Meta-ethnography on the Experiences of Women From Around the World Who Exclusively Breastfed Their Full-Term Infants.

OBJECTIVE: To synthesize evidence from qualitative studies on the experiences of women from around the world who exclusively breastfed their full-term infants. DATA SOURCES: CINAHL Plus, PubMed, APA PsycInfo, Scopus, and ProQuest Dissertation & Theses Global. STUDY SELECTION: We selected reports of qualitative studies that were conducted in high-, middle-, and low-income countries; published between January 2001 and February 2022 in English; and focused on the experiences of women who exclusively breastfed their full-term infants. DATA EXTRACTION: We extracted the following data from included studies: methodological characteristics (i.e., country of origin, authors' disciplines, research design, sample size, sampling, data collection, and data analysis method), participants' demographics (i.e., age, parity, marital status, education, and exclusive breastfeeding duration) and direct participant quotes, and key concepts and themes about women's experiences of exclusive breastfeeding. We managed and stored extracted data using a Microsoft Excel spreadsheet. DATA SYNTHESIS: We synthesized reciprocal translations using Noblit and Hare's approach to meta-ethnography. Five overarching themes emerged from the meta-synthesis: Favorable Conditions, Not a Smooth Journey,Support, Determination and Perseverance, and Reflections on Benefits. CONCLUSION: In the included studies, participants experienced challenges with exclusive breastfeeding; however, they also recounted benefits. We recommend 6-month maternity leave and support from family and health care professionals to improve rates of exclusive breastfeeding.

Relationship Between Feeders and Exclusive Breastfeeding and Mixed Feeding During the First Month of Life.

BACKGROUND: The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants. PURPOSE: To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge. METHODS: This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding. RESULTS: More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 ( P < .001), week 3 ( P < .05), and week 4 ( P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001). IMPLICATION FOR PRACTICE: Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice. IMPLICATIONS FOR RESEARCH: Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.

The Role of Emotion Regulation in Pain Management Among Women From Labor to Three Months Postpartum: An Integrative Review.

BACKGROUND: Emotion regulation is a regulatory process to modify emotional activation in a wide range of situations and shows potential effects to reduce pain and emotional distress. The purpose of this review was to enhance an understanding of the role of emotion regulation strategies and their outcomes in reducing women's pain from labor to 3 months postpartum. DESIGN: Integrative review. METHODS: The literature was reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted using electronic databases CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertation from 1990-2019. RESULTS: Nine publications were included. Two emotion regulation strategies, mindfulness and distraction, were used. The findings revealed that prolonged training in mindfulness-based interventions produced significant improvements in decreasing pain intensity during labor and increasing maternal comfort 2 hours postpartum. The distraction strategy showed a significant decrease in pain intensity during labor for women who were trained and self-practiced during the prenatal period. CONCLUSIONS: Both mindfulness and distraction would be offered to pregnant women as part of alternative self-pain management strategies to prepare them for dealing with pain and other discomforts. Future research needs to test the effects of the intervention beyond childbirth.

Maternal perception of paternal breastfeeding support: A secondary qualitative analysis.

OBJECTIVE: To describe how women perceive paternal support of breastfeeding and identify actions women value during the early breastfeeding postpartum. DESIGN: A qualitative secondary analysis of semi-structured interviews using thematic analysis collected after birth and via telephone at 1, 2, 3, and 4 weeks after discharge. SETTING: A regional medical center in the southeast region of the United States. PARTICIPANTS: Sixty-two women yielded 130 transcripts with 32 transcripts conducted after birth, and 19, 16, 27, and 36 transcripts conducted after discharge via telephone at weeks 1, 2, 3, and 4, respectively. FINDING: Women reported three themes of paternal support of breastfeeding (1) participating in the breastfeeding decision, (2) being a partner of breastfeeding, and (3) caring for breastfeeding mothers. CONCLUSION AND IMPLICATION FOR PRACTICE: Paternal support of breastfeeding is a learning process that requires teamwork for women and their partners to master breastfeeding. Women and their partners as co-parents solve breastfeeding problems and achieve their breastfeeding goals, which promotes maternal well-being and bonding with their infants. Future interventions will guide partners to support breastfeeding and women's postpartum physical and psychological needs.

Predictors of serious adverse drug events from opioids: Results from the Food and Drug Administration Adverse Events Reporting System.

