Chantal Razurel

Stressful events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study

OBJECTIVE to identify problems and events perceived as stressful by primiparous mothers during the postpartum period, and to explore the social support and coping strategies they used to face these situations. DESIGN a qualitative study. Data were collected via semi-structured interviews and analysed using a content-analysis method. SETTING Geneva University Hospitals, Geneva, Switzerland from October 2006 to March 2007. PARTICIPANTS 60 women interviewed six weeks after the birth at term of their first child. FINDINGS during the early postpartum period, interaction with caregivers was an important source of perceived stress. Upon returning home, the partner was considered as the primary source of social support, but the first need expressed was for material support. Breast feeding was perceived negatively by the new mothers, and this may be due to the difference between the actual problems encountered and the idealised expectations conveyed by prenatal information. Educational information dispensed by medical staff during the prenatal period was not put into practice during the postpartum period. Mothers expressed the need to be accompanied and counselled when problems arose and regretted the lack of long-term postpartum support. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE both the prenatal education and postpartum social support seem to mismatch womens needs and expectations. Concerted efforts are required by health professionals at the maternity unit and in the community to provide mothers with more adequate postpartum assistance.

Determinants of postpartum physical activity, dietary habits and weight loss after gestational diabetes mellitus.

AIM To describe the most significant findings of the studies that examined the prevalence and determinants of postpartum health behaviours (physical activity, dietary habits and/or weight loss) in patients with gestational diabetes mellitus (GDM). BACKGROUND Patients with gestational diabetes have a high risk of developing type 2 diabetes in the months after delivery. For this reason, GDM patients are encouraged to practice specific health behaviours during the postpartum period. It is important to identify the factors that may impact the adherence to these behaviours. EVALUATION Eighteen published research articles that examined postpartum health behaviours and/or their potential determinants in women diagnosed with GDM were selected from electronic databases. KEY ISSUES Physical activity and diet rarely meet the recommendations. Risk perception, health beliefs, social support and self-efficacy are the main factors identified as having an impact on the adoption of health behaviours. However, the cross-sectional nature of the studies and the lack of social, geographical and/or ethnic variety in the populations studied do not allow us to generalize the conclusions. IMPLICATIONS FOR NURSING MANAGEMENT This literature review reports all the information currently available that can enable nurses and midwives to engage in the evaluation and optimization of their interventions in GDM patients. Motivational interventions based on Social Cognitive Theory are proposed.

The Role of Satisfaction with Social Support on the Psychological Health of Primiparous Mothers in the Perinatal Period

The aim of this study was to develop a satisfaction scale for social support and to investigate the relation of satisfaction with social support to the psychological health of primiparous mothers in terms of depressive symptoms, anxiety, and parental self-efficacy. We carried out a quantitative study during the last month of pregnancy (T1) and 6 weeks after birth (T2) including 235 mothers who were expecting their first child in Geneva (Switzerland) from September 2010 to April 2012. The satisfaction scale for social support revealed five sources of support (from the spouse, young woman’s mother, family, friends, professionals), each associated with different types of support (i.e., emotional, esteem, material, and informative). This scale showed good internal consistency for each factor. Moreover, the results revealed a relationship between satisfaction with social support and the mental health of mothers, in particular in the postnatal period for depressive symptoms, anxiety, and self-efficacy. This study highlights the important role of social support and the scale specifically developed during this period is a useful tool to investigate this aspect.

