Pregnancy, labor, and birth are normal physiologic processes in women's lives. Women should recei... more Pregnancy, labor, and birth are normal physiologic processes in women's lives. Women should receive care that supports a physiologic approach, using medical interventions only when needed, and continuing to support normal aspects of pregnancy and birth in more complex situations when possible. The academy supports the normalcy of pregnancy and birth and a woman-centered physiologic approach to providing care on hospital birthing units.
Introduction: Exercise during pregnancy is associated with reduced rates of preeclampsia, gestati... more Introduction: Exercise during pregnancy is associated with reduced rates of preeclampsia, gestational diabetes, anxiety, insomnia, and excessive weight gain. Continued exercise during the postpartum period is important for healthy weight loss and reduced anxiety. Unfortunately, pregnant and postpartum women are significantly less active than nonpregnant women. The purpose of this pilot study was to evaluate a telephone-based exercise intervention designed for pregnant and postpartum women. Methods: Healthy women (N = 37) who were pregnant (16 weeks' gestation or less) or postpartum (6 months or less) participated in a 3-month, telephone-based exercise intervention based on the transtheoretical model and social cognitive theory. Exercise was assessed by using the 7-Day Physical Activity Recall Interview. Results: Pregnant participants significantly increased their exercise from a mean (standard deviation [SD]) of 60.47 (63.1) minutes per week at baseline to 132.9 (82.3) minutes at 3 months, F(1,13) = 9.96, P Ͻ .01. Postpartum participants significantly increased their exercise from a mean (SD) of 68.9 (63.5) minutes per week at baseline to 123.8 (48.8) minutes at 3 months, F(1,15) = 6.56, P Ͻ .05. Discussion: Participants responded positively to the intervention by significantly increasing their exercise levels. There is a need for a large, randomized controlled trial examining the efficacy of telephone-based exercise interventions for pregnant and postpartum women.
The American College of Obstetricians and Gynecologists recommends that women with low-risk pregn... more The American College of Obstetricians and Gynecologists recommends that women with low-risk pregnancies participate in moderate-intensity exercise during their pregnancy. Currently, only 15.1% of pregnant women exercise at the recommended levels, which is significantly lower than the general population's 45%. One potential reason is that exercise during pregnancy is perceived as risky. In this article, the authors provide a critical review of the literature examining the effect of exercise on preeclampsia, gestational diabetes, weight gain, labor and birth, and other issues associated with pregnancy. Overall, the evidence indicates that exercise during pregnancy is safe and perhaps even reduces the risk of preeclampsia and gestational diabetes. The evidence for weight gain and labor and birth (rates of cesarean sections, duration of labor) is mixed. Unfortunately, much of the research examining exercise during pregnancy is observational, and the few randomized controlled trials ...
International journal of nursing education scholarship, 2008
Web-based education brings a new dimension to the issue of measuring faculty workload. Current li... more Web-based education brings a new dimension to the issue of measuring faculty workload. Current literature reflects instructor concerns related to the time required to teach web-based courses (McAlpine, Lockerbie, Ramsay & Beaman 2002; Sellani & Harrington, 2002; Smith, Ferguson & Caris, 2001). This descriptive, comparative study seeks to determine the time required to teach web-based graduate nursing courses and compare that to teaching similar courses in the face-to-face setting. Utilizing time records previously collected as part of a federally funded grant, data from 11 web-based and five face-to-face graduate level nursing courses were analyzed. Although a statistically significant difference in teaching time requirements was not demonstrated, several interesting trends did appear. Examples include differences related to preparation time and the division of teacher time while teaching web-based as opposed to face-to-face courses. Future research and continued data collection rel...
Background: Perineal traumas particularly caused by following vaginal delivery are associated wit... more Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother's pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis-tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman's preference during delivery.
