Collaboration With Tribal Stakeholders to Explore Care for Postpartum Depression in the Chickasaw Nation.

OBJECTIVE: To describe and interpret Indigenous women's experiences of postpartum depression (PPD) from the perspectives of community advisory board members. DESIGN: Qualitative, descriptive design with a community-engagement approach. SETTING: Virtual group interviews. PARTICIPANTS: Community advisory board members (N = 8) who were tribal employees, citizens of the tribe, and/or family members of citizens who had detailed knowledge of PPD among Indigenous women and issues surrounding their care. METHODS: In video- and audio-recorded virtual group interviews, we asked participants questions using a semistructured interview guide. We used qualitative content analysis to generate results. RESULTS: Major themes included The "Who, What, and Where" of PPD in Indigenous Women; Meanings Attributed to PPD in Indigenous Women; Realities of PPD Care in the Chickasaw Nation; and Feasibility, Acceptability, Perceived Barriers, and Facilitators of a Future Collaboration. CONCLUSION: The participants identified next steps for addressing PPD in the Chickasaw Nation: raise awareness of PPD among providers, patients, and families; improve messaging about PPD to decrease stigma and normalize mental health care; and develop or adapt a culturally appropriate and relevant tool to screen for PPD in Indigenous women.

Effects of Mindfulness-Based Interventions on Cardiometabolic-Related Adverse Pregnancy Outcomes: A Systematic Review.

BACKGROUND: Growing evidence suggests maternal stress contributes to the development of adverse pregnancy outcomes that are associated with cardiovascular and cardiometabolic risk in birthing persons. Mindfulness-based interventions may positively affect psychological stress in pregnancy and, in turn, reduce stress. However, few study authors have examined the effects of mindfulness-based interventions on adverse pregnancy outcomes that heighten cardiovascular risk. OBJECTIVE: The aim of this study was to appraise available literature examining the effects of mindfulness-based interventions delivered during pregnancy on adverse pregnancy outcomes associated with future cardiovascular and cardiometabolic disease risk. METHODS: In this systematic review, multiple electronic databases were searched using major keywords, including "mindfulness-based intervention," "pregnancy," "preterm delivery," "gestational diabetes," "small for gestational age," "preeclampsia," and "hypertension in pregnancy" during February 2023. RESULTS: Six studies using mindfulness-based interventions during pregnancy were included. The review indicated that these interventions were largely effective at reducing prenatal stress; however, the overall effects of interventions were mixed concerning their impact on pregnancy complications. Study authors examining the effects on gestational diabetes-related outcomes reported significant improvements in blood glucose levels, hemoglobin A1c, and oral glucose tolerance. Outcomes were mixed or inconclusive related to the effects of interventions on the incidence of preterm birth, birth of a small-for-gestational-age newborn, and preeclampsia. CONCLUSIONS: Mitigating cardiovascular and cardiometabolic risk-associated adverse pregnancy outcomes through mindfulness-based approaches may represent an emerging field of study. The few studies and limited, mixed findings synthesized in this review indicate that high-validity studies are warranted to examine the effects of mindfulness-based interventions on pregnancy complications that contribute to cardiovascular-related maternal morbidity and suboptimal life course health for diverse birthing persons.

Establishment of a Community Advisory Board to Address Postpartum Depression Among Indigenous Women.

In this article, we describe the process of establishing an academically and tribally supported community advisory board (CAB) to guide and inform community-engaged research about postpartum depression (PPD) among Indigenous women. Using a community-based participatory research framework, we created a CAB with stakeholders from the Chickasaw Nation because they are well situated to inform a research agenda about PPD in Indigenous women. We developed CAB roles, goals, and responsibilities; established processes for compensation and recognition; identified and recruited potential members; and conducted meetings to build rapport, brainstorm, receive feedback, and invite discussion of topics related to PPD that have been deemed important by the tribe (October 2021 through June 2022). The CAB defined specific roles, goals, and responsibilities for the academic-community partnership, including assumptions, expectations, and confidentiality. We used a standing agenda item to recognize member achievements. Members of the CAB represented many tribal departments and professional disciplines. We use a CAB framework to evaluate our process and to provide recommendations for future research and policymaking.

Perinatal Care of Childhood Sexual Abuse Survivors: Scoping Review.

