Postnatal infant crying and maternal tiredness : examining their evolution and interaction in the first 12 weeks postpartum

A new mother lazing in childbed is a blessing for her family” is an old Swiss proverb. Maternal rest and recuperation after birth was a common concern in the past and was frequently supported by the extended family. However, mothers today barely enjoy restful days after birth; instead they enter directly into the challenge of combining baby- and selfcare. They often struggle to soothe a crying baby, while coping with their own exhaustion, which can adversely affect family health. Surveys on maternal health consistently report tiredness and fatigue as the most frequent complaint postpartum, affecting 46%-87% of new mothers [1, 2]. Inconsolable infant crying is the most cited reason why parents consult health professionals [3]. To date little is known on how mothers confront and handle these challenges after birth. Routine postnatal care lacks effective strategies to alleviate the burden of infant crying and maternal tiredness which can adversely affect family health in the earliest stage. Following the traditional division between neonatal and maternal healthcare, research has usually focussed on conditions affecting either the mother or the neonate, but little attention has been given to the interplay of infant crying and maternal tiredness. While maternal tiredness after birth can be seen as normal reaction to the efforts of gestation and birth [4], maternal fatigue is more severe than tiredness, and can be defined as imbalance of activity and rest [5]. Whereas tiredness is naturally relieved in the circadian rhythm by periods of sleep, fatigue persists through the circadian rhythm, cannot be relieved through a single period of sleep, and is accompanied with a negative feeling [6]. Fatigue hampers the well-being of the affected person and is known as risk factor for the development of postpartum depression [7] and for a slightly less optimal development of the infants’ fine motor and coordinative skills [8]. Postnatal infant crying is currently regarded as a normal part of a child’s neuro-behavioural development following a typical curve which peaks during the sixth week postpartum at nearly 3 hours crying per day, and declines to below 1 hour per day by 12 weeks of age, with large inter-individual variation [9, 10]. Excessive crying is usually defined by ‘Wessel’s rule of three’. It lasts more than 3 hours on more than 3 days per week, and recurs for more than 3 weeks [3, 11]. Such crying behaviour is a known risk factor for the development of maternal postpartum depression, dysfunctional parent-child relation and, in extreme cases, for shaken baby syndrome or other forms of child abuse [12-14]. Our interest in the present research project was not limited to the pathologic forms of maternal fatigue and excessive crying, but embraced the entire continuum from physiologic maternal tiredness to fatigue, and from normal to excessive infant crying. If healthcare is to address the prominent concerns of parents caring for a neonate, we need a deeper understanding of how infant crying and maternal tiredness develop and interact, and what support new parents need to overcome these early challenges to family health. The aim of this study was therefore to explore the evolution and interaction of postnatal infant crying and maternal tiredness. Understanding these interactions could hold potential to develop evidence based interventions to enhance the adaptive circularity of infant soothing and maternal recovery, and to prevent a vicious circle of infant crying and maternal fatigue and its’ adverse effects on family health. A mixed methods approach was used, which combined qualitative and quantitative methods for data collection and analysis. We first conducted a systematic review to synthesize the evidence on the interconnectedness of infant crying and maternal tiredness in the first three months postpartum. Both quantitative and qualitative studies were included. Evidence from this review showed that infant crying was related to the experience of tiredness and/or fatigue in new mothers. Whereas the included quantitative studies mainly implied that infant crying was a predictor of maternal tiredness, the qualitative studies also depicted how maternal tiredness can negatively impact a mother’s capacity to respond to her child’s needs. We concluded that the interconnectedness of infant crying and maternal tiredness is a cyclical process. Second, we conducted a case control study to analyse socio-demographic, reproductive-maternal, and neonatal predictors of crying problems as reported by midwives conducting postnatal home care. We found that the interconnectedness of maternal conditions and infant crying was already evident in the immediate postpartum period, as maternal distress during the first ten days after birth was strongly associated with reports of crying problems. Finally, we added the perspective of new mothers’ lived experiences by conducting a longitudinal qualitative study that used an interpretive phenomenological approach. Mothers’ accounts indicated that their personal beliefs about beneficial childcare practices shaped the way they combined newborn and self-care and how they handled conflicting needs in the context of changing postnatal care practices. Synthesizing the findings of