A group of primiparas who combined bre?&feeding and emptoyment are dexnbed in terms of how they f... more A group of primiparas who combined bre?&feeding and emptoyment are dexnbed in terms of how they felt about the experience. the difficulties they encountered. factors that affected their total duration of breast-feeding. and patterns of leeding while separated from their infant These women are contrasted with primiparas who weaned prior to remmmg to work and those who remaned homemakers. Of the 619 women includPd in the analyses. 499 ,806sbt o, the women returned to work or whaol by 12 months postparmm and 288 (46.5%) continued to breast-feed after returning to work. Women who combined breast-feeding and employment were older. had more yean of educanon. worked fewer hours per week. and more worked in profe&mal ,obs than those who weaned prior to returning to work. A number of women who chose to express breast milk only at home thought they would have had problems wth having enough time and finding a place to express and to store expressed milk had they bied to express breast milk at work. The overwhelming majori@ of women who combined breast-feeding and employment felt that it was worth the trouble. that they would recommend it to r&en. and that they had done wnethiny speaat for theu mfants t3.t no one else could do. The findings suggest that "using interventions and workplace accomn,odations could assist more women to experience the benefits and rewards of continuing to breast-feed after returning to employment. Breast-feeding is now practiced by approximately 55% of ail new mothers (11, many of whom return to work within the first six months followlng their infant's birth (2.3). In 1987.52% makers, employed women who combined breast-feeding and employment. and women who weaned their infants before returning to work? Are there differences in tvpe of employment. hours workeb per week, and number of weeks postpartum when the mothers returned to work between employed mothers who combined breast-feeding and employment and those who weaned before returning to work? Sharon Hills-Bonqk is a heokh edtmtor with many years 01 experience in teaching and supporting breastfeeding ruomen. She is e co-Pm,ect director/or (I three-year research project conducted et the University of Mi""es0ro sctlw, 0, Nursing, Brewfeeding Behaviors: Testing a Shuctwal Model. funded by the Notiond Center for Nursing Research VCNS,, N080"0, I"Etitute5 0) Health. MeEsw D. Awry b o pmcticing numemidwife with Group Health, Inc. She is elsso D co-projecl directorfor the NCNRjunded research pmjed BreasHeeding Behaviors: Testing a S'ructurat Model and B dodoml candid& at the LJmuenlty of Minnesota School of Nursing. Susan P&r has maw years of eaperience as m obstetic nursk and manager in molemakhild health. She is also a co-project director,or the NCNR-junded reseamh pro,ec, Breastfeeding Behaviors: Testing a Structural Model.
Insufficient milk is a poorly understood problem that is often identified as a major reason for e... more Insufficient milk is a poorly understood problem that is often identified as a major reason for early discontinuation of breastfeeding. This study explored the relationship between anemia and insufficient milk in 630 first-time mothers. The frequency of anemia (postpartum hemoglobin < 10 g/dL) was 22 percent. Anemic mothers reported a higher level of symptomatology associated with insufficient milk and were more frequently classified as having insufficient milk syndrome. Mothers with the syndrome reported a shorter period of full breastfeeding, and weaned at an earlier age. They identified not having enough milk, baby nursing too often, and baby not gaining enough weight as the main reasons for discontinuing breastfeeding, compared with baby's disinterest and conflicts with school or work as main reasons among mothers not reporting symptoms related to insufficient milk syndrome. The study results suggest that anemia is associated with the development of insufficient milk, which in turn, is related to duration of full breastfeeding and to age at weaning.
This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas w... more This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas who breastfed longer than 12 months. They were compared with 541 primiparas who weaned their infants within theJirst year. Greater age, education, and weeks of exclusive brrasrfeeding were associated with longer duration o j breastfeeding. More than two-thirds (68%) of the women who breastfed longer than one year returned to employment before their infant was I year old. The most frequently chosen reasoil for long-term breastfeeding was that breastjeeding was a special time for mother and baby that the mother was not ready to give up. Nearly half of the women reported breastfeeding their-babies on demand. At 12 to 15 months, 54 percent of the babies slept in (I crib in a separate room, and 37 percent slept in the same bed with their mother all or part of the night. Most mothers (57%) considered their support group to he slightly or moderately important in influencing their decision to breastfeed beyond a year, and I0 percent considered it to he extremely important. The major themes that emerged from women's comincnts were the importance of being strong in the face of social unacceptability, development of n close mother-child bond, and the naturalness of breastfeeding beyond 12 months. Health caregivers should recognize the emotionul and interpersonal aspects of long-term hreastjeeding, support the hreastfeeding relationship, and avoid contributing to the development of "closet nursers" so that women may feel free to discuss their concerns about their child's health.
