Psychological health of women who have conceived using assisted reproductive technology in Taiwan: findings from a longitudinal study

Background: Despite the increasing use of Assisted Reproductive Technology (ART) and the significant physical and emotional commitments that these treatments and procedures involve, only limited evidence exists regarding the psychological health of women who undergo ART. This study investigated the changes over time in the psychological health of women who have conceived using ART during the first, second, and third trimesters of pregnancy and during the postpartum period in Taiwan. Methods: A quantitative longitudinal study was conducted at a fertility centre in Taiwan. 158 pregnant women who had conceived using ART completed a web-based questionnaire that included the following instruments: State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Modified Maternal Foetal Attachment Scale, Pregnancy Stress Rating Scale, Maternity Social Support Scale, Intimate Bond Measure, and Parenting Stress Index. The data were collected the first (9–12 weeks), second (19–22 weeks), third (28–31 weeks) trimesters of pregnancy and at 7–10 weeks postpartum. Results: Levels of anxiety and depression, which are both key indicators of psychological health, were highest during the first trimester, with scores of 42.30 ± 11.11 and 8.43 ± 4.44, respectively. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy, with scores of 38.03 ± 10.58 in the second and 38.39 ± 10.36 in the third trimester, but increased at two-months postpartum, attaining a score of 41.18 ± 11.68. Further, depression scores showed a similar pattern, declining to a mean of 7.21 ± 4.23 in the second and 6.99 ± 4.11 in the third trimester and then increasing to 8.39 ± 5.25 at two-months postpartum. Pregnancy stress and social support were found to be the most important predictors of change in psychological health during pregnancy and the postpartum period. Conclusion: Psychological health was found to be poorest during the first trimester and at two-months postpartum. Moreover, pregnancy stress and social support were identified as key predictors of change in psychological health. The findings indicate a need for increased sensitivity among healthcare professionals to the psychological vulnerability of women who have conceived using ART as well as a need to introduce tailored interventions to provide appropriate psychological support to these women

First-time mothers\u2019 experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

Background: Assisted reproductive technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers\u2019 experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method: Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women\u2019s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results: The mothers\u2019 accounts reflected three main themes: \u2018being different from mothers who became pregnant naturally\u2019, \u2018ensuring health and safety of the foetus\u2019, and \u2018welcoming new lives with excitement\u2019. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family\u2019s assistance and support, and worrying about the impact of ART on health. The theme on \u2018ensuring health and safety of the foetus\u2019 encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around \u2018welcoming new lives with excitement\u2019 reflected four subthemes: overcoming hardship for worthwhile results, realising one\u2019s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion: Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes

First-time mothers’ experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

Background Assisted Reproductive Technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’; ‘ensuring health and safety of the foetus’; and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes

A systematic review of randomised controlled trials on the effectiveness of exercise programs on lumbo pelvic pain among postnatal women

Background: A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods: A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results: Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion: Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment

生產醫療措施與計畫剖腹生產產婦泌乳起始時間之相關研究

[[abstract]]本研究旨在探討生產醫療措施與計畫剖腹生產產婦泌乳起始時間之相關性研究。採描述相關研究，以方便取樣方式於北部某區域教學醫院，針對計畫剖腹生產產婦進行收案，共收案116名無任何合併症之產後婦女。研究工具包括人口學屬性及產科學調查表，生產醫療措施調查表、語言疼痛評估量表、以及自覺泌乳起始時問訪談表。研究結果發現：(1)泌乳起始時間的平均值爲757±168小時（範圍40至117小時）；(2)產婦自覺延遲泌乳的發生機率爲500%(n=58)，其中延遲泌乳的初產婦有27位，佔所有初產婦(n=42)的64.3%，延遲泌乳的經產婦有31位，佔所有經產婦(n=74)的41.9%，經產婦發生延遲泌乳的機率較低；(3)產次、術後禁食時間以及配方乳使用，是泌乳起始時間的重要預測因子，共可解釋計畫剖腹產婦泌乳起始時間總變異數的22.5%。醫護人員應該鼓勵產婦以純母乳餵養嬰兒，以及縮短術後禁食時間，提早讓產婦進食，以減少延遲泌乳的發生機會，進而促進產婦成功哺乳。[[abstract]]This study explored the relationship between birth practices and onset of lactation during hospital stay in women undergoing planned cesarean. The study design was descriptive correlation. A convenience sample of 116 healthy mothers was recruited from a Northern Taiwan regional teaching hospital. The study instruments included: demographic and obstetrical data, childbirth health care environment inventory, and verbal pain rating scales. An interview guide entitled, "Maternal Perception of the Onset of Lactation" was also used to obtain milk secretion data. The analytical results revealed a mean onset of lactation of 75.7±16.8 hours (range=40 to 117). The prevalence of delayed lactation onset was 50.5% (n=58); 64.3% (n=42) were primiparous, and 41.9% (n=74) were multiparous. Parity, hours of withholding oral intake post-operation, and use of formula were significant predictors of perceived lactation onset. These factors explained 22.5% of perceived lactation onset in postpartum women who planned cesarean section. To increase milk secretion and to promote breastfeeding, medical personnel should encourage mothers to breastfeed exclusively in order to minimize the duration of restriction oral intake post-operation