the three studies yields the following key aspects which contribute to the current state of knowledge: The interconnectedness of postnatal infant crying and maternal tiredness cannot be fully explained by a unidirectional cause-effect relationship. The complexity of this interplay is better understood as a cyclical process embracing reciprocal influences of maternal and infant factors, which are embedded and shaped by the specific family, healthcare, socio-cultural and political context. Conditions which add to new mothers’ stress appear to have a deteriorating effect on early infant crying problems. Potential sources of stress included maternal mood states, physical health problems, and social conditions (i.e. immigrant status or plans to resume paid work directly after the paid maternity leave of 14 weeks). The strongest protective factor for reported crying problems was having more than one child. According to the mothers’ accounts, they acquired experience in response to crying in a multi-dimensional learning process. During this process mothers’ attitudes and skills changed in a way which promoted a calmer and de-escalating response to infant crying. A novel and surprising finding was how the women’s personal beliefs about beneficial childcare practices shaped the way they cared for the newborn and their own needs after birth. These beliefs reflected the ongoing discourse on beneficial child rearing practices over the last decades, and ranged from an infant-centred approach focused on the infant’s development of a basic sense of trust, to an approach aimed at balancing infants’ demands with own needs. According to their beliefs, mothers differed in their willingness to minimize their own needs for the child’s sake, what influenced their opportunities to rest, and could mitigate or contribute to maternal tiredness and exhaustion. Health professionals’ support played an important role in how mothers managed to combine baby- and self-care. Some mothers experienced care attuned to their and their child’s needs, which reduced stress and enhanced their well-being. Others experienced care following a professional agenda even though it conflicted with their specific needs, producing frustration and increasing maternal stress. Balancing of infant’s and maternal needs was especially delicate when unsettled babies impeded maternal sleep at night during the postpartum hospital stay. Whereas some professionals showed empathy and offered the mother respite from child care, others appeared to expect mothers to take care of her baby alone. This approach could contribute to maternal sleep deprivation and exhaustion. Based on the findings of this research project, we propose a conceptual model which situates the interplay of postnatal infant crying and maternal tiredness as embedded in and influenced by the socio-cultural and political contexts (see p. 100/101). Changing discourses on beneficial childcare and policies that regulate maternity and family leave appear to have a clear impact on the strategies and resources of the involved persons. The support of the family and professional caregivers can strengthen adaptive dynamics of infant soothing and maternal repose when all the actors (i.e. the newborn, the mother, family members and health professionals) are attuned to each other’s needs and abilities. Mothers’ prior experience with infant care is an additional resource to sustain adaptive dynamics. However, lack of family and professional support and diminished attunement constitute a risk for the adaptive circularity of infant soothing and maternal repose, and can fuel a vicious circle of increased crying and maternal fatigue. This comprehensive conceptual model can be used as a guiding framework to plan both research and interventions at the micro-, meso-, and macro-levels of maternal and child healthcare. Areas of interest embrace direct clinical practice and postnatal care policies, cultural perceptions of child care, and politics and laws affecting motherhood and early family life. Future research should surmount the traditional division between women’s and child health, scrutinize maternal, neonatal and paternal needs after birth, and consider the family as unit of interest. Furthermore, research should evaluate individualized and family-friendly forms of care provision, and investigate the impact of socio-cultural and political conditions on family health after birth. Analogously, interventions have to target different levels. Campaigns and publicity aimed at enhancing public awareness of health needs in the postpartum period are needed to re-establish social conditions which enable adequate rest and repose for new mothers. Initiatives to extend paid maternity and family leaves would further strengthen conditions which are conducive for early family health. On the level of care provision the challenge is to develop new models of care which are responsive to families’ postnatal needs of individualized care. Working in such care setting should prepare and enable nurses and midwives to provide care, which is attuned to the mother’s, the newborn’s and the family’s current situation. Such care has the potential to reduce the stress of families who care for their newborn child after birth, to mitigate early crying problems and maternal tiredness, and thereby, to protect and promote family health from the earliest stage

