treatment for pelvic gridle pain and/or low back pain postpartum. The level of evidence for each form of physical exercise needs to increase through more studies, more participants and blinded outcome follow-up.

Flera studier visar amningens fysiska och psykiska hälsofördelar för mor och barn, dock avvänjer kvinnor som lider av postpartum depression amning tidigt om de presenteras med utmaningar under amningen. Syfte med denna studie är därför att beskriva hur kvinnor som lider av postpartum depression upplever amning. Nio kvinnor deltog i studien, fem förstföderskor och fyra omföderskor, varav 5 intervjuades och 4 erhöll semistrukturerade frågeformulär med öppna svarsalternativ. En reflekterande livsvärldsansats som baserar på fenomenologi användes under datainsamling och dataanalys. Resultatet visar att amningen som fenomen är komplex och innebär en utmaning för kvinnan. Den essentiella innebörden av fenomenet beskrivs som ”amning som en kraftkälla, där den har potential att vara både kraftgivande och stärkande samt riskerar vara kraftdränerande”. Detta beskrivs vidare utifrån fyra innebördselement: ”att knyta kontakt med och lära känna sitt barn”, amning som återhämtning”, ”amning som energikrävande” och ”att känna sig ömtålig och utsatt”. Vårdande av kvinnor som lider av postpartum depression under amning innebär att assistera kvinna att möta sin osäkerhet och stärka hennes förtroende för att lita på sin förmåga att amma sitt barn. När amningen fungerar bra har den potentialen att inge kraft och stärka kvinnan i moderskapet. Fungerar amningen däremot inte bra riskerar den att dränera kraft och strävan efter samhörighet och bekräftelse sätts på spel vilket späder på kvinnans redan sköra situation och gör henne ännu mer sårbar i förhållande till barnet och sig själv.

The aim of this thesis was to increase understanding of how rumination, defined as the behaviours and thoughts that focus an individual’s attention on their depressive symptoms and on the implications of these symptoms (Nolen-Hoeksema, 1991), affects the relationship between postnatal depressive symptoms and maternal sensitivity. Study 1 examined the impact of self-reported maternal rumination on perceived maternal attunement and mood, and the role of perceived social support and infant temperament in this relationship in a community sample of mothers (N = 203). Rumination mediated the relationship between maternal depressive symptoms and maternal responsiveness when infant negative affect was low but not high. Contrary to predictions, rumination did not mediate the relationship between social support and maternal attunement. Study 2 incorporated a second assessment point approximately six months later with the same sample. Prospective analyses were undertaken to examine the directional relationship between rumination and maternal attunement in the context of depressive symptoms. Unexpectedly, analyses revealed that maternal bonding prospectively predicted rumination at six months, after controlling for rumination at baseline. The converse relationship was not significant. This was contrary to the thesis hypothesis that increased rumination would predict impaired attunement at six months. Partially consistent with the thesis hypotheses, the relationship between rumination and maternal attunement was moderated by depressive symptoms at baseline; such that mothers who were low in depressive symptoms and had lower bonding at baseline reported higher levels of rumination at 6 months. Study 3 also explored the directional relationships between maternal mood, rumination and maternal attunement at a state level in a daily diary study with a community sample of mothers (N = 94) with infants aged between 3 and 14 months. Consistent with the findings of study 2, state maternal bonding at Time 1 predicted both state maternal rumination and state maternal mood at Time 2, and state rumination at Time 2 mediated the relationship between state bonding at Time 1 and state mood at Time 2. In the final study, the causal relationships between an experimentally induced state of ruminative thinking and observed maternal behaviours in a mother-infant interaction task were examined in a sample of dysphoric and non-dysphoric mothers (N = 79) and their infants. The analyses examined change in mother-infant interaction quality from baseline to post rumination induction, and subsequent change following an infant stressor task. Findings revealed a significant reduction in maternal sensitivity and mother-infant dyadic synchrony in the rumination group, but not the control group. For maternal sensitivity, the effect of rumination was exacerbated following the stressor task. Contrary to predictions, this relationship was not moderated by dysphoric symptoms. The findings of this thesis indicate that ruminative thinking directly impairs observed maternal behaviours, but that perceived poorer maternal attunement also increases self-reported ruminative thinking. The significance of these findings for theoretical explanations of rumination in a postnatal context are considered, and the clinical implications for parenting programmes and interventions for both mothers in the community as well as those considered at risk are discussed.

Purpose: Postnatal depression (PND) has significant negative outcomes for both mother and baby. The literature indicates that cognitive behavioural interventions can be effective and efficacious treatments, less is known about what mechanisms underpin change in such interventions. The present study aimed to explore severity of depression as a moderator and Behavioural Activation (BA) as a possible mediator of treatment outcome in an online BA intervention for PND. Methods: Follow-up of postnatal women participating in a feasibility Randomised Controlled Trial (RCT) of Netmums, an online BA treatment with telephone support. Results: There was no evidence to support the hypothesis that severity of depression acted as a moderator for treatment outcome. No mediation effects for BA were found. Rumination and avoidance did predict treatment outcome, but this did not differ between the treatment and control group. Post Hoc sudden gains analysis revealed that 48.90% of the treatment group sample experienced a sudden gain. Those who experienced a sudden gain had better post intervention outcomes. Conclusions: The findings have important implications for both theory and the design of future interventions. Future research should consider collecting weekly measures from both treatment and control groups.

