Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder (PTSD). This study examined the role of health practitioner support and personal control during birth as predictors of PTS symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms. Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, three-weeks and three-months after the birth. Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (beta = -.41, R2 = 16%) at both three-weeks and three-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms three-months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention. Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer-term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth

Evaluation of changes in postnatal care using the "Parents' Postnatal Sense of Security" instrument and an assessment of the instrument's reliability and validity

<p>Abstract</p> <p>Background</p> <p>A sense of security is important for experiences of parenthood in the early postpartum period. The objectives of this study were to evaluate two models of postnatal care using a questionnaire incorporating the Parents' Postpartum Sense of Security (<it>PPSS</it>) instrument and to test the validity of the <it>PPSS </it>instrument.</p> <p>Methods</p> <p>Postal surveys were sent to 234 mothers who had experienced two different forms of postnatal care (study group and control group) and returned by 86.8%. These two groups of mothers were compared for total scores on the <it>PPSS </it>instrument. Demographic variables and mothers' opinions about care interventions were also compared and these variables were tested for correlations with the total <it>PPSS </it>score. A regression analysis was carried out to assess areas of midwifery care which might affect a sense of security. The internal consistency and concurrent validity of the instrument were tested for the total population.</p> <p>Results</p> <p>there were no significant differences between the groups for scores on the <it>PPSS </it>instrument. A total of three variables predicted 26% of the variability on the <it>PPSS </it>scores for the study group and five variables predicted 37% of the variability in the control group. One variable was common to both: "<it>The midwives on the postnatal ward paid attention to the mother as an individual"</it>. There were significant correlations between the total <it>PPSS </it>scores and scores for postpartum talks and visits to the breastfeeding clinic. There was also a significant correlation between the single question: "<it>I felt secure during the first postpartum week</it>" and the total <it>PPSS </it>score. Tests for internal consistency and concurrent validity were satisfactory.</p> <p>Conclusion</p> <p>The proposed new model of care neither improved nor impaired mothers' feelings of security the week following birth. Being seen as an individual by the midwife who provides postnatal care may be an important variable for mothers' sense of postnatal security. It is possible that postpartum talks may encourage the processing of childbirth experiences in a positive direction. Availability of breastfeeding support may also add to a sense of security postpartum. The <it>PPSS </it>instrument has shown acceptable reliability and validity.</p

Identifying patterns of alumni commitment in key strategic relationship programmes

Higher education institutions (HEIs) need to understand their alumni when drawing strategic relationship programmes. This paper aims to identify clusters of alumni based on their commitment relationship and to analyse factors influencing their intention to collaborate with the HEI. The study took place at a Portuguese university, considering a dataset of 1075 of alumni asserting intention to collaborate. First, a cluster analysis was conducted to identify patterns of commitment relationship. Secondly, a logistic regression was run to identify determinants of intention to collaborate. Both techniques revealed the decisive role of HEI commitment in the process. Relationship advantages and positive feelings towards the HEI were also pointed out as important. Alumni asserted recommendations, further training, sharing experiences and giving help as ways to collaborate with HEI. Regression results suggest that sociodemographic variables such as gender, marital status and volunteering are significantly associated with a probability to collaborate. Results also show that affiliation in sororities/fraternities and participation in extracurricular activities are significantly associated with that collaborative intention. The findings provide clues to support strategic relationship programmes based on consistent marketing campaigns, while bringing value to the literature in the European context, where alumni culture requires real insights to evolve.info:eu-repo/semantics/publishedVersio

Gastrointestinal malformations: impact of prenatal diagnosis on gestational age at birth.

The aim of the study was to analyse the degree to which gestational age (GA) has been shortened due to prenatal diagnosis of gastrointestinal malformations (GIM). The data source for the study was 14 population-based registries of congenital malformations (EUROCAT). All liveborn infants with GIMs and without chromosomal anomalies, born 1997-2002, were included. The 14 registries identified 1047 liveborn infants with one or more GIMs (oesophageal atresia, duodenal atresia, omphalocele, gastroschisis and diaphragmatic hernia). Median GA at birth was lower in prenatally diagnosed cases for all five malformations, although not statistically significant for gastroschisis. There was little difference in median birthweight by GA for the pre- and postnatally diagnosed infants. The difference in GA at birth between prenatally and postnatally diagnosed infants with GIMs is enough to increase the risk of mortality for the prenatally diagnosed infants. Clinicians need to balance the risk of early delivery against the benefits of clinical convenience when making case management decisions after prenatal diagnosis. Very few studies have been able to show benefits of prenatal diagnosis of congenital malformations for liveborn infants. This may be because the benefits of prenatal diagnosis are outweighed by the problems arising from a lower GA at birth

The effect of postnatal symptoms of post-traumatic stress and depression on the couple's relationship and parent-baby bond

Objectives: Research has shown that between 1 and 3% of women may suffer from post-traumatic stress disorder (PTSD) following childbirth. However, the potential effect of childbirth on fathers, and the implications of post-natal symptoms of PTSD for family relationships, have received little attention. The current study therefore examined the potential effects of PTSD symptoms on the couple's relationship and parent-baby bond. Design: Internet-based questionnaire study. Methods: One hundred and fifty-two parents (126 women and 26 men) completed questionnaire measures of PTSD, depression, quality of the couple's relationship, and the parent-baby bond. Results: Symptoms of PTSD and depression were significantly correlated with the couples' relationship and parent-baby bond. Structural equation modelling found the model that best fitted the data was one where PTSD symptoms had a direct effect on the parent-baby bond, but the effect of PTSD on the couples' relationship was mediated by depression. Conclusions: The results indicate the importance of examining the psychological reactions of men and women after birth; and suggest that symptoms of PTSD have an effect on the parent-baby bond. However, methodological considerations mean further research is needed to replicate and extend this study before firm conclusions can be drawn