Postnatal infant crying and maternal tiredness : examining their evolution and interaction in the first 12 weeks postpartum

A new mother lazing in childbed is a blessing for her family” is an old Swiss proverb. Maternal rest and recuperation after birth was a common concern in the past and was frequently supported by the extended family. However, mothers today barely enjoy restful days after birth; instead they enter directly into the challenge of combining baby- and selfcare. They often struggle to soothe a crying baby, while coping with their own exhaustion, which can adversely affect family health. Surveys on maternal health consistently report tiredness and fatigue as the most frequent complaint postpartum, affecting 46%-87% of new mothers [1, 2]. Inconsolable infant crying is the most cited reason why parents consult health professionals [3]. To date little is known on how mothers confront and handle these challenges after birth. Routine postnatal care lacks effective strategies to alleviate the burden of infant crying and maternal tiredness which can adversely affect family health in the earliest stage. Following the traditional division between neonatal and maternal healthcare, research has usually focussed on conditions affecting either the mother or the neonate, but little attention has been given to the interplay of infant crying and maternal tiredness. While maternal tiredness after birth can be seen as normal reaction to the efforts of gestation and birth [4], maternal fatigue is more severe than tiredness, and can be defined as imbalance of activity and rest [5]. Whereas tiredness is naturally relieved in the circadian rhythm by periods of sleep, fatigue persists through the circadian rhythm, cannot be relieved through a single period of sleep, and is accompanied with a negative feeling [6]. Fatigue hampers the well-being of the affected person and is known as risk factor for the development of postpartum depression [7] and for a slightly less optimal development of the infants’ fine motor and coordinative skills [8]. Postnatal infant crying is currently regarded as a normal part of a child’s neuro-behavioural development following a typical curve which peaks during the sixth week postpartum at nearly 3 hours crying per day, and declines to below 1 hour per day by 12 weeks of age, with large inter-individual variation [9, 10]. Excessive crying is usually defined by ‘Wessel’s rule of three’. It lasts more than 3 hours on more than 3 days per week, and recurs for more than 3 weeks [3, 11]. Such crying behaviour is a known risk factor for the development of maternal postpartum depression, dysfunctional parent-child relation and, in extreme cases, for shaken baby syndrome or other forms of child abuse [12-14]. Our interest in the present research project was not limited to the pathologic forms of maternal fatigue and excessive crying, but embraced the entire continuum from physiologic maternal tiredness to fatigue, and from normal to excessive infant crying. If healthcare is to address the prominent concerns of parents caring for a neonate, we need a deeper understanding of how infant crying and maternal tiredness develop and interact, and what support new parents need to overcome these early challenges to family health. The aim of this study was therefore to explore the evolution and interaction of postnatal infant crying and maternal tiredness. Understanding these interactions could hold potential to develop evidence based interventions to enhance the adaptive circularity of infant soothing and maternal recovery, and to prevent a vicious circle of infant crying and maternal fatigue and its’ adverse effects on family health. A mixed methods approach was used, which combined qualitative and quantitative methods for data collection and analysis. We first conducted a systematic review to synthesize the evidence on the interconnectedness of infant crying and maternal tiredness in the first three months postpartum. Both quantitative and qualitative studies were included. Evidence from this review showed that infant crying was related to the experience of tiredness and/or fatigue in new mothers. Whereas the included quantitative studies mainly implied that infant crying was a predictor of maternal tiredness, the qualitative studies also depicted how maternal tiredness can negatively impact a mother’s capacity to respond to her child’s needs. We concluded that the interconnectedness of infant crying and maternal tiredness is a cyclical process. Second, we conducted a case control study to analyse socio-demographic, reproductive-maternal, and neonatal predictors of crying problems as reported by midwives conducting postnatal home care. We found that the interconnectedness of maternal conditions and infant crying was already evident in the immediate postpartum period, as maternal distress during the first ten days after birth was strongly associated with reports of crying problems. Finally, we added the perspective of new mothers’ lived experiences by conducting a longitudinal qualitative study that used an interpretive phenomenological approach. Mothers’ accounts indicated that their personal beliefs about beneficial childcare practices shaped the way they combined newborn and self-care and how they handled conflicting needs in the context of changing postnatal care practices. Synthesizing the findings of