The major objective of this study was to identify predictor variables that accurately differentia... more The major objective of this study was to identify predictor variables that accurately differentiated breastfeeding women who weaned during the first 4 weeks, those who weaned between 5 and 26 weeks, and those who weaned after 26 weeks. Predictors were demographic variables, Theory of Planned Behavior (TPB) variables, breastfeeding knowledge, and difficulties experienced during the first month. Methods: Primiparas who delivered healthy infants in an urban midwestern hospital provided initial data prior to discharge. Follow-up occurred at 1,3,6,9, and 12 months. Following appropriate bivariate analyses, polychotomous logistic regression was used to determine predictors of weaning group. Linear multiple regression was used to predict intended duration. Results: Most of the 84 women who weaned very early had intended to breastfeed considerably longer. According to the multivariate analysis, women who weaned earlier were younger, had completed fewer years of education, had a more positive bottle-feeding attitude and a less positive breastfeeding attitude, intended to breastfeed less time, had lower knowledge scores, had higher perceived insufficient milk scores, and planned to work outside the home. Variables postulated by the TPB to be direct predictors of intention explained 36% of the variance in intended duration. Conclusions: Women at risk for early weaning can be identified with reasonable accuracy using a TPB-based conceptual framework expanded to include breastfeeding specific variables. Casefinding using empirically derived screening methods and careful postpartum follow-up, along with professional intervention, should be used to avert unintended early weaning.
Breast-feeding is the recommended method of infant feeding because it is clearly associated with ... more Breast-feeding is the recommended method of infant feeding because it is clearly associated with health benefits for infants and their mothers. Yet, many women who initiate breast-feeding fail to meet their own personal goals or recommended standards for duration of breast-feeding. To refine a Theory of Planned Behavior (TPB)-based structural model for explaining variability in breast-feeding intention and duration. The study design was prospective, multicorrelational, and longitudinal. Out of the total sample of 635 women, 602 mothers of healthy, full-term infants provided complete datasets over the entire course of their breast-feeding experience and these datasets were used in the modeling analyses. Simultaneous multisample analysis of covariance structures was used to develop the model. The resulting TPB for Breast-Feeding (TPB-BrF) describes the rational, motivational processes of the original TPB, but reconfigures the relationships among them, for homemakers (TPB-BrF/H), women employed half-time or less (TPB-BrF/EL), and women employed more than half-time (TPB-BrF/EM). Mothers' early postpartum ratings of adequacy of milk supply and stimulus conditions of maternal education and breast-feeding knowledge were included in the TPB-BrF to better explain breast-feeding outcomes. Model complexity increased with employment effort. The TPB-BrF is a comprehensive, theoretically based, empirically verified model that can serve as a useful heuristic for understanding the personal motivational components of breast-feeding behavior.
Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In a... more Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team-Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient-centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Background: Research indicates that poor sleep is associated with postpartum depression; however,... more Background: Research indicates that poor sleep is associated with postpartum depression; however, little is known regarding this relationship among postpartum women who are at high for postpartum depression. This study examined the relationship between changes in self-reported sleep patterns (from six weeks to seven months postpartum) and depressive symptoms at seven months postpartum among women who were at high risk for postpartum depression. Methods: Participants (n = 122) were postpartum women who were at an increased risk for postpartum depression (personal or maternal history of depression) and had participated in a randomized exercise intervention trial. For the current trial, participants completed the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 (PHQ-9; assessed depression) at six weeks and seven months postpartum. Results: Overall, sleep problems significantly improved from six weeks to seven months postpartum. However, linear regression analyses indicated that worsening or minimal improvement of sleep problems were associated with higher depressive symptoms at seven month postpartum. Regarding the specific types of sleep problems, selfreported changes in sleep latency (i.e., how long it takes to fall asleep at night), daytime dysfunction (i.e., difficulty staying awake during the day), and sleep quality (i.e., subjective rating of sleep quality) were associated with higher levels of depressive symptoms. Conclusions: Sleep problems typically improve during the postpartum phase. However, postpartum women who are at high risk for postpartum depression are at an increased risk for depressive symptoms later in the postpartum phase if sleep problems worsen or show only minimal improvement over time. Therefore, at the six-week postpartum clinic visit, women should receive education regarding potential worsening of sleep patterns and strategies for preventing sleep-related problems. Trial registration: Registered with ClinicalTrials.gov (NCT00961402) on August 18, 2009 prior to the start of the trial.
BACKGROUND: Quality midwifery education globally is essential to improving maternal and infant ou... more BACKGROUND: Quality midwifery education globally is essential to improving maternal and infant outcomes worldwide.PURPOSE: Determine midwife educators’ perceptions of the need for an international recognition program identifying a midwifery educational program having met the International Confederation of Midwives’ (ICM) Global Standards for Midwifery Education.STUDY DESIGN: A descriptive web-based survey available in English, French, and Spanish. Midwife educators were asked about (a) perceived need for a recognition program identifying programs meeting ICM Education Standards, (b) ability and resources to complete a self-evaluation report, (c) kinds of verification activities expected and needed resources, and (d) willingness of local educators to be trained as evaluators.RESULTS: Surveys completed from 52 countries and all four ICM regions (n = 197) with 14% from low-/lower middle income countries. Majority of respondents (79%) endorsed a need for a recognition program. Most were...
Pregnancy, labor, and birth are normal physiologic processes in women's lives. Women should recei... more Pregnancy, labor, and birth are normal physiologic processes in women's lives. Women should receive care that supports a physiologic approach, using medical interventions only when needed, and continuing to support normal aspects of pregnancy and birth in more complex situations when possible. The academy supports the normalcy of pregnancy and birth and a woman-centered physiologic approach to providing care on hospital birthing units.
Introduction: Exercise during pregnancy is associated with reduced rates of preeclampsia, gestati... more Introduction: Exercise during pregnancy is associated with reduced rates of preeclampsia, gestational diabetes, anxiety, insomnia, and excessive weight gain. Continued exercise during the postpartum period is important for healthy weight loss and reduced anxiety. Unfortunately, pregnant and postpartum women are significantly less active than nonpregnant women. The purpose of this pilot study was to evaluate a telephone-based exercise intervention designed for pregnant and postpartum women. Methods: Healthy women (N = 37) who were pregnant (16 weeks' gestation or less) or postpartum (6 months or less) participated in a 3-month, telephone-based exercise intervention based on the transtheoretical model and social cognitive theory. Exercise was assessed by using the 7-Day Physical Activity Recall Interview. Results: Pregnant participants significantly increased their exercise from a mean (standard deviation [SD]) of 60.47 (63.1) minutes per week at baseline to 132.9 (82.3) minutes at 3 months, F(1,13) = 9.96, P Ͻ .01. Postpartum participants significantly increased their exercise from a mean (SD) of 68.9 (63.5) minutes per week at baseline to 123.8 (48.8) minutes at 3 months, F(1,15) = 6.56, P Ͻ .05. Discussion: Participants responded positively to the intervention by significantly increasing their exercise levels. There is a need for a large, randomized controlled trial examining the efficacy of telephone-based exercise interventions for pregnant and postpartum women.