BACKGROUND: An estimated one in nine women seeking perinatal care is a survivor of childhood sexual abuse (CSA), yet CSA may be unknown to nurses and other health care providers. Childhood sexual abuse can have adverse physical and psychological effects for survivors, and the intimacy of perinatal care can trigger distress like intrusive thoughts. PURPOSE: To explore available literature about CSA survivors and perinatal care. Specific aims were to 1) identify nursing actions that ease undesirable feelings during perinatal care for CSA survivors and 2) identify gaps in the literature on perinatal care for CSA survivors. STUDY DESIGN AND METHODS: Following the PRISMA-ScR Checklist, MEDLINE and CINAHL databases were searched using: "Child Abuse, Sexual," "Perinatal Care," and "Parturition." Initial yield was 109 records. RESULTS: Applying inclusion and exclusion criteria produced 14 full-text articles. Findings suggest that obtaining consent, promoting safety, trust, and control, fostering a healthy nurse-patient relationship, and inquiring about abuse may improve how CSA survivors experience perinatal care. Gaps in literature include nursing assessments for history of CSA with nonverbal cues. CLINICAL IMPLICATIONS: For all patients, nurses should foster security and trust. It is critical that CSA survivors be in control of their care. Procedures should be thoroughly explained, and most importantly, consent should be obtained prior to every physical touch. Nurses must ask about history of CSA because it is part of patient-centered care, which is central to nursing.

"It Took Away the Joy:" First American Mothers' Experiences with Postpartum Depression.

BACKGROUND: Postpartum depression (PPD) is a devastating mental illness associated with adverse health outcomes for mother, child, and family. Higher PPD prevalence in First American women suggests a racial/ethnic disparity, yet little is known about how PPD is experienced from their perspective. PURPOSE: To 1) describe First American women's PPD experiences and the meanings they ascribe to those experiences and 2) describe the cultural knowledge, influences, and practices during the perinatal period. STUDY DESIGN AND METHODS: This phenomenological study used a community-based participatory research approach. Criterion and snowball sampling captured First American women who had PPD now or in the past (N = 8). Interviews used a semistructured guide and thematic analysis followed. RESULTS: Mean age was 30.25 years. Most women were multigravidas (n = 7) and rated themselves as "very" (n = 4) or "mostly" (n = 3) Native American. Women were mostly of low socioeconomic status and had a history of depression (n = 7) and/or a history of prenatal depression (n = 6). Themes: 1) stressors that contributed to PPD; 2) how PPD made me feel; 3) what made my PPD better; 4) heritage-centered practices; 5) support through PPD; 6) how I felt after PPD; and 7) am I a good mother? CLINICAL IMPLICATIONS: This study provides a better understanding of some First American women's PPD experiences that facilitates judgment of the importance of PPD within a cultural context. Clinicians need to create culturally appropriate responses to First American women's PPD needs.

Maternal Mortality Among American Indian/Alaska Native Women: A Scoping Review.

Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an "Other" race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.

Postpartum Depression in American Indian/Alaska Native Women: A Scoping Review.

BACKGROUND: Postpartum depression (PPD) is the most common complication of childbirth and affects one in nine new mothers in the United States. OBJECTIVE: The purpose of this review was to synthesize PPD research in American Indian/Alaska Native (AI/AN) women. Specific aims were to 1) explore the extent to which PPD literature includes AI/AN women measured by the proportion of study samples that were AI/AN women and 2) identify and analyze gaps in the PPD literature for AI/AN women. DESIGN: Databases were searched using: "postpartum depression" and "American Indian," "Native American," "Alaska Native," "Inuit," and "Indigenous." "Postpartum depressive symptoms" and "puerperal mood disorder" were each paired with race/ethnicity search terms, yielding a final sample of nine articles. RESULTS: The proportion of study samples that were AI/AN women ranged from 0.8% to 100%. Compared with all women in the United States (11%), AI/AN women have higher PPD prevalence (14%-29.7%), suggesting a disparity among the different groups of women. Screening instruments were inconsistent among studies, and not all studies used a screening instrument specific to PPD. No cultural influences, risk, or protective factors were reported for AI/AN women. In the only intervention study, no significant differences in PPD symptoms between groups were found after the intervention. CONCLUSIONS: This review uncovered significant gaps in the literature and suggested ways to advance the PPD science for AI/AN women. Clinical implications were described.

Screening for Postpartum Depression in American Indian/Alaska Native Women: A Comparison of Two Instruments.

This review examined validation studies of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) to identify an appropriate postpartum depression (PPD) screening tool for American Indian and Alaska Native (AI/AN) women in the U.S. Databases were searched using: EPDS paired with psychometric properties or validation and PHQ-9 paired with PPD and psychometric properties or validation, yielding a final sample of 58 articles. Both tools have good internal consistency, but discriminative validity for detecting PPD in women from non-Western cultures is low. Positive predictive values in these women are low and diverse (EPDS [n = 21] median 67%, range 21.1-90%; PHQ-9 [n = 1] median 26%). The low predictive accuracy of both tools suggests the tools may be culturally biased.