the three studies yields the following key aspects which contribute to the current state of knowledge: The interconnectedness of postnatal infant crying and maternal tiredness cannot be fully explained by a unidirectional cause-effect relationship. The complexity of this interplay is better understood as a cyclical process embracing reciprocal influences of maternal and infant factors, which are embedded and shaped by the specific family, healthcare, socio-cultural and political context. Conditions which add to new mothers’ stress appear to have a deteriorating effect on early infant crying problems. Potential sources of stress included maternal mood states, physical health problems, and social conditions (i.e. immigrant status or plans to resume paid work directly after the paid maternity leave of 14 weeks). The strongest protective factor for reported crying problems was having more than one child. According to the mothers’ accounts, they acquired experience in response to crying in a multi-dimensional learning process. During this process mothers’ attitudes and skills changed in a way which promoted a calmer and de-escalating response to infant crying. A novel and surprising finding was how the women’s personal beliefs about beneficial childcare practices shaped the way they cared for the newborn and their own needs after birth. These beliefs reflected the ongoing discourse on beneficial child rearing practices over the last decades, and ranged from an infant-centred approach focused on the infant’s development of a basic sense of trust, to an approach aimed at balancing infants’ demands with own needs. According to their beliefs, mothers differed in their willingness to minimize their own needs for the child’s sake, what influenced their opportunities to rest, and could mitigate or contribute to maternal tiredness and exhaustion. Health professionals’ support played an important role in how mothers managed to combine baby- and self-care. Some mothers experienced care attuned to their and their child’s needs, which reduced stress and enhanced their well-being. Others experienced care following a professional agenda even though it conflicted with their specific needs, producing frustration and increasing maternal stress. Balancing of infant’s and maternal needs was especially delicate when unsettled babies impeded maternal sleep at night during the postpartum hospital stay. Whereas some professionals showed empathy and offered the mother respite from child care, others appeared to expect mothers to take care of her baby alone. This approach could contribute to maternal sleep deprivation and exhaustion. Based on the findings of this research project, we propose a conceptual model which situates the interplay of postnatal infant crying and maternal tiredness as embedded in and influenced by the socio-cultural and political contexts (see p. 100/101). Changing discourses on beneficial childcare and policies that regulate maternity and family leave appear to have a clear impact on the strategies and resources of the involved persons. The support of the family and professional caregivers can strengthen adaptive dynamics of infant soothing and maternal repose when all the actors (i.e. the newborn, the mother, family members and health professionals) are attuned to each other’s needs and abilities. Mothers’ prior experience with infant care is an additional resource to sustain adaptive dynamics. However, lack of family and professional support and diminished attunement constitute a risk for the adaptive circularity of infant soothing and maternal repose, and can fuel a vicious circle of increased crying and maternal fatigue. This comprehensive conceptual model can be used as a guiding framework to plan both research and interventions at the micro-, meso-, and macro-levels of maternal and child healthcare. Areas of interest embrace direct clinical practice and postnatal care policies, cultural perceptions of child care, and politics and laws affecting motherhood and early family life. Future research should surmount the traditional division between women’s and child health, scrutinize maternal, neonatal and paternal needs after birth, and consider the family as unit of interest. Furthermore, research should evaluate individualized and family-friendly forms of care provision, and investigate the impact of socio-cultural and political conditions on family health after birth. Analogously, interventions have to target different levels. Campaigns and publicity aimed at enhancing public awareness of health needs in the postpartum period are needed to re-establish social conditions which enable adequate rest and repose for new mothers. Initiatives to extend paid maternity and family leaves would further strengthen conditions which are conducive for early family health. On the level of care provision the challenge is to develop new models of care which are responsive to families’ postnatal needs of individualized care. Working in such care setting should prepare and enable nurses and midwives to provide care, which is attuned to the mother’s, the newborn’s and the family’s current situation. Such care has the potential to reduce the stress of families who care for their newborn child after birth, to mitigate early crying problems and maternal tiredness, and thereby, to protect and promote family health from the earliest stage

