Christine Kurtz Landy

The Experiences of Socioeconomically Disadvantaged Postpartum Women in the First 4 Weeks at Home

We used a qualitative descriptive approach to explore and describe the situated experiences of socioeconomically disadvantaged (SED) postpartum women in the first 4 weeks after hospital discharge. Qualitative content analysis was used to analyze the data from in-depth interviews with 24 SED postpartum women. Two intertwining, overarching themes emerged: (a) the ongoing burden of their day-to-day lives, with subthemes of poverty and material deprivation, stigmatization through living publicly examined lives, and precarious social support; and (b) the ongoing struggles to adjust to changes that came with the babys arrival, with subthemes of “the first weeks were hard,” “feeling out of control,” “absence of help at home,” “complex relationship with the babys father,” and “health and well-being.” Knowledge of SED womens situated experiences is vital to the development of health policies and services that will truly meet their needs.

A descriptive phenomenology study of newcomers' experience of maternity care services: Chinese women's perspectives

BackgroundMaternity health care available in Canada is based on the needs of women born in Canada and often lacks the flexibility to meet the needs of immigrant women. The purpose of this study was to explore immigrant Chinese women’s experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada.MethodsThis descriptive phenomenology study used in-depth semi-structured interviews to examine immigrant Chinese women’s experiences. Fifteen participants were recruited from the Chinese community in Toronto, Canada by using purposive sampling. The interviews were digitally recorded and transcribed verbatim into written Chinese. The transcripts were analyzed using Colaizzi’s (1978) phenomenological method.ResultsSix themes were extracted from the interviews: (1) preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, (2) strategies to deal with the inconvenience of the Canadian healthcare system (3) multiple resources to obtain pregnancy information, (4) the merits of the Canadian healthcare system, (5) the need for culturally sensitive care, and (6) the emergence of alternative supports and the use of private services.ConclusionsThe findings provide new knowledge and understanding of immigrant Chinese women’s experiences in accessing maternity health services within a large metropolitan Canadian city. Participants described two unique experiences within the themes: preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, and the emergence of alternative supports and the use of private services. Few studies of immigrant maternity service access have identified these experiences which may be linked to cultural difference. Further investigation with women from different cultural backgrounds is needed to develop a comprehensive understanding of immigrant women’s experiences with maternity care.

The Effect of Delivery Method on Breastfeeding Initiation from the The Ontario Mother and Infant Study (TOMIS) III

OBJECTIVE To report on the relationship between delivery method (cesarean vs. vaginal) and type (planned vs. unplanned) and breastfeeding initiation in hospital and continuation to 6 weeks postpartum as self-reported by study participants. DESIGN Quantitative sequential mixed methods design. SETTING Women were recruited from 11 hospital sites in Ontario, Canada. PARTICIPANTS Participants included 2,560 women age 16 years or older who delivered live, full-term, singleton infants. METHODS Data were collected from an in-hospital questionnaire, hospital records, and a 6-week postpartum interview. RESULTS Ninety-two percent of women reported initiating breastfeeding, and 74% continued to 6 weeks. The method of delivery, when defined as cesarean versus vaginal, was not a determining factor in breastfeeding initiation in hospital or in the early postdischarge period. An unexpected delivery method (i.e., unplanned cesarean or instrument-assisted vaginal deliveries) was associated, at a statistically significant level, with an increased likelihood of initiating breastfeeding and continuation to 6 weeks postdischarge. CONCLUSION Breastfeeding can be considered a coping strategy that serves to normalize an abnormal experience and allows the individual to once again assume control. These unexpected results warrant further investigation to understand why women make the decision to initiate breastfeeding, why they choose to continue breastfeeding, and how they can be supported to achieve exclusive breastfeeding as recommended for infants in the first 6 months.

The Ontario Mother and Infant Study (TOMIS) III: a multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year.

BackgroundThe caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge.Methods and designThe Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings.DiscussionThe findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to hospital- and community-based postpartum care providers, managers, and administrators in guiding risk assessment and early intervention strategies. Finally, the research findings can provide the basis for policy modification and implementation strategies to improve outcomes and reduce costs of care.

Performance of the Angle Labor Pain Questionnaire During Initiation of Epidural Analgesia in Early Active Labor.

