Effectiveness of Discharge Education on Postpartum Depression.

PURPOSE: To determine effectiveness of an educational intervention in reducing or preventing symptoms of postpartum depression (PPD). STUDY DESIGN AND METHODS: English-speaking women age 18 or older with a singleton, term, healthy newborn were recruited from an 11-bed maternity unit in Southern New Hampshire. Using a quasi-experimental design, the first 120 respondents received usual care (control), and the following 120 respondents received the education (treatment) including PPD predictors, symptoms, prevention, and management. Current risk factors were measured using the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Symptoms of depression were measured using the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks, 3 months, and 6 months postpartum. Two-proportion z-tests were used to determine whether the education had a significant impact on EPDS scores at each of the three follow-ups. RESULTS: There was no significant difference in symptoms of depression as measured by the EPDS between the treatment and control group at 6 weeks, 3 months, or 6 months postpartum. However, consistent with previous studies, low socioeconomic status and a history of depression or anxiety prior to or during the pregnancy were significant predictors of PPD. CLINICAL IMPLICATIONS: Postpartum nursing discharge education did not decrease depression symptoms up to 6 months after discharge. More research is needed to determine the most appropriate timing and content of education about PPD. Many women at risk can be identified prior to birth. Education to improve literacy about PPD may need to be provided prenatally and reinforced during postpartum hospitalization and after discharge.

Employment and breastfeeding outcomes in a sample of black women in the United States.

Black women have lower rates of breastfeeding initiation and duration than other racial groups have, but the effects of employment on breastfeeding, specifically for Black women, have not been studied extensively. The purpose of this research was to determine the influence of work or maternity leave on breastfeeding duration in a sample of Black women. Participants were recruited in the first postpartum week, and then followed monthly for six months or until complete weaning. The timing of returning to work significantly influenced the risk of weaning. Women who returned to work prior to 12 weeks were more likely to wean their babies than both those who returned to work after 12 weeks as well as those who remained at home. Policies that allow for at least 12 weeks' maternity leave would be likely to increase breastfeeding duration for employed Black women. Interdisciplinary research is needed to address health and economic issues of maternity leave and to eliminate racial disparities.

Psychometric testing of the Breastfeeding Self-Efficacy Scale-Short Form in a sample of Black women in the United States.

The benefits of breastfeeding increase with duration and exclusivity, but significant racial disparities exist in breastfeeding rates. Breastfeeding self-efficacy, as measured by the Breastfeeding Self-Efficacy Scale Short-Form (BSES-SF), is a significant predictor of breastfeeding outcomes in diverse samples. The purpose of this study was to assess the psychometric properties of the BSES-SF in Black women in the US. The psychometric characteristics were consistent with previous studies, including internal consistency, comparison with contrasted groups, and correlation with the construct of breastfeeding network support. Breastfeeding self-efficacy significantly predicted breastfeeding at 4 and 24 weeks postpartum. The results are consistent with previous research, and they suggest the BSES-SF could be used to identify women at risk for prematurely discontinuing breastfeeding.

Breastfeeding self-efficacy in women of African descent.

OBJECTIVE: To determine whether breastfeeding self-efficacy predicts the duration and pattern of breastfeeding in a sample of Black women of African descent. DESIGN: Descriptive, longitudinal, cohort study. Participants were recruited during the postpartum hospitalization and followed monthly for 6 months or until complete weaning. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale--Short Form (BSES-SF) (Dennis, 2003). SETTING: A large urban teaching hospital in New England. PATIENTS/PARTICIPANTS: Women who self-identified as being of African descent with full-term infants who were planning to breastfeed (N=125). MAIN OUTCOME MEASURES: Breastfeeding pattern was determined by the total number of feedings the infant received in the past 24 hours and how many of these were breast milk. Duration of breastfeeding was defined as the number of weeks until complete weaning. RESULTS: Higher levels of breastfeeding self-efficacy predicted longer duration and a more exclusive pattern of breastfeeding at 1 and 6 months postpartum, consistent with prior research (p<.01). Planned pattern of feeding predicted actual pattern of feeding at 1 month postpartum (p<.01). Returning to work after 12 weeks was protective of breastfeeding to 6 months postpartum (p<.01). CONCLUSION: Theory-based interventions to enhance self-efficacy will help improve breastfeeding outcomes.

Is breastfeeding fair? Tensions in feminist perspectives on breastfeeding and the family.

Breastfeeding is widely acknowledged to have health benefits for mothers and infants. Because it is sex-specific, it challenges the feminist principle of gender-neutral childbearing. Various feminist theories addressing breastfeeding from the perspective of gender ideology, cultural feminism, and history are reviewed and contrasted. Employment and race disparities are addressed within feminist contexts. Feminist health activism is suggested as a unifying perspective.

How does postpartum depression affect breastfeeding?

PURPOSE: To examine patterns of exclusive breastfeeding, combination feeding, and exclusive bottle-feeding among a sample of women identified at 2-4 weeks postpartum with positive PPD symptoms. STUDY DESIGN AND METHODS: The sample included 122 women who were part of a larger study testing an intervention for promoting maternal-infant interaction among women with elevated PPD symptoms. Data were collected during three postpartum home visits. Demographic and feeding pattern data were described. Variables related to and predictors of feeding pattern were analyzed. The sample was compared to a random sample of postpartum women in New England. RESULTS: Severity of depression was not significantly related to breastfeeding. Older maternal age, living with a partner, and higher income were positively related to breastfeeding. Compared to a random sample, the level of exclusive breastfeeding was significantly lower in this sample than the level of combination feeding. CLINICAL IMPLICATIONS: Nurses should be involved in screening all prenatal and postpartum women for PPD symptoms, particularly when they present with breastfeeding difficulties, and refer for treatment when appropriate. For breastfeeding mothers, PPD treatment must include consideration of therapeutic options as well as implications for the breastfeeding relationship. When appropriate treatment for PPD is being considered, thought should be given to the importance and value of breastfeeding to the mother.

Medications in pregnancy and lactation.

The issue of medication use during pregnancy is of concern because the physiology of pregnancy affects the pharmokinetics of medications used, and certain medications can reach the fetus and cause harm. Studying medication safety in pregnancy and lactation is challenging; thus, the U.S. Food and Drug Administration (FDA) categories of medication risk in pregnancy are limited, especially for the lactating mother. A better understanding of the role of physiologic changes in pregnancy, placental function, effects of medication on the fetus, and the mechanisms of drug transfer into breast milk can help nurses teach their patients both preconceptionally and during pregnancy and lactation. This article provides a review of current literature so nurses can become more aware of the basic principles involved in medication use for pregnant and lactating women.

Teenage mothers and breastfeeding: does paternal age make a difference?

This descriptive investigation explores the impact of paternal age on a teenage mother's decision regarding infant-feeding method during the postpartum hospital stay. Eighty-six teenagers who delivered a live birth were asked the age of the fathers of their babies and what, if any, influence the fathers had on infant feeding. Although the fathers of the babies frequently voiced an opinion regarding infant feeding, teenage mothers partnered with older men were less likely to breastfeed during the postpartum hospital stay than were teenagers partnered with male peers. Implications for future research and clinical nursing practice are presented.

Parvovirus B19 in pregnancy.

Parvovirus B19 is a common, self-limiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. Acute infection in pregnancy can cause B19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age at the time of infection. Susceptibility to parvovirus B19 infection should be determined in selected pregnant women at high risk for exposure, and counseling should be provided regarding prevention, testing, and treatment options if exposed.