The American College of Obstetricians and Gynecologists recommends that women with low-risk pregn... more The American College of Obstetricians and Gynecologists recommends that women with low-risk pregnancies participate in moderate-intensity exercise during their pregnancy. Currently, only 15.1% of pregnant women exercise at the recommended levels, which is significantly lower than the general population's 45%. One potential reason is that exercise during pregnancy is perceived as risky. In this article, the authors provide a critical review of the literature examining the effect of exercise on preeclampsia, gestational diabetes, weight gain, labor and birth, and other issues associated with pregnancy. Overall, the evidence indicates that exercise during pregnancy is safe and perhaps even reduces the risk of preeclampsia and gestational diabetes. The evidence for weight gain and labor and birth (rates of cesarean sections, duration of labor) is mixed. Unfortunately, much of the research examining exercise during pregnancy is observational, and the few randomized controlled trials ...
International journal of nursing education scholarship, 2008
Web-based education brings a new dimension to the issue of measuring faculty workload. Current li... more Web-based education brings a new dimension to the issue of measuring faculty workload. Current literature reflects instructor concerns related to the time required to teach web-based courses (McAlpine, Lockerbie, Ramsay & Beaman 2002; Sellani & Harrington, 2002; Smith, Ferguson & Caris, 2001). This descriptive, comparative study seeks to determine the time required to teach web-based graduate nursing courses and compare that to teaching similar courses in the face-to-face setting. Utilizing time records previously collected as part of a federally funded grant, data from 11 web-based and five face-to-face graduate level nursing courses were analyzed. Although a statistically significant difference in teaching time requirements was not demonstrated, several interesting trends did appear. Examples include differences related to preparation time and the division of teacher time while teaching web-based as opposed to face-to-face courses. Future research and continued data collection rel...
Background: Perineal traumas particularly caused by following vaginal delivery are associated wit... more Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother's pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis-tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman's preference during delivery.
A group of primiparas who combined bre?&feeding and emptoyment are dexnbed in terms of how they f... more A group of primiparas who combined bre?&feeding and emptoyment are dexnbed in terms of how they felt about the experience. the difficulties they encountered. factors that affected their total duration of breast-feeding. and patterns of leeding while separated from their infant These women are contrasted with primiparas who weaned prior to remmmg to work and those who remaned homemakers. Of the 619 women includPd in the analyses. 499 ,806sbt o, the women returned to work or whaol by 12 months postparmm and 288 (46.5%) continued to breast-feed after returning to work. Women who combined breast-feeding and employment were older. had more yean of educanon. worked fewer hours per week. and more worked in profe&mal ,obs than those who weaned prior to returning to work. A number of women who chose to express breast milk only at home thought they would have had problems wth having enough time and finding a place to express and to store expressed milk had they bied to express breast milk at work. The overwhelming majori@ of women who combined breast-feeding and employment felt that it was worth the trouble. that they would recommend it to r&en. and that they had done wnethiny speaat for theu mfants t3.t no one else could do. The findings suggest that "using interventions and workplace accomn,odations could assist more women to experience the benefits and rewards of continuing to breast-feed after returning to employment. Breast-feeding is now practiced by approximately 55% of ail new mothers (11, many of whom return to work within the first six months followlng their infant's birth (2.3). In 1987.52% makers, employed women who combined breast-feeding and employment. and women who weaned their infants before returning to work? Are there differences in tvpe of employment. hours workeb per week, and number of weeks postpartum when the mothers returned to work between employed mothers who combined breast-feeding and employment and those who weaned before returning to work? Sharon Hills-Bonqk is a heokh edtmtor with many years 01 experience in teaching and supporting breastfeeding ruomen. She is e co-Pm,ect director/or (I three-year research project conducted et the University of Mi""es0ro sctlw, 0, Nursing, Brewfeeding Behaviors: Testing a Shuctwal Model. funded by the Notiond Center for Nursing Research VCNS,, N080"0, I"Etitute5 0) Health. MeEsw D. Awry b o pmcticing numemidwife with Group Health, Inc. She is elsso D co-projecl directorfor the NCNRjunded research pmjed BreasHeeding Behaviors: Testing a S'ructurat Model and B dodoml candid& at the LJmuenlty of Minnesota School of Nursing. Susan P&r has maw years of eaperience as m obstetic nursk and manager in molemakhild health. She is also a co-project director,or the NCNR-junded reseamh pro,ec, Breastfeeding Behaviors: Testing a Structural Model.