Validation of the post-delivery perceived stress inventory

This article presents the post-delivery perceived stress inventory (PDPSI) and its psychometric properties. This inventory is unique in that it links the measurement of perceived stress to events experienced during and after delivery. A total of 235 French-speaking, primiparous mothers completed the PDPSI two days after their delivery. To evaluate the predictive validity of the PDPSI on anxiety and depression, participants also completed the EPDS and the STAI two days and six weeks postpartum. The exploratory analysis revealed a 16-item structure divided into five factors: F1: relationship with the child; F2: delivery; F3: fatigue after delivery; F4: breastfeeding; and F5: relationship with the caregivers. The PDPSI demonstrated good internal consistency. Moreover, confirmatory factor analysis produced excellent indices, indicating that the complexity of the PDPSI was taken into account and its fit to the sample. The discriminant analysis showed that the PDPSI was not sensitive to specific changes in the sample making the inventory generalizable to other populations. Predictive validity showed that the scale significantly predicted depression and anxiety in the early postpartum period as well as anxiety six weeks postpartum. Overall, the PDPSI showed excellent psychometric qualities, making it a useful tool for future research-evaluating interventions related to perceived stress during the postpartum period.

Validation of the antenatal perceived stress inventory

This article presents the Antenatal Perceived Stress Inventory. The originality of this scale is to assess the impact of events experienced during pregnancy on the stress perceived by mothers. Scale validation was performed using data from 150 French-speaking nulliparous mothers and collected between 36 and 39 weeks of gestation (T1), and between 2 days (T2) and 6 weeks postpartum (T3). Factor analysis revealed a hierarchical three-factor structure that closely fit the data, including medical and obstetric risks/fetal health (F1), psychosocial changes (F2), and the prospect of childbirth (F3). The Antenatal Perceived Stress Inventory is a valid French prenatal stress scale with good psychometric properties.

Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support.

ABSTRACT The aim of the authors in this study was to evaluate the relationships between perceived perinatal stress and social support to psychological health outcomes in mothers. A longitudinal, quantitative study was conducted in Geneva, Switzerland on 235 primiparous mothers from September 2010 to January 2012. Data were collected between gestational weeks 37 and 41 (T1), 2 days post-delivery (T2), and at 6 weeks postpartum (T3). Perinatal stress was associated with depressive symptoms (R2 = 0.223), anxiety (R2 = 0.242), and a low sense of parental self-efficacy (R2 = 0.21). However, satisfaction with social support moderated the relationship of stress to the health of mothers. In particular, the authors noted that the more women were provided with support from their partners, the less depressive symptoms and elevated levels of anxiety they reported, even under stressful conditions, while the satisfaction of support from their mothers boosted their sense of competency. Furthermore, satisfaction with emotional support from professionals tempered the stress during the post-partum period (∆R2 = 0.032; p < .05). The results revealed that perinatal stress was related to the psychological health of mothers, but social support may modulate these effects. A number of approaches could be implemented to manage this stress.

Determinants of Health Behaviors After Gestational Diabetes Mellitus: A Prospective Cohort Study in Geneva

INTRODUCTION Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The objective of this study was to specify the determinants of postpartum physical activity and dietary habits after a pregnancy complicated by GDM in a population of Swiss women. This information will be used to improve health promotion and diabetes prevention interventions for women with a history of GDM. METHODS A prospective cohort study of 173 pregnant women with a diagnosis of GDM was carried out. Quantitative data were collected at the end of pregnancy (T1) and at 6 months postpartum (T3). Bivariate and multivariate logistic regression analysis was conducted to assess associations between the level of healthy lifestyle at 6 months postpartum, clinical and sociodemographic characteristics, motivation to adopt a healthy lifestyle after birth at the end of pregnancy, and postulated psychosocial correlates of health behaviors. RESULTS Multivariate regression analysis showed that only 2 variables were determinants in a low adherence to healthy lifestyle in the postpartum period after GDM: a lower level of social support (odds ratio [OR], 1.5; P < .001) and more perceived barriers to a healthy lifestyle (OR, 1.2; P = .002). DISCUSSION This study shows that, for women who had GDM, the problem of low adherence to a healthy lifestyle to prevent the onset of type 2 diabetes may be secondary to the lack of resources available for the promotion and development of healthy eating habits and regular physical activity. The findings of this study suggest that some women with a history of GDM do not have the means and resources in the postpartum period to apply the advice given during antenatal monitoring.