[[alternative]]Nursing Care Experiences of a Borderline Personality Patient With Spiritual Distress

[[abstract]]邊緣性人格疾患，常對人生、存活價值產生質疑，若能瞭解及提供個案的靈性健康需求，是極具價值和有意義的護理經驗。本篇個案報告探討一位邊緣性人格疾患的年輕女性，產生靈性困擾之護理經驗，護理期間自2010年2月24日至2010年12月15日，利用觀察、會談和查閱病歷進行靈性照護需求四向度評估，包括個人與自我、他人、信仰及自然環境間的關係，加以彙整分析資料後，發現個案因疾病憂鬱情緒、過去成長背景缺失、缺乏支持系統及有效壓力調適技巧、造成個人生命存活價值的質疑，有自殺及自傷的行為表現；在此護理過程中，筆者以個別會談方式運用傾聽技巧、誘導個案表達靈性的困擾，進而以辯證行為治療團體、教導技巧訓練，增強正向思考的價值觀，降低自殺或自傷的行為出現，使個案能對生命存在意義有較正向的看法，增加個案的自我尊重和生活品質，藉此提供日後照顧類似臨床個案的參考。[[abstract]]Patients with Borderline Personality Disorder (BPD) often question the purpose and value of their life.Understanding the spiritual needs of BPD patients is essential to providing more appropriate care and achieving greater care efficacy. This case report investigated a woman with BPD who had experienced spiritual distress during nursing care. Between February 24th and December 15th, 2010, the authors conducted an assessment of the four dimensions of spiritual care for the patient using observation, interviews and patient medical records. The four dimensions included the relations between the individual and herself, others, religious belief, and the natural environment. After integrating and analyzing data, the authors found the patient questioned the purpose and value of her life and contemplated selfinjury/ suicide due to inadequate support systems and a lack of effective stress management and coping skills caused by illness-induced depression and the lingering effects of a difficult childhood. In the process of nursing care, the authors employed one-to-one interviews with listening skills to induce the patient to describe her spiritual distress, and then employed dialectical behavior therapy groups and education skills training to enhance the values of positive thinking and reduce suicidal / self-injury tendencies to help the patient foster a more positive outlook toward life. The result increased patient self-respect and quality of life. The authors hope this case may provide a reference for treating similar clinical cases in the future

[[alternative]]Improve the Maternal Movement of Low Risk Women during Early Stage of Labor

