Mother's Milk and Mother's Tears: Breastfeeding Experiences in Mothers with Postpartum Depression

With an increasing amount of attention being paid to maternal mental health and the knowledge that maternal depression has the potential to adversely affect the breastfeeding relationship, the demand for appropriate breastfeeding support for mothers struggling with postpartum depression is on the rise. Using a hermeneutic phenomenological approach, the objective of this thesis research was to explore the lived experience of breastfeeding in women with postpartum depression to enhance understanding of what it means for these women to feel supported by registered nurses. After obtaining ethical and operational approval, recruitment began in September 2011 via the Saskatoon Postpartum Depression Support Program, a community wellness program offered by the Saskatoon Health Region. The researcher conducted in-depth, conversation-style interviews with five postpartum mothers. Interviews were transcribed verbatim and were analyzed according to emerging themes. The lived experience of breastfeeding with postpartum depression presented itself across interviews as overarching patterns, which are expressed by the following four themes: making the decision to breastfeed and having great expectations; learning the moves and wanting reassurance (establishing the breastfeeding relationship); breastfeeding in the dark (maintaining the breastfeeding relationship while trying to manage the symptoms of depression); keeping it under wraps and waiting it out (the issue of support). The mothers in this study valued the breastfeeding relationship when it went well; however, breastfeeding difficulties intensified symptoms of depression. Mothers who made the decision to breastfeed their infants needed ongoing support from healthcare professionals and loved ones to continue to breastfeed when faced with the debilitating symptoms of postpartum depression. This research concluded that women need increased anticipatory guidance to be prepared for the demands of motherhood. Women who are at risk for postpartum depression need appropriate treatment throughout the perinatal period and beyond. To these ends nurses must enhance their role as breastfeeding and postpartum depression educators across an extended perinatal period. Nurses should work along with other healthcare providers (midwives, social workers, physicians) to assess the effectiveness and appropriateness of prenatal classes as they are currently offered. Increased emphasis should be focused on newborn feeding and care for mother and baby postnatally in conjunction with prenatal preparation for birth itself. The issue of professional nursing support for breastfeeding must be explored from a sociopolitical context in order to determine if nurses have the cultural and institutional support they need to provide responsive care to mothers and babies. Enhanced support for breastfeeding certification among frontline staff is recommended. It is also recommended that staffing guidelines to decrease nurse-to-client ratios be implemented in order to give nurses the time needed to support mothers as they work through breastfeeding challenges (especially those mothers at risk for postpartum depression). Further, nurses need to enhance efforts to engage mothers and their families in a participatory manner so that knowledge gleaned results in responsive interventions

Survey Of Teacher Opinions On The Use Of Learning Analytics To Improve Student Learning

This investigation focused on opinions of K-12 teachers from North Carolina regarding awareness, usage, resources, and attitudes about learning analytics. Results contribute to validation of the 2013 Horizon Report predictions for implementation in K-12 schools. An online survey of 32 fixed-response items was used for data collection. Teacher impressions of learning analytics were disheartening. Likely, some had heard the buzzword, had reviewed products and strategies, had acquired technical skills, but had not gained a cohesive overview of the potential of the concept

The state of play in European coaching & mentoring

This report provides an overview of the main findings from the 2017 European Coaching and Mentoring Research Project, undertaken by Jonathan Passmore and Hazel Brown, in partnership with the EMCC and the wider European coaching and mentoring industry. The study was planned in 2016 and undertaken during a 12-week period, between March and May 2017. This is one of a number reports published. This Executive Report is available free of charge, along with a National Report in countries that achieved over 50 coach or mentor participants. Each National Report is published in the language chosen by of the respective national coaching community. The aim of these national reports is to deepen understanding of coaching and mentoring and to widen engagement with coaching and mentoring.peer-reviewe

Learning needs of family physicians, pediatricians and obstetricians to support breastfeeding and inform physician education