BACKGROUND: Opioids pose significant increased risk for serious adverse drug events (ADEs). PURPOSE: The purpose was to identify significant predictors and their associated magnitude of risk for serious life-threatening opioid ADEs. METHODS: A post hoc design was used to examine predictors of opioid analgesics ADEs with Food and Drug Administration Adverse Events Reporting System (FAERS) data. The sample consisted of all eligible cases from the second quarter of the 2019 FAERS where an opioid analgesic was identified as the primary suspect for an ADE. Logistic regression was used to predict serious life-threatening ADEs. Final predictors included age, gender, misuse/substance use disorder, number of concurrent opioids; use of benzodiazepines, other sedatives, and antidepressants; and use of morphine, fentanyl, and oxycodone. RESULTS: Life-threatening ADEs, excluding suicide and suicide attempts, comprised 19.9% of the cases. Protective factors that reduced risk included female gender, use of antidepressants, and use of morphine. Harmful factors that increased risk of a serious ADE included misuse/substance use disorder, use of benzodiazepines, and use of other sedatives. Persons taking an opioid with both a benzodiazepine and another sedative increased risk of a serious ADE by 18.78 times. IMPLICATIONS FOR PRACTICE: Results provide risk data helpful to share with people who use prescribed opioids for self-management of pain. Combination of opioids and clinically indicated antidepressants that do not both promote serotonin uptake inhibition may reduce risk for serious opioid ADEs. Practitioners should continue to avoid prescribing benzodiazepines and other sedatives when opioids are used.

Women's Experience of Pelvic Girdle Pain After Childbirth: A Meta-Synthesis.

INTRODUCTION: Persistent pelvic girdle pain (PGP) and the resulting consequences may occur for more than 10 years after birth. The purpose of this meta-synthesis is to provide a new interpretation and deeper understanding of women's experience of living with PGP postpartum. METHODS: A literature review of CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertations was conducted for any qualitative study addressing PGP after birth and published in English from 2000 to 2019. A meta-synthesis using Noblit and Hare's meta-ethnography approach was performed. RESULTS: Seven studies were found describing the experiences of women living with PGP from birth to 13 years after birth. Six themes emerged that represented women's experience: invisible pain, life being restrained, failure to perform the maternal role, experiencing downward emotional spiral, need for active social support, and adaptation to a new conditional life. DISCUSSION: The experiences of women living with PGP after birth highlight the need for holistic care. Interventions by health care providers should support the ability of women to perform daily functions and adapt to their new reality instead of a disease-focused intervention. In addition, women with PGP emphasize the importance of active social support from family members and health care providers. Future research that examines the differences between PGP during the first 3 months postpartum versus that which persists later is needed to develop targeted interventions.

Predictors of hemorrhagic stroke in older persons taking nonsteroidal anti-inflammatory drugs: Results from the Food and Drug Administration Adverse Event Reporting System.

BACKGROUND: Hemorrhagic strokes have not declined in the United States despite a decline worldwide. PURPOSE: To identify hemorrhagic stroke risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs), other medications associated with increased risk for hemorrhagic stroke, and diabetes, cardiovascular disease, gender, and age. METHODS: A post hoc design was used to examine predictors of hemorrhagic stroke for adults of age 65 years and older from the Food and Drug Administration Adverse Events Reporting System database. The initial sample consisted of all cases reported during the third quarter of 2016 and the second quarter of 2018 with an NSAID as the primary suspect for the adverse drug event (ADE). An additional 397 cases with warfarin as the primary suspect were included in the final sample (N = 3,784) to test for bias from including only NSAID as the primary ADE suspect cases. Extracted data included the primary ADE (hemorrhagic stroke or other ADE), age, gender, primary suspect drug (NSAID or warfarin), and presence of a second NSAID, rivaroxaban, warfarin, clopidogrel, antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants), inhaled corticosteroids, diabetes, or cardiovascular medications. Logistic regression was used to predict hemorrhagic stroke. RESULTS: Aspirin and warfarin increased the risk for hemorrhagic stroke by 3.458 and 3.059, respectively. Presence of an additional NSAIDs reduced the risk by 48%. IMPLICATIONS FOR PRACTICE: Hemorrhagic stroke risk specific to older adults may provide helpful estimates for practitioners as they weigh the risk benefit of prescribing aspirin as an antiplatelet therapy for older adults.