Safe start at home : what parents of newborns need after early discharge from hospital - a focus group study

The length of postpartum hospital stay is decreasing internationally. Earlier hospital discharge of mothers and newborns decreases postnatal care or transfers it to the outpatient setting. This study aimed to investigate the experiences of new parents and examine their views on care following early hospital discharge.; Six focus group discussions with new parents (n = 24) were conducted. A stratified sampling scheme of German and Turkish-speaking groups was employed. A 'playful design' method was used to facilitate participants communication wherein they used blocks and figurines to visualize their perspectives on care models The visualized constructions of care models were photographed and discussions were audio-recorded and transcribed verbatim. Text and visual data was thematically analyzed by a multi-professional group and findings were validated by the focus group participants.; Following discharge, mothers reported feeling physically strained during recuperating from birth and initiating breastfeeding. The combined requirements of infant and self-care needs resulted in a significant need for practical and medical support. Families reported challenges in accessing postnatal care services and lacking inter-professional coordination. The visualized models of ideal care comprised access to a package of postnatal care including monitoring, treating and caring for the health of the mother and newborn. This included home visits from qualified midwives, access to a 24-h helpline, and domestic support for household tasks. Participants suggested that improving inter-professional networks, implementing supervisors or a centralized coordinating center could help to remedy the current fragmented care.; After hospital discharge, new parents need practical support, monitoring and care. Such support is important for the health and wellbeing of the mother and child. Integrated care services including professional home visits and a 24-hour help line may help meet the needs of new families

Does coordinated postpartum care influence costs?

Questions under study: To investigate changes to health insurance costs for post-discharge postpartum care after the introduction of a midwife-led coordinated care model. Methods: The study included mothers and their newborns insured by the Helsana health insurance group in Switzerland and who delivered between January 2012 and May 2013 in the canton of Basel Stadt (BS) (intervention canton). We compared monthly post-discharge costs before the launch of a coordinated postpartum care model (control phase, n = 144) to those after its introduction (intervention phase, n = 92). Costs in the intervention canton were also compared to those in five control cantons without a coordinated postpartum care model (cross-sectional control group: n = 7, 767). Results: The average monthly post-discharge costs for mothers remained unchanged in the seven months following the introduction of a coordinated postpartum care model, despite a higher use of midwife services (increasing from 72% to 80%). Likewise, monthly costs did not differ between the intervention canton and five control cantons. In multivariate analyses, the ambulatory costs for mothers were not associated with the post-intervention phase. Cross-sectionally, however, they were positively associated with midwifery use. For children, costs in the post-intervention phase were lower in the first month after hospital discharge compared to the pre-intervention phase (difference of –114 CHF [95%CI –202 CHF to –27 CHF]), yet no differences were seen in the cross-sectional comparison. Conclusions: The introduction of a coordinated postpartum care model was associated with decreased costs for neonates in the first month after hospital discharge. Despite increased midwifery use, costs for mothers remained unchanged

Crying babies, tired mothers - challenges of the postnatal hospital stay: an interpretive phenomenological study