BACKGROUND:The Angle Labor Pain Questionnaire (A-LPQ) is a new, 22-item multidimensional psychometric questionnaire that measures the 5 most important dimensions of women’s childbirth pain experiences using 5 subscales: The Enormity of the Pain, Fear/Anxiety, Uterine Contraction Pain, Birthing Pain, and Back Pain/Long Haul. Previous work showed that the A-LPQ has overall good psychometric properties and performance during early active labor in women without pain relief. The current study assessed the tool’s sensitivity to change during initiation of labor epidural analgesia with the standardized response mean (SRM, primary outcome). METHODS:Two versions of the A-LPQ were administered once, in each of 2 test sessions, by the same trained interviewer during early active labor. The sequence of administration was randomized (ie, standard question order version [Test 1] followed by mixed version [Test 2] or vice versa). Test 1 was completed before epidural insertion; Test 2 commenced 20 to 30 minutes after the test dose. Providers assessed/treated pain independently of the study. Sensitivity to change was assessed using SRMs, Cohen’s d, and paired t tests. Overall pain intensity was concurrently examined using Numeric Rating Scale and the Verbal Rating Scale (VRS); coping was assessed with the Pain Mastery Scale. Changes in pain were measured with the Patient Global Impression of Change Scale. Internal consistency was assessed with Cronbach’s &agr;. Concurrent validity with other tools was assessed using Spearman’s rank correlation coefficient. RESULTS:A total of 51 complete datasets were analyzed. Most women reported moderate (63%, 32/51) or severe (18%, 9/51) baseline pain on VRS scores during Test 1; 29% (15/51) reported mild pain, and 6% (3/51) reported moderate pain during Test 2. Approximately 90% (46/51) of women reported much or very much improved pain at the end of testing. Cronbach’s &agr; for A-LPQ summary scores was excellent (0.94) and ranged from 0.78 (acceptable) to 0.92 (excellent) for subscales (Test 1). Large SRMs were found for A-LPQ summary scores (1.6, 95% CI: 1.2, 2.1) and all subscales except the Birthing Pain subscale (moderate, 0.60, 95% CI: 0.23, 0.97). Significant (P < .001) differences were found between A-LPQ summary scores and between all subscales on paired t tests. Correlations between A-LPQ summary and Numeric Rating Scale scores (overall pain intensity) were strong (&rgr; > 0.73), correlations were moderate (&rgr; > 0.5) with VRS scores and coping scores (&rgr; > 0.67). CONCLUSIONS:Findings support A-LPQ use for measurement of women’s childbirth pain experiences during initiation of labor epidural analgesia during early active labor. Combined with our previous work, they also support the use of the A-LPQ in late labor and at delivery.

The Social Construction of Mental Health Inequities Experienced by Mothers Who Are Socioeconomically Disadvantaged During Early Motherhood: A Canadian Perspective

Introduction: Early motherhood brings with it multiple challenges that can negatively impact women’s mental health (Final Report of the Commission on Social Determinants of Health, http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf, 2008; Postpartum care of the mother and newborn: A practical guide, Geneva). Mental health problems, particularly postpartum depression are the most common postpartum morbidities experienced after hospital discharge (Acta Psychiatrica Scandinavica 110:338–46, 2004). Postpartum women who are socioeconomically disadvantaged are at higher risk for developing mental health problems with reported postpartum depression rates ranging between 19 and 30 % (American Journal of Obstetrics and Gynecology 186:899–902, 2002; BMC Health Services Research 8:203, 2008). The aim of this study was to illuminate the social organization of the experiences of postpartum women who are SED in the early postpartum weeks that contribute to mental health inequities. The research question that guided this endeavor was: How are the daily experiences/work of postpartum women who are SED determined by extra-local social relations?

Comparison of various modeling approaches in the analysis of longitudinal data with a binary outcome: The Ontario Mother and Infant Study (TOMIS) III

1Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada; 2Biostatistics Unit, St Joseph’s Healthcare, Hamilton, ON, Canada; 3Department of Clinical Epidemiology and Biostatistics, 4School of Nursing, McMaster University, Hamilton, ON, Canada; 5Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; 6School of Nursing, York University, Toronto, ON, Canada; 7School of Social Work, McMaster University, Hamilton, ON, Canada

Public health policy & the anesthesia human resource crisis: Impact on provision of maternity anesthesia services in small , rural & rural remote Ontario hospitals

INTRODUCTION: Health Services Research is virtually non-existent in obstetric anesthesia yet health policy and the availability of maternity anesthesia providers drives patient access to care and the breadth of the services provided. We describe the first Canadian study to evaluate the impact of the anesthesia human resource crisis on maternity care in large and small, rural and rural remote hospitals in Ontario. This qualitative research project was conducted to identify key issues and barriers to maternity anesthesia services a well as provide potential solutions.