[[abstract]]下床活動可以轉移待產時子宮收縮的疼痛不適，本專案旨在改善單位待產婦女下床活動作業。經現況調查發現問題，平均每星期高達80%的待產婦女不瞭解下床活動目的、現行未有下床活動護理指導標準、護理人員執行低危險待產婦女下床活動護理指導規範滿意度為2.1分，待產婦女缺乏下床活動的動機。經由問卷調查、現況分析及文獻查證後，進行解決方案：（一）制訂下床活動護理指導標準規範；（二）單位內設置下床活動－生產球推動小組；（三）修訂下床活動護理指導單張及製作海報。經實施解決方案後，待產婦女下床活動比率由20%提昇至達100%，顯示專案經由正確的分析，透過制度面來進行改善作業，能有效的提升下床活動比率達到專案的目的。[[abstract]]This article describes the outcome on the project of improving maternal movement for low risk women during early stage of labor. Literature review indicated that maternal movement reduces labor pain during contraction. There were four barriers found to be related to low maternal movements: lack of standards in nursing practice, lack of knowledge on the benefits of increasing maternal movement in early stages of labor among 80% of women in labor, lack of motivation and low satisfaction towards education. Three improving strategies were adopted including setting up standards of nursing practice on maternal movement, establishing a birth ball exercises education team, as well as developing patient education brochures and posters. The maternal movement in low risk women increased from 20% to 100%

Evaluation of a lactation intervention program to encourage breastfeeding: a longitudinal study

[[abstract]]The purpose of this study was to evaluate the implementation of a change to the breastfeeding policy in seven hospitals in accordance with the ‘Ten Steps to Successful Breastfeeding’ issued by the World Health Organization and the United Nations Children’s Fund and to assess the impact of hospital practices on breastfeeding. A 3-year quasi-experimental pre-post test design was conducted in 12 hospitals. The subjects were composed of 4614 lactating women in both experimental and control groups. The research instruments included the Baby-Friendly hospital Initiative training programs and questionnaires on breastfeeding duration, knowledge, attitude, and demographic data. Breastfeeding rates (including exclusive breastfeeding, mixed breastfeeding, and overall breastfeeding rates) of the experimental and control groups were measured and compared at four different times, during the hospital stay and at 2 weeks, 1 and 2 months postpartum. The results indicated that the exclusive and overall breastfeeding rates of the experimental group were higher than those of the control group (p1.96, p<0.05) with scores increasing year by year. The results also showed that higher scores reflected better knowledge in breastfeeding, and, in turn, a longer duration of breastfeeding

Effects of birth ball exercise on pain and self-efficacy during childbirth: A randomised controlled trial in Taiwan

[[abstract]]OBJECTIVES: To examine the effectiveness of a birth ball exercise programme during childbirth by measuring childbirth self-efficacy and childbirth pain. In addition, it tested the mediating effects of childbirth self-efficacy on the relationship between the birth ball exercise programme and childbirth pain. DESIGN: Randomised controlled trial. PARTICIPANTS AND SETTING: The study was conducted from December 2008 to November 2009, at two birth units, one at a regional hospital and one at a medical centre, with 600 and 1022 annual births, respectively. One hundred and eighty-eight expectant mothers were recruited (recruitment rate: 47%) and were allocated by block randomisation into the two arms of the study, but only 48 intervention and 39 control group participants completing the trial. INTERVENTIONS: The birth ball exercise programme consisted of a 26-page booklet and a 19-minute videotape, with periodic follow-ups during prenatal checks. All members of the experimental group were asked to practise the exercises and positions at home for at least 20 minutes three times a week for a period of 6-8 weeks. Each woman in the experimental group was given a birth ball for use during labour and encouraged every hour to choose the most comfortable positions, movements, and exercises. Both the experimental and control groups received standard nursing and midwifery care from hospital staff nurses in all aspects of pregnancy and childbirth. MEASUREMENT AND FINDINGS: When cervical dilations were four centimetres and eight centimetres, the women completed demographic and obstetrics information, the Childbirth Self-efficacy Inventory (CBSEI), and the short form of the McGill Pain Questionnaire (SF-MPQ). Our study revealed that birth ball exercises provided statistically significant improvements in childbirth self-efficacy and pain. Specifically, self-efficacy had a 30-40% mediating effect on relationships between birth ball exercises and childbirth pain. Mothers in the experimental group had shorter first-stage labour duration, less epidural analgesia, and fewer caesarean deliveries than the control group. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Clinical implementation of the birth ball exercise programme could be an effective adjunctive tool to improve childbirth self-efficacy and reduce pain among women in labour. On the basis of our mediating model, the results further suggest that confidence is greater after prenatal preparation powerfully related to decreased pain perception and decreased medication/analgesia use during labour