Eileen R. Fowles

Postpartum Maternal Health Care in the United States: A Critical Review

Postpartum maternal health care is a neglected aspect of womens health care. This neglect is evident in the limited national health objectives and data related to maternal health. Missed opportunities for enhancing the health care of postpartum women occur in the scope of routine postpartum care. Differing perceptions of maternal needs between nurses and new mothers also contribute to inadequate health care. Therefore, collecting national data on postpartum maternal morbidity, reforming postpartum care policies, providing holistic and flexible maternal health care, encouraging family support and involvement in support groups, and initiating educational programs are recommended. Further research is needed on issues related to postpartum maternal health.

THE RELATIONSHIP BETWEEN MATERNAL ROLE ATTAINMENT AND POSTPARTUM DEPRESSION

The purpose of this study is to examine the relationship between postpartum depressive symptoms and maternal role attainment. This study was part of a larger project using a nonrandomized, longitudinal, descriptive design. A convenience sample of 168 primiparous women in their last trimester of an uncomplicated pregnancy were recruited from community hospital-sponsored prenatal classes in central Illinois, and 136 women completed questionnaires 9-14 weeks after delivery. Postpartum depression was measured with the Edinburgh Postnatal Depression Scale. Three measures of maternal role attainment were the Myself as Mother Scale, My Baby Scale, and Perceived Competence Scale. Postpartum depression demonstrated a significant, negative relationship to all measures of maternal role attainment (r = -.20 to -.35, p < .01). The occurrence of postpartum depression and its negative influence on maternal role attainment emphasize the need to assess all new mothers for depression 2-3 months after delivery.

Prenatal Nutrition and Birth Outcomes

The complex relationship between maternal nutritional and birth outcomes emphasizes the need for consistent and thorough assessments of womens diet throughout pregnancy and individualized nutritional education to promote positive birth outcomes. The purpose of this article is to examine the influence of prenatal nutrition on birth outcomes, describe research on the effects of macro- and micronutrients on birth outcomes, and discuss strategies for monitoring diet and implementing nutrition education during pregnancy.

An Investigation of Nursing Competence and the Competency Outcomes Performance Assessment Curricular Approach: Senior Students' Self-Reported Perceptions

This study was designed to measure the construct of competence as perceived by nursing students in different programs of study. An exploration of a competence-based curricular model was undertaken to determine if there are distinguishing differences between schools that have formally adopted Dr. Carrie Lenburgs Competency Outcomes Performance Assessment (COPA) model as a curricular guide and those who have do not have a formal competence model guiding the curriculum. The Six-Dimension Scale of Nursing Performance (6-D Scale) was used to evaluate nursing competence. Using a purposive sample, senior nursing students (N = 391) from three different types of nursing programs (baccalaureate, associate [ADN], and diploma) were surveyed. Students completed a two-part questionnaire that included the 6-D Scale, demographic questions, and a researcher-generated questionnaire designed to measure competency-based learning and evaluation. Faculty (n = 101) from these same programs were also surveyed. The results revealed that students from COPA and non-COPA schools reported slightly lower scores in three subscales: teaching/collaboration, critical care, and leadership. Significant curricular differences as defined by the Klein Scales were found between COPA and non-COPA senior students, with 17% to 30% of the variance explained for the COPA students. The findings reflect that baccalaureate students reported significantly lower 6-D Scale scores in multiple areas when compared to diploma and ADN students. Enhancement of student learning and curricular revisions designed to improve leadership and technical expertise are suggested by the findings of this study.