No description available.

The study was developed after research with older women suffering urinary symptoms showed that many had tolerated social, psychological and hygiene effects on their lives for some time. There is evidence that some symptoms in later life may originate from pregnancy and childbirth. However, whist there is evidence that pelvic floor muscle exercises can be effective in the short term, there is a paucity of research on the reasons why women tolerate symptoms in the postnatal period rather than seek help. It was also unclear what significance the interactions with health professionals had in aiding or suppressing help-seeking. The aim of this qualitative study was to use grounded theory methodology to describe women’s experiences and knowledge of urinary symptoms in the postnatal period and the perceptions of health professionals. Fifteen women were interviewed in the postnatal period, and one woman was interviewed twice. From the interviews and observations of antenatal clinics and postnatal groups three categories emerged; messages women receive, seeking and understanding information and responding to the messages. Views and knowledge of health professionals were obtained through two focus groups of five. From the analysis of the findings the following five categories emerged; clarifying pathways of care, clarifying education, improving communication, understanding actions and serious issues. The core category arising from this; overcoming barriers to facilitate empowerment, revealed barriers that women and health professionals must overcome in order to approach the issue of urinary incontinence collaboratively. This study identified that there can be problems with communication at all levels between women and health professionals, resulting in poor communication regarding urinary symptoms and accessing treatment. Furthermore, superficial education regarding pelvic floor muscle exercises and dysfunction, both in the antenatal and postnatal periods, coupled with difficulties with disclosure on a sensitive subject could be disempowering for women and health professionals. In particular, women found the possibility of an examination so soon after delivery worrying. Normalisation was a negative but powerful influence on women, encouraged by friends and family. It is suggested that, by developing interventions that enable women and health professionals to overcome the barriers of communication and knowledge exchange, women could be empowered in relation to their physical health after childbirth to manage their urinary symptoms. Empowerment for women, therefore, with regard to postnatal urinary symptoms means being able to believe that looking after the pelvic floor is normal rather than accepting urinary symptoms after childbirth as inevitable.

Introduction: There is growing evidence that many parents with learning disabilities, when given adequate support, can parent successfully. Childbirth is a significant life event that marks a woman's transition to motherhood and is a time when parents first learn to nurture their children. Postnatal care aims to facilitate this learning experience as well as promote the emotional and physical well-being of both infant and mother. To date, no research has explored the support mothers with learning disabilities receive during the postnatal period. To fill this gap in the research and help inform service provision, this study aims to explore how mothers with learning disabilities experience postnatal care. Method: Semi-structured interviews were carried out with six mothers with learning disabilities. The data were collected and analysed using Interpretative Phenomenological Analysis. Results: Mothers experiences of postnatal care were conceptualised within four superordinate themes: challenges of providing support, how support was delivered , learning to cope and challenges to building trust. All of these had accompanying subthemes. Discussion: The results are discussed in the context of relevant literature. Consistent with previous research which has been carried out with parents with learning disabilities, participants were found to be highly dependent on informal support. The participants acknowledged the value of professional input and their perceptions of how this support was delivered had important implications. Learning how to cope with the demands of their new role raised issues not dissimilar to those of parents without learning disabilities. Challenges, however, were faced in establishing trusting relationships with professionals. The findings were found to have implications for clinical practice which are described and suggestions for future research made. Conclusion: The findings suggest that participant informal supports play a key role during the initial stages of parenthood particularly with providing practical support in areas which present challenges. Professional input was valued when delivered according to the typical pathway of care post-birth. It is recommended that consideration is given to how the support is delivered to participants. This should essentially seek to empower parents rather than undermine them as how support was perceived by parents impacted on their subsequent engagement with professionals.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Objetivo: Determinar la relación existente entre características sociodemográficas y riesgo de depresión postparto en puérperas atendidas en el servicio de Ginecología y Obstetricia de la Clínica Good Hope, Miraflores - Lima, noviembre de 2015. Materiales y métodos: Se realizó un estudio descriptivo, correlacional, observacional, transversal aplicando la escala de depresión postnatal de Edimburgo (EDPE) para detectar el riesgo DPP. La población estuvo conformada por la totalidad de mujeres que acudieron a dar a luz en la Clínica que cumplieron con los criterios de inclusión. Se encontró 110 puérperas que cumplieron con los criterios de inclusión, siendo seleccionadas por conveniencia. Para el procesamiento y análisis de datos, se diseñó una base de datos en Excel 2,010 y STATA version13, que permitió la elaboración de tablas de distribución de frecuencias y gráficos. Resultados: Se encontró (Tabla1) que existe un riesgo de depresión postparto en 20% (riesgo limite10,91% y probable depresión postparto 9,09%).Se encontró que el mayor porcentaje de puérperas 29% oscila entre las edades de 26 a 30 años. 96% estaban acompañadas por su pareja, ya sea conviviente o estar casadas. 60% eran primíparas. 88 % referían parto por cesárea. 96% poseían estudios superiores y 50% manifestaron embarazo planeado. No se encontró asociación entre el riesgo de DPP y las variables sociodemograficas. Conclusiones: No existe asociación significativa entre el riesgo de Depresión Postparto y las características Sociodemográficas. Existe 20% de riesgo de DPP.