Critical views on postpartum care expressed by new mothers

<p>Abstract</p> <p>Background</p> <p>Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not.</p> <p>Methods</p> <p>Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed.</p> <p>Results</p> <p>Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother.</p> <p>Conclusion</p> <p>The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.</p

Pediatrisk omvårdnad och föräldrarskap : Studier av ett vårdprogram med tidig hemgång av underburna barn, mödrars upplevelse av vården vid BVC samt föräldrarstress

This thesis aimed at: 1) evaluating the effect of early discharge of preterm infants, followed by domiciliary nursing care, on infant health, utilisation of health services, parental anxiety and breastfeeding; 2) identifying risk factors for not being satisfied with the overall care provided at the child health clinic (CHC) during the infant's first year in a national sample of Swedishspeaking mothers; and 3) studying risk factors for parenting stress one year after childbirth in the same sample. In total, 88 infants who were physiologically stable but in need of additional care, such as gavage feeding , were allocated either to an early discharge group (EDG = 45 infants) where they were offered home visits by a nurse and back-up by neonatologists, or to a control group where they were offered standard neonatal care (CC = 43 infants). Length of hospital stay after birth was on average 9.3 days shorter in the EDG than in the CC. No statistical differences were found in health outcomes, except a lower rate of respiratory infections in the EDG (6 infants vs. 16 in CC; p=0.02). Hospital admissions and visits to the out-patient clinic did not differ between the two groups during the infant's first 12 months, and breastfeeding rates were similar during the first 6 months. No statistical differences were observed regarding parental anxiety. The study of maternal satisfaction with CHC care included 2,415 women recruited from 593 (97 %) antenatal clinics in Sweden, who answered three questionnaires: in early pregnancy, 2 months after the birth and 1 year after the birth. Seventy-nine per cent were satisfied with the overall care given, while 21 % had mixed or negative feelings. Maternal depressive symptoms, worry about caring for the newborn baby, and saying that the infant had serious feeding problems were risk factors for not being satisfied. Thirty-five per cent of all mothers were not satisfied with the attention paid to their own needs, and 35 per cent said information about vaccinations was insufficient. Mothers with depressive symptoms at 2 months as well as 1 year after the birth were least satisfied. The study of risk factors for parenting stress included 2,424 women. Risk factors identified during pregnancy were unemployment, non-Swedish speaking background, inconvenient timing of pregnancy and expecting a second child. Factors identified postpartum were maternal worry, depressive symptoms, lack of support from the woman's partner and dissatisfaction with support by the CHC nurse. The mother's own experience of her infant's health and behaviour was associated with parenting stress, but not preterm birth, functional impairment or chronic illness. Social support seemed to protect against parenting stress. In conclusion, this thesis demonstrated the feasibility of a programme with early discharge of preterm infants. With the support of a neonatal nurse and back-up by neonatologists, new parents were able to care for their infant at home, even when gavage feeding and oxygen therapy was necessary. The findings regarding infant health and parents' experiences were promising, but larger studies are necessary in order to allow valid conclusions about these outcomes. A majority of Swedish-speaking women were satisfied with the care provided at the CHC during the infant's first year. Women with depressive symptoms and those who experienced that their infant had feeding problems were at the highest risk of not being satisfied. Many women were dissatisfied with the attention paid to their own needs. The mother's psy cho-social background and experience of her baby's health and behaviour were more important predictors of parenting stress than the more objective measures of infant health

A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding

AIM: To evaluate the effects of almost continuous skin-to-skin contact (SSC) on salivary cortisol, parental stress, parental depression, and breastfeeding. STUDY DESIGN: This is a randomised study engaging families of late preterm infants (32-35weeks gestation). Salivary cortisol reactivity was measured in infants during a nappy change at one month corrected age, and in infants and mothers during still-face at four month corrected age. Both parents completed the Swedish Parenthood Stress Questionnaire (SPSQ) at one month and the Edinburgh Postnatal Depression Scale (EPDS) at one and four months. Ainsworth's sensitivity scale was used to control for parental sensitivity. SUBJECTS: Thirty-seven families from two different neonatal care units in Sweden, randomised to either almost continuous SSC or standard care (SC). RESULTS: Infants randomised to SSC had a lower salivary cortisol reactivity at one month (p=0.01). There was a correlation between the mothers' and the preterm infants' salivary cortisol levels at four months in the SSC group (ρ=0.65, p=0.005), but not in the SC group (ρ=0.14, p=0.63). Fathers in SSC scored lower on the SPSQ sub-scale spouse relationship problems compared to fathers in SC (p&lt;0.05). CONCLUSIONS: Almost continuous SSC decreases infants' cortisol reactivity in response to handling, improves the concordance between mothers' and infants' salivary cortisol levels, and decreases fathers' experiences of spouse relationship problems.The authors gratefully acknowledge the participating families, Lisbet de Jounge, Birgitta Lundin, Elisabeth Olhager, and Ihsan Sarman, and staff members at the Neonatal Intensive Care Units at Linkoping University Hospital and at Sachs' Children's Hospital in Stockholm. This study was supported by the County Council of Ostergotland (LiO-12134, LiO-17711, LiO-278801), South Sweden Nursing Society (SSSH-2008), Halsofonden (LiU-2009), and Linkoping University.</p