Background: Physicians require breastfeeding education appropriate to their roles. The aim of this survey was to determine physician learning needs and to inform development of breastfeeding education for physicians.Methods: A cross sectional survey was distributed to family physicians, pediatricians and obstetricians in a tertiary institution. Importance of knowledge to practice and confidence to manage was assessed for 18 learning topics proposed by a multi-specialty physician working group. Descriptive statistics, ANOVA and tests for equality of variances were calculated. Mean values of importance to practice and confidence to manage for each topic suggested learning priorities.Results: The study group included 75 physicians. The most important topics were “informed choice when supporting newborn feeding,” “analgesics, antidepressants and other medications while breastfeeding” and “community resources for breastfeeding support.”  Confidence to manage was lowest for “latch assessment,” “what mom can do during pregnancy to promote milk production,” and “risk factors for delayed lactogenesis.” Preferred learning formats were 15-minute online modules and grand rounds.Conclusions: Physicians acknowledged the importance of all topics but report lowest confidence to manage latch assessment, prenatal interventions to support lactogenesis and management of delayed lactogenesis.  Participants placed relatively low importance on learning about latch assessment despite the central nature of this skill in supporting early breastfeeding.Contexte : Les médecins ont besoin d’une formation sur l’allaitement adaptée à leur rôle. L’objectif de cette enquête était de contribuer à l’élaboration d’une telle formation en déterminant les besoins d’apprentissage des médecins dans ce domaine.Méthodes : Une enquête transversale a été réalisée auprès des médecins de famille, des pédiatres et des obstétriciens dans un établissement tertiaire. L’importance des connaissances pour la pratique et de la confiance envers la prise en charge a été évaluée pour 18 sujets d’apprentissage proposés par un groupe de travail de médecins de diverses spécialités. On a effectué des statistiques descriptives, une analyse de la variance et des tests de l’égalité des variances. Les valeurs moyennes de l’importance pour la pratique et de la confiance dans la prise en charge pour chaque sujet indiquent les priorités d’apprentissage.Résultats : Le groupe d’étude comprenait 75 médecins. Les sujets les plus importants étaient « le choix éclairé concernant l’alimentation du nouveau-né », « la prise d’analgésiques, d’antidépresseurs et d’autres médicaments pendant l’allaitement » et « les ressources communautaires de soutien à l’allaitement ». La confiance dans la prise en charge était la plus faible en ce qui concerne « l’évaluation de la prise du sein », « ce que la mère peut faire pendant la grossesse pour favoriser la production de lait » et « les facteurs de risque associés au retard de la lactogenèse ». Les formats d’apprentissage préférés étaient les modules en ligne de 15 minutes et les séances plénières.Conclusions : Les médecins reconnaissent l’importance de tous les sujets mais ils se disent moins confiants dans leur capacité d’évaluer la prise du sein, de faire les interventions prénatales pour favoriser la lactogenèse et de prendre en charge la lactogenèse retardée. Les participants ont accordé relativement peu d’importance à l’apprentissage de l’évaluation de la prise du sein, malgré l’importance de cette compétence pour soutenir le démarrage précoce de l’allaitement

Besoins d’apprentissage des médecins de famille, des pédiatres et des obstétriciens pour les outiller à soutenir l’allaitement et pour mieux orienter leur formation