Predictors of dietary quality in low-income pregnant women: A path analysis

Background:Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. Objective:The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. Method:A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. Results:The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (&bgr; = .36) and a direct (&bgr; = −.23) and indirect effect on dietary quality (&bgr; = −.30). Poor eating habits had a direct effect on dietary quality (&bgr; = −.18). Social support had no effect on dietary quality. Age had significant direct effects on education (&bgr; = .39) and nutritional knowledge (&bgr; = .18) and an indirect effect on dietary quality (total effect, &bgr; = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. Discussion:Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Correlates of Dietary Quality and Weight Retention in Postpartum Women

The purpose of this study1 was to identify correlates of dietary quality and postpartum weight retention in women and to examine the association of dietary quality and weight retention. A secondary analysis was conducted of data from 100 women who delivered singleton babies and were over 18 years of age. In sum, 44 women had adequate dietary quality. Most women had adequate intake of meat (79%), milk (66%), and fruit (51%) but not bread (14%) or vegetables (24%). Dietary quality was significantly associated with breast-feeding (rs = .378, p < .000). Dietary quality was not associated with postpartum weight retention. In all, 43% of the variance in postpartum retained weight was explained by weight gained during pregnancy and weight-related distress. A gap exists in the nutrition education and weight management of women after childbirth that allows for a reversal of the healthy eating patterns adopted during pregnancy and throughout the ensuing postpartum life transition.

Ethnic-Specific Weight-Loss Interventions for Low-Income Postpartum Women Findings and Lessons

Promoting weight loss among overweight low-income postpartum women has proven difficult. The study’s aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo (n = 23), African American (n = 25), and Hispanic low-income postpartum women (n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated significantly with self-efficacy (Spearman r = .50) for White/Anglo women and self-efficacy (Spearman r = −.48) and perceived stress (Spearman r = .48) for African American women. In follow-up interviews, women felt interventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control groups (mailed interventions later) were generally more pleased with their assignment than intervention groups.

Healthy eating during pregnancy: determinants and supportive strategies.

This article provides a review of the determinants of healthy eating in pregnancy by synthesizing current research findings and offers strategies to promote healthy eating during pregnancy. This article is guided by the ecological model for health promotion that suggests the determinants of healthy eating as intrapersonal or collective determinants of food choices and public policies that support healthy eating during pregnancy. Community health nurses can apply this model to gain insights into identifying gaps in practice and to prioritize action strategies to guide program development and interventions designed to support healthy eating by all pregnant women.

Identifying healthy eating strategies in low-income pregnant women: Applying a positive deviance model

Using positive deviance methodology, we identified strategies that enabled some low-income pregnant women to eat healthy meals while others did not. We used a descriptive design consisting of small group interviews of low-income pregnant women and identified 6 of 18 women as eating healthy diets. Women with healthy diets knew to eat balanced meals, had family support, were willing to prepare foods that were different than other family members, and ate at home more frequently than women with unhealthy diets. Health care providers can use the positive deviance approach to guide the development of interventions to improve womens diets using community-specific solutions to enhance the health of mothers and infants.

Stress, Depression, Social Support, and Eating Habits Reduce Diet Quality in the First Trimester in Low-Income Women: A Pilot Study

Maternal diet quality influences birth outcomes. Yet, little research exists that assesses womens diet quality during the first trimester of pregnancy, a crucial time of placental and fetal development. This cross-sectional study, describing diet quality and its relationship with stress, depression, social support, and eating habits in the first trimester, may identify low-income women needing intensive dietary intervention. Seventy-one low-income women completed validated instruments measuring stress, depression, social support, and eating habits; had their height and weight measured; received training on portion-size estimation; and completed three 24-hour dietary recalls (1 weekend day and 2 nonconsecutive weekdays) from July 2009 to February 2010. Comparative and correlational analyses were done. Women with diet quality scores below the median (n=35) had more depression (9.6±5.1 vs 6.7±5.1) and stress (22.1±5.4 vs 19.3±4.8) and less control over meal preparation (5.0±1.5 vs 4.2±1.5) and support from others (52.0±12.0 vs 57.4±7.2) than did women with high diet quality scores (n=36). Diet quality was negatively related to depression (r=-0.41), stress (r=-0.35), skipping meals (r=-0.41), and control over meal preparation (r=-0.33), and positively related to support from others (r=0.38). Low-income women experiencing life stressors represent an at-risk group for low diet quality and may need intensive dietary intervention before and during pregnancy. More research designed to improve diet quality in low-income pregnant women is needed.