Elisabeth Kurth

Safe start at home: what parents of newborns need after early discharge from hospital – a focus group study

BackgroundThe length of postpartum hospital stay is decreasing internationally. Earlier hospital discharge of mothers and newborns decreases postnatal care or transfers it to the outpatient setting. This study aimed to investigate the experiences of new parents and examine their views on care following early hospital discharge.MethodsSix focus group discussions with new parents (n = 24) were conducted. A stratified sampling scheme of German and Turkish-speaking groups was employed. A ‘playful design’ method was used to facilitate participants communication wherein they used blocks and figurines to visualize their perspectives on care models The visualized constructions of care models were photographed and discussions were audio-recorded and transcribed verbatim. Text and visual data was thematically analyzed by a multi-professional group and findings were validated by the focus group participants.ResultsFollowing discharge, mothers reported feeling physically strained during recuperating from birth and initiating breastfeeding. The combined requirements of infant and self-care needs resulted in a significant need for practical and medical support.Families reported challenges in accessing postnatal care services and lacking inter-professional coordination. The visualized models of ideal care comprised access to a package of postnatal care including monitoring, treating and caring for the health of the mother and newborn. This included home visits from qualified midwives, access to a 24-h helpline, and domestic support for household tasks. Participants suggested that improving inter-professional networks, implementing supervisors or a centralized coordinating center could help to remedy the current fragmented care.ConclusionsAfter hospital discharge, new parents need practical support, monitoring and care. Such support is important for the health and wellbeing of the mother and child. Integrated care services including professional home visits and a 24-hour help line may help meet the needs of new families.

Was Wöchnerinnen wünschen: Eine qualitative Studie zur häuslichen Wochenbettbetreuung nach der Spitalentlassung durch frei praktizierende Hebammen

In Switzerland, decreases in regular hospital treatment after birth are leading increasingly to mother and child being cared for at home by independent midwives. The research herein was carried out in order to understand the needs of mothers in their home once they leave the hospital and what this midwife provided care consists of. In 2008, eight women from central Switzerland were interviewed on two separate occasions after the birth of their child, and the interviews were analysed using content analysing techniques. Mothers explained that they wanted their baby and themselves to be well cared for. They needed rest and support for recuperation and wished to spend quality time with their new family. The midwifes assisted the mothers to fulfil their needs by counselling, by instructing and by giving information, but they rarely encouraged them to be together as a family. The relationship between midwife and mother turned out to be an important support. Mothers were satisfied if mutual trust was built and if the midwife perceived their needs, respected their autonomy and took the time to be with them. Midwives contribute to the basic well-being of families and support women with medical expertise and ongoing care. Furthermore families need support in general household issues so that new mothers can recover sufficiently.

15 Schreiende Babys, müde Mütter: Gesundheitliche Herausforderungen für junge Familien

Einen weinenden Saugling zu trosten, wahrend man sich selber mude und erschopft fuhlt, bringt viele Eltern an die Grenzen ihrer Belastbarkeit. Diese Probleme erhohen das Risiko fur eine postpartale De

[Paradise lost - Reflexion of preterm birth from the perspective after a brain injury. A case study].

This case study describes the history of an older person, born in 1942 preterminally, who suffered from a brain injury in 2005. Problems in rehabilitation elicited the search for a new meaning in life. In analysing and interpreting the brain injury, preterm birth played a crucial role. The theme of lifelong compensation of deficits, caused by preterm birth, gained new importance. The consequences of brain injury left unsuccessful his former modes of compensation. He was confronted with finding new strategies in order to counterbalance the growing decompensation. This report is based on and was developed through respect for the principles of user involvement in research.

Säuglingsschreien und mütterliche Müdigkeit in den ersten 12 Wochen nach der Geburt (Postnatal Infant Crying and Maternal Tiredness: Examining their evolution and interaction in the first 12 weeks postpartum)

A new mother lazing in childbed is a blessing for her family” is an old Swiss proverb. Maternal rest and recuperation after birth was a common concern in the past and was frequently supported by the extended family. However, mothers today barely enjoy restful days after birth; instead they enter directly into the challenge of combining baby- and selfcare. They often struggle to soothe a crying baby, while coping with their own exhaustion, which can adversely affect family health. Surveys on maternal health consistently report tiredness and fatigue as the most frequent complaint postpartum, affecting 46%-87% of new mothers [1, 2]. Inconsolable infant crying is the most cited reason why parents consult health professionals [3]. To date little is known on how mothers confront and handle these challenges after birth. Routine postnatal care lacks effective strategies to alleviate the burden of infant crying and maternal tiredness which can adversely affect family health in the earliest stage. Following the traditional division between neonatal and maternal healthcare, research has usually focussed on conditions affecting either the mother or the neonate, but little attention has been given to the interplay of infant crying and maternal tiredness. While maternal tiredness after birth can be seen as normal reaction to the efforts of gestation and birth [4], maternal fatigue is more severe than tiredness, and can be defined as imbalance of activity and rest [5]. Whereas tiredness is naturally relieved in the circadian rhythm by periods of sleep, fatigue persists through the circadian rhythm, cannot be relieved through a single period of sleep, and is accompanied with a negative feeling [6]. Fatigue hampers the well-being of the affected person and is known as risk factor for the development of postpartum depression [7] and for a slightly less optimal development of the infants’ fine motor and coordinative skills [8]. Postnatal infant crying is currently regarded as a normal part of a child’s neuro-behavioural development following a typical curve which peaks during the sixth week postpartum at nearly 3 hours crying per day, and declines to below 1 hour per day by 12 weeks of age, with large inter-individual variation [9, 10]. Excessive crying is usually defined by ‘Wessel’s rule of three’. It lasts more than 3 hours on more than 3 days per week, and recurs for more than 3 weeks [3, 11]. Such crying behaviour is a known risk factor for the development of maternal postpartum depression, dysfunctional parent-child relation and, in extreme cases, for shaken baby syndrome or other forms of child abuse [12-14]. Our interest in the present research project was not limited to the pathologic forms of maternal fatigue and excessive crying, but embraced the entire continuum from physiologic maternal tiredness to fatigue, and from normal to excessive infant crying. If healthcare is to address the prominent concerns of parents caring for a neonate, we need a deeper understanding of how infant crying and…