Insufficient milk is a poorly understood problem that is often identified as a major reason for e... more Insufficient milk is a poorly understood problem that is often identified as a major reason for early discontinuation of breastfeeding. This study explored the relationship between anemia and insufficient milk in 630 first-time mothers. The frequency of anemia (postpartum hemoglobin < 10 g/dL) was 22 percent. Anemic mothers reported a higher level of symptomatology associated with insufficient milk and were more frequently classified as having insufficient milk syndrome. Mothers with the syndrome reported a shorter period of full breastfeeding, and weaned at an earlier age. They identified not having enough milk, baby nursing too often, and baby not gaining enough weight as the main reasons for discontinuing breastfeeding, compared with baby's disinterest and conflicts with school or work as main reasons among mothers not reporting symptoms related to insufficient milk syndrome. The study results suggest that anemia is associated with the development of insufficient milk, which in turn, is related to duration of full breastfeeding and to age at weaning.
This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas w... more This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas who breastfed longer than 12 months. They were compared with 541 primiparas who weaned their infants within theJirst year. Greater age, education, and weeks of exclusive brrasrfeeding were associated with longer duration o j breastfeeding. More than two-thirds (68%) of the women who breastfed longer than one year returned to employment before their infant was I year old. The most frequently chosen reasoil for long-term breastfeeding was that breastjeeding was a special time for mother and baby that the mother was not ready to give up. Nearly half of the women reported breastfeeding their-babies on demand. At 12 to 15 months, 54 percent of the babies slept in (I crib in a separate room, and 37 percent slept in the same bed with their mother all or part of the night. Most mothers (57%) considered their support group to he slightly or moderately important in influencing their decision to breastfeed beyond a year, and I0 percent considered it to he extremely important. The major themes that emerged from women's comincnts were the importance of being strong in the face of social unacceptability, development of n close mother-child bond, and the naturalness of breastfeeding beyond 12 months. Health caregivers should recognize the emotionul and interpersonal aspects of long-term hreastjeeding, support the hreastfeeding relationship, and avoid contributing to the development of "closet nursers" so that women may feel free to discuss their concerns about their child's health.
The major objective of this study was to identify predictor variables that accurately differentia... more The major objective of this study was to identify predictor variables that accurately differentiated breastfeeding women who weaned during the first 4 weeks, those who weaned between 5 and 26 weeks, and those who weaned after 26 weeks. Predictors were demographic variables, Theory of Planned Behavior (TPB) variables, breastfeeding knowledge, and difficulties experienced during the first month. Methods: Primiparas who delivered healthy infants in an urban midwestern hospital provided initial data prior to discharge. Follow-up occurred at 1,3,6,9, and 12 months. Following appropriate bivariate analyses, polychotomous logistic regression was used to determine predictors of weaning group. Linear multiple regression was used to predict intended duration. Results: Most of the 84 women who weaned very early had intended to breastfeed considerably longer. According to the multivariate analysis, women who weaned earlier were younger, had completed fewer years of education, had a more positive bottle-feeding attitude and a less positive breastfeeding attitude, intended to breastfeed less time, had lower knowledge scores, had higher perceived insufficient milk scores, and planned to work outside the home. Variables postulated by the TPB to be direct predictors of intention explained 36% of the variance in intended duration. Conclusions: Women at risk for early weaning can be identified with reasonable accuracy using a TPB-based conceptual framework expanded to include breastfeeding specific variables. Casefinding using empirically derived screening methods and careful postpartum follow-up, along with professional intervention, should be used to avert unintended early weaning.