ABSTRACT: BACKGROUND: According to an old Swiss proverb, 'a new mother lazing in childbed is a blessing to her family'. Today mothers rarely enjoy restful days after birth, but enter directly into the challenge of combining baby- and self-care. They often face a combination of infant crying and personal tiredness. Yet, routine postnatal care often lacks effective strategies to alleviate these challenges which can adversely affect family health. We explored how new mothers experience and handle postnatal infant crying and their own tiredness in the context of changing hospital care practices in Switzerland. METHODS: Purposeful sampling was used to enroll 15 mothers of diverse parity and educational backgrounds, all of who had given birth to a full term healthy neonate. Using interpretive phenomenology, we analyzed interview and participant observation data collected during the postnatal hospital stay and at 6 and 12 weeks post birth. This paper reports on the postnatal hospital experience. RESULTS: Women's personal beliefs about beneficial childcare practices shaped how they cared for their newborn's and their own needs during the early postnatal period in the hospital. These beliefs ranged from an infant-centered approach focused on the infant's development of a basic sense of trust to an approach that balanced the infants' demands with the mother's personal needs. Getting adequate rest was particularly difficult for mothers striving to provide infant-centered care for an unsettled neonate. These mothers suffered from sleep deprivation and severe tiredness unless they were able to leave the baby with health professionals for several hours during the night. CONCLUSION: New mothers often need permission to attend to their own needs, as well as practical support with childcare to recover from birth especially when neonates are fussy. To strengthen family health from the earliest stage, postnatal care should establish conditions which enable new mothers to balanc the care of their infant with their own need

Telefondolmetschen in der geburtshilflichen Nachbetreuung von fremdsprachigen Migrantinnen durch Hebammen zu Hause

Perinatal health disadvantage of migrants is exacerbated in presence of language barriers. Interpreting has the potential to optimize both, communication and outcome of mother and child. In Switzerland, a regional midwifery network provides access to telephone interpreting services although it is not remunerated by health insurances, and thus, is often impeded. This study examined usefulness, areas of use and difficulties of telephone interpreting in home postpartum care by midwives. Data was collected between September 2013 and March 2016 by midwives of the network. The questionnaire contained multiple- choice questions, a visual analogue scale and free-text fields. 46 questionnaires were evaluated. 10 out of 29 specially trained midwives exerted the service. Telephone interpreting was primarily used to record women’s concerns and provide information. The main topics were the somatic health of mother and child, breastfeeding, and more rarely psychosocial issues and information on care provision. Achieved understanding, increased women’s satisfaction and improved health competence were the perceived advantages in using the service. Difficulties, especially with the extra time needed for the consultation, insufficient telephone connection and professionality of the telephone interpreter, were stated less often. Overall, the midwives estimated the benefits of telephone interpreting for the quality of care with 7.4 out of 10 possible points. Although telephone interpreting improved the quality of care, midwives did infrequently use it. Specific training and video interpreting have the potential to increase the quality of the interpreted conversations and to minimize possible hurdles. Psychosocial issues should be addressed more intensively.Die gesundheitliche Benachteiligung von Migrantinnen in der geburtshilflichen Versorgung verschärft sich, wenn Sprachbarrieren vorliegen. Dolmetschen optimiert die Verständigung und das Outcome von Mutter und Kind, ist aber für viele Fachpersonen und Migrantinnen unzugänglich. Ein regionales Hebammennetzwerk stellt die in der Schweiz nicht krankenkassenpflichtigen Telefondolmetschdienste zur Verfügung. In dieser Untersuchung wurden der von Hebammen wahrgenommene Nutzen, die Einsatzbereiche und Schwierigkeiten des Telefondolmetschens im Rahmen der häuslichen Wochenbettnachsorge untersucht. Die Daten wurden bei jedem gedolmetschten Gespräch zwischen September 2013 und März 2016 durch die Hebammen des Netzwerkes erhoben. Der Fragebogen enthielt deskriptiv analysierte Fragen mit Mehrfachantworten, eine Frage mit visueller Analogskala sowie Freitextfelder. Insgesamt wurden 46 Fragebogen ausgewertet. Zehn von 29 eigens dazu geschulte Hebammen nutzten den Telefondolmetschdienst, und zwar vorwiegend zur Erfassung der Anliegen der Frau und zur Vermittlung von Informationen. Thema waren vor allem die somatische Gesundheit von Mutter und Kind und das Stillen, seltener die psychosoziale Situation und Informationen zu Versorgungsangeboten. Die erreichte Verständigung, die Zufriedenheit der Klientin und eine Verbesserung der Gesundheitskompetenz wurden als Vorteile gesehen. Schwierigkeiten, insbesondere mit dem zusätzlichen Zeitaufwand, der Telefonverbindungsqualität und der Qualität der Übersetzung, wurden seltener erlebt. Insgesamt schätzten die Hebammen den Nutzen des Telefondolmetschens für die Betreuungsqualität mit 7,4 von 10 möglichen Punkten ein. Obschon Telefondolmetschen die Qualität der Versorgung verbessert, wurde es von den Hebammen verhältnismässig wenig genutzt. Schulungen und möglicherweise Videodolmetschen haben das Potenzial, die Qualität der gedolmetschten Gespräche zu erhöhen und mögliche Hürden bei der Anwendung zu minimieren. Psychosoziale Themen sollten vermehrt besprochen werden

Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters

To describe communication barriers faced by allophone migrant women in maternity care provision from the perspectives of migrant women, healthcare professionals, and intercultural interpreters.; Perinatal health inequality of migrant women hinges on barriers to services, with a major barrier being language. Their care is often also perceived as demanding due to conflicting values or complex situations. Potentially divergent perceptions of users and providers may hinder efficient communication.; Qualitative explorative study.; A convenience sample of 36 participants was recruited in the German speaking region of Switzerland. The sample consisted of four Albanian and six Tigrinya speaking women, 22 healthcare professionals and four intercultural interpreters (March-June 2016) who participated in three focus group discussions and seven semi-structured interviews. Audio recordings of the discussions and interviews were transcribed and thematically analysed.; The analysis revealed three main themes: the challenge of understanding each other's world, communication breakdowns and imposed health services. Without interpretation communication was reduced to a bare minimum and thus insufficient to adequately inform women about treatment and address their expectations and needs.; A primary step in dismantling barriers is guaranteed intercultural interpreting services. Additionally, healthcare professionals need to continuously develop and reflect on their transcultural communication. Institutions must enable professionals to respond flexibly to allophone women's needs and to offer care options that are safe and in accordance to their cultural values.; Our results give the foundation of tenable care of allophonic women and emphasize the importance of linguistic understanding in care quality

A spastic paraplegia mouse model reveals REEP1-dependent ER shaping

Axonopathies are a group of clinically diverse disorders characterized by the progressive degeneration of the axons of specific neurons. In hereditary spastic paraplegia (HSP), the axons of cortical motor neurons degenerate and cause a spastic movement disorder. HSP is linked to mutations in several loci known collectively as the spastic paraplegia genes (SPGs). We identified a heterozygous receptor accessory protein 1 (REEP1) exon 2 deletion in a patient suffering from the autosomal dominantly inherited HSP variant SPG31. We generated the corresponding mouse model to study the underlying cellular pathology. Mice with heterozygous deletion of exon 2 in Reep1 displayed a gait disorder closely resembling SPG31 in humans. Homozygous exon 2 deletion resulted in the complete loss of REEP1 and a more severe phenotype with earlier onset. At the molecular level, we demonstrated that REEP1 is a neuron-specific, membrane-binding, and membrane curvature-inducing protein that resides in the ER. We further show that Reep1 expression was prominent in cortical motor neurons. In REEP1-deficient mice, these neurons showed reduced complexity of the peripheral ER upon ultrastructural analysis. Our study connects proper neuronal ER architecture to long-term axon survival