Dyanne D. Affonso

Stressful events related to pregnancy and postpartum

This study represents a preliminary attempt to identify the psychosocial stressors of childbearing. A convenience sample of 221 women were used to identify these stressors. They represented three groups: first trimester women (n = 81), third trimester women (n = 80), and postpartum women (n = 60). Stressors were rated according to their frequency and intensity. The results focused both on the most intense stressors for each group as well as the changes in stressor intensity across the groups. The most intense stressors common to all groups were concerns regarding babys welfare, labor and delivery, and issues related to their mate/spouse. One unexpected pattern was the continued stress due to thoughts of labor and delivery among postpartum women. The authors suggest a possible explanation for this phenomenon.

Infant temperament and postpartum depression: A review

Although limited in number, reported research studies indicate a relationship between maternal perceptions of infant temperament and postpartum depression. Excessive crying in particular and the extent of adaptability and predictability have been implicated as infant behavioral indices. In this article, we present the results of a review of the literature linking early infant temperament to postpartum depression. Measurement issues for both infant temperament and depression are discussed. Recommendations for future research are offered.

Worry: conceptual dimensions and relevance to childbearing women.

Worry is a cognitive activity that can be a behavioral expression to better understand how a person is coping and will adapt to his or her situation. The content and expression of worries are influenced by characteristics, such as personality, coping styles, cultural orientation, and social environment. Women experience multiple worries during the childbearing period, such as how pregnancy affects ones body image, whether the baby will be normal and healthy, how being pregnant affects the relationship with spouse/mate, whether to continue employment during or after pregnancy, and uncertainties about adequate finances to support the new or growing family. In this article we present the conceptual dimensions of worries with application to womens childbearing adaptation. Implications for development of research studies and the design of clinical practice strategies are identified.

A Personality Measure of Erikson's Life Stages: The Inventory of Psychosocial Balance

The development and initial validation of the Inventory of Psychosocial Balance (IPB), designed to assess all eight Eriksonian psychosocial stages, is described. A pool of 208 items that survived a clinical analysis was administered to 528 subjects and then factor analyzed. The resulting eight factors parallel the eight stages and account for 72.34% of the total variance. Subsequent administrations of the IPB to various samples indicate adequate internal consistency and high test-retest reliability; significant correlations with the California Psychological Inventory (CPI) Social Maturity Index; consistent Q-sort portraits of high-scoring and low-scoring women; negligible correlations with test taking response styles, intelligence, and measures of psychopathology; and moderate developmental trends.

Predictors of depression symptoms during pregnancy and postpartum

In a prospective study to assess the predictive value of four factors probing levels of depression symptoms in childbearing202 primiparae from obstetric clinics at three San Francisco Bay Area Health Maintenance Organizations (HMOs) were studied at 10-1420-2230-32 weeks of pregnancy and 1-28 and 14 weeks postpartum. Predictors of depression symptoms were measured by six self-report questionnaires for marital relationshipstresssocial support and cognitive influences. Multiple regression analyses showed the four psychosocial factors as an entity accounted for a significant proportion of variance at each of six succeeding assessments (61%18%20%24%39% and 41%respectively). In additionthe squared semipartial correlation (sr2) showed cognitive influences measured by maternal attitudes and cognitive adaptation contributed consistently to explaining the variance in depression symptoms across all assessments. The findings offer corroborative evidence of the role of cognition (thoughtsbeliefs) in maternal adaptatio...

Disturbances in Post-Partum Adaptation and Depressive Symptomatology

An exploratory study was conducted to identify disturbances in womens postpartum adaptation and the relationship between such disturbances and self-report of depressive symptomatology. Eighty women completed 3 questionnaires (Inventory of Post-partum Adaptation, Beck Depression Inventory, and Pitt Questionnaire) during the third and eighth post-partum weeks. Five areas of post-partum adaptation were assessed: changes in daily activities, impact of childbirth events, interactions with the new baby, social activities and supports, judgments about ones self and future. Results indicated that disturbances in adaptation occurred mainly in the areas of changes in daily activities, social activities and supports, and judgments about the self. Correlational analyses indicated that selected areas of womens post-partum adaptation had positive relationships with depressive symptomatology: mood changes, decreased energy level, inability to maintain eating schedule, negative affect while with baby, lack of comfort ...

Common stressors reported by a group of childbearing American women

A study was conducted on a group of 221 women (81 in the first trimester, 80 in the third trimester, and 60 in the postpartum period) to identify stressors common to pregnancy and to quantify their intensity using an interval rating scale. The most frequent stressors were related to physical symptoms, body image, baby welfare, changes in living patterns, emotional disturbances, and pregnancy-technological concerns. Stressors of high intensity targeted the babys welfare, labor and delivery, pregnancy, newborn behaviors, and relationship with the babys father. The frequency and intensity of stressors changed across pregnancy and postpartum, suggesting a need to tailor prenatal care to the different childbearing phases. Additional findings suggest that the normal physical changes of pregnancy can trigger disruptions in body image, relationship with the babys father, and emotional functioning.

Cognitive Adaptation to Stressful Events During Pregnancy And Postpartum: Development and Testing of the CASE Instrument

The purpose of this article is to describe the development and testing during pregnancy and postpartum of a new instrument, the Cognitive Adaptation to Stressful Events Scale (CASE). The conceptual framework for the CASE is based on Taylors theory of cognitive adaptation to threatening events using the dimensions of meaning, mastery, and self-esteem. A convenience sample of 202 primigravida women completed the CASE at six assessment points: 10 to 12, 20 to 22, and 30 to 32 weeks of pregnancy and 1 to 2, 8, and 14 weeks postpartum. Regression analysis conducted with CASE scores at each of the assessment points in relation to psychological symptom distress as measured with the SCL-90R Global Severity Index (GSI) indicated a strong relationship during each time period. Although replication with multiethnic, high-risk pregnancy and clinically depressed groups is needed, the CASE is a promising tool for examining the cognitive adaptation process occurring during pregnancy and postpartum.

Prenatal and Pospartum Care in Hawaii: A Community-Based Approach

Given the problems of access, retention, and relevant prenatal care content, supplements to existing programs for health-care delivery during pregnancy and after birth are necessary. This article describes a community-based approach to prenatal and postpartum care that has been developed to address these issues. Culturally sensitive strategies were created for use with Hawaiian, Filipino, and Japanese women living on the island of Hawaii. Six nursing care and community outreach interventions were used. Local public health nurses assisted in developing the program and are responsible for its coordination and implementation.

Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project.

Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.