Breast-feeding is the recommended method of infant feeding because it is clearly associated with ... more Breast-feeding is the recommended method of infant feeding because it is clearly associated with health benefits for infants and their mothers. Yet, many women who initiate breast-feeding fail to meet their own personal goals or recommended standards for duration of breast-feeding. To refine a Theory of Planned Behavior (TPB)-based structural model for explaining variability in breast-feeding intention and duration. The study design was prospective, multicorrelational, and longitudinal. Out of the total sample of 635 women, 602 mothers of healthy, full-term infants provided complete datasets over the entire course of their breast-feeding experience and these datasets were used in the modeling analyses. Simultaneous multisample analysis of covariance structures was used to develop the model. The resulting TPB for Breast-Feeding (TPB-BrF) describes the rational, motivational processes of the original TPB, but reconfigures the relationships among them, for homemakers (TPB-BrF/H), women employed half-time or less (TPB-BrF/EL), and women employed more than half-time (TPB-BrF/EM). Mothers' early postpartum ratings of adequacy of milk supply and stimulus conditions of maternal education and breast-feeding knowledge were included in the TPB-BrF to better explain breast-feeding outcomes. Model complexity increased with employment effort. The TPB-BrF is a comprehensive, theoretically based, empirically verified model that can serve as a useful heuristic for understanding the personal motivational components of breast-feeding behavior.
Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In a... more Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team-Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient-centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Background: Research indicates that poor sleep is associated with postpartum depression; however,... more Background: Research indicates that poor sleep is associated with postpartum depression; however, little is known regarding this relationship among postpartum women who are at high for postpartum depression. This study examined the relationship between changes in self-reported sleep patterns (from six weeks to seven months postpartum) and depressive symptoms at seven months postpartum among women who were at high risk for postpartum depression. Methods: Participants (n = 122) were postpartum women who were at an increased risk for postpartum depression (personal or maternal history of depression) and had participated in a randomized exercise intervention trial. For the current trial, participants completed the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 (PHQ-9; assessed depression) at six weeks and seven months postpartum. Results: Overall, sleep problems significantly improved from six weeks to seven months postpartum. However, linear regression analyses indicated that worsening or minimal improvement of sleep problems were associated with higher depressive symptoms at seven month postpartum. Regarding the specific types of sleep problems, selfreported changes in sleep latency (i.e., how long it takes to fall asleep at night), daytime dysfunction (i.e., difficulty staying awake during the day), and sleep quality (i.e., subjective rating of sleep quality) were associated with higher levels of depressive symptoms. Conclusions: Sleep problems typically improve during the postpartum phase. However, postpartum women who are at high risk for postpartum depression are at an increased risk for depressive symptoms later in the postpartum phase if sleep problems worsen or show only minimal improvement over time. Therefore, at the six-week postpartum clinic visit, women should receive education regarding potential worsening of sleep patterns and strategies for preventing sleep-related problems. Trial registration: Registered with ClinicalTrials.gov (NCT00961402) on August 18, 2009 prior to the start of the trial.
BACKGROUND: Quality midwifery education globally is essential to improving maternal and infant ou... more BACKGROUND: Quality midwifery education globally is essential to improving maternal and infant outcomes worldwide.PURPOSE: Determine midwife educators’ perceptions of the need for an international recognition program identifying a midwifery educational program having met the International Confederation of Midwives’ (ICM) Global Standards for Midwifery Education.STUDY DESIGN: A descriptive web-based survey available in English, French, and Spanish. Midwife educators were asked about (a) perceived need for a recognition program identifying programs meeting ICM Education Standards, (b) ability and resources to complete a self-evaluation report, (c) kinds of verification activities expected and needed resources, and (d) willingness of local educators to be trained as evaluators.RESULTS: Surveys completed from 52 countries and all four ICM regions (n = 197) with 14% from low-/lower middle income countries. Majority of respondents (79%) endorsed a need for a recognition program. Most were...
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Papers by Melissa Avery