Background: Physicians require breastfeeding education appropriate to their roles. The aim of this survey was to determine physician learning needs and to inform development of breastfeeding education for physicians. Methods: A cross sectional survey was distributed to family physicians, pediatricians and obstetricians in a tertiary institution. Importance of knowledge to practice and confidence to manage was assessed for 18 learning topics proposed by a multi-specialty physician working group. Descriptive statistics, ANOVA and tests for equality of variances were calculated. Mean values of importance to practice and confidence to manage for each topic suggested learning priorities. Results: The study group included 75 physicians. The most important topics were “informed choice when supporting newborn feeding,” “analgesics, antidepressants and other medications while breastfeeding” and “community resources for breastfeeding support.”  Confidence to manage was lowest for “latch assessment,” “what mom can do during pregnancy to promote milk production,” and “risk factors for delayed lactogenesis.” Preferred learning formats were 15-minute online modules and grand rounds. Conclusions: Physicians acknowledged the importance of all topics but report lowest confidence to manage latch assessment, prenatal interventions to support lactogenesis and management of delayed lactogenesis.  Participants placed relatively low importance on learning about latch assessment despite the central nature of this skill in supporting early breastfeeding.Contexte : Les médecins ont besoin d’une formation sur l’allaitement adaptée à leur rôle. L’objectif de cette enquête était de contribuer à l’élaboration d’une telle formation en déterminant les besoins d’apprentissage des médecins dans ce domaine. Méthodes : Une enquête transversale a été réalisée auprès des médecins de famille, des pédiatres et des obstétriciens dans un établissement tertiaire. L’importance des connaissances pour la pratique et de la confiance envers la prise en charge a été évaluée pour 18 sujets d’apprentissage proposés par un groupe de travail de médecins de diverses spécialités. On a effectué des statistiques descriptives, une analyse de la variance et des tests de l’égalité des variances. Les valeurs moyennes de l’importance pour la pratique et de la confiance dans la prise en charge pour chaque sujet indiquent les priorités d’apprentissage. Résultats : Le groupe d’étude comprenait 75 médecins. Les sujets les plus importants étaient « le choix éclairé concernant l’alimentation du nouveau-né », « la prise d’analgésiques, d’antidépresseurs et d’autres médicaments pendant l’allaitement » et « les ressources communautaires de soutien à l’allaitement ». La confiance dans la prise en charge était la plus faible en ce qui concerne « l’évaluation de la prise du sein », « ce que la mère peut faire pendant la grossesse pour favoriser la production de lait » et « les facteurs de risque associés au retard de la lactogenèse ». Les formats d’apprentissage préférés étaient les modules en ligne de 15 minutes et les séances plénières. Conclusions : Les médecins reconnaissent l’importance de tous les sujets mais ils se disent moins confiants dans leur capacité d’évaluer la prise du sein, de faire les interventions prénatales pour favoriser la lactogenèse et de prendre en charge la lactogenèse retardée. Les participants ont accordé relativement peu d’importance à l’apprentissage de l’évaluation de la prise du sein, malgré l’importance de cette compétence pour soutenir le démarrage précoce de l’allaitement

Health-related quality of life in children and young adults with Marfan syndrome

Objective: To assess health-related quality of life (HRQOL) in a large multicenter cohort of children and young adults with Marfan syndrome participating in the Pediatric Heart Network Marfan Trial. Study design: The Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales were administered to 321 subjects with Marfan syndrome (5-25 years). PedsQL scores were compared with healthy population norms. The impact of treatment arm (atenolol vs losartan), severity of clinical features, and number of patient-reported symptoms on HRQOL was assessed by general linear models. Results: Mean PedsQL scores in children (5-18 years) with Marfan syndrome were lower than healthy population norms for physical (P <= .003) and psychosocial (P < .001) domains; mean psychosocial scores for adults (19-25 years) were greater than healthy norms (P < .001). HRQOL across multiple domains correlated inversely with frequency of patient-reported symptoms (r = 0.30-0.38, P < .0001). Those <18 years of age with neurodevelopmental disorders (mainly learning disability, attention-deficit/hyperactivity disorder) had lower mean PedsQL scores (5.5-7.4 lower, P < .04). A multivariable model found age, sex, patient-reported symptoms, and neurodevelopmental disorder to be independent predictors of HRQOL. There were no differences in HRQOL scores by treatment arm, aortic root z score, number of skeletal features. or presence of ectopia lentis. Conclusions: Children and adolescents with Marian syndrome were at high risk for impaired HRQOL. Patient-reported symptoms and neurodevelopmental disorder. but not treatment arm or severity of Marian syndrome-related physical findings, were associated with lower HRQOL