John R. Britton

Pre-discharge anxiety among mothers of well newborns: prevalence and correlates.

OBJECTIVE To explore the prevalence and correlates of maternal postpartum anxiety. METHODS 422 of 973 invited mothers (43%) were screened for anxiety before hospital discharge with the State-Trait Anxiety Inventory (STAI). Recent medical and social life events, stress, resiliency (mastery, social support, and marital satisfaction), length of stay, discharge readiness, anticipatory medical care, and history of psychiatric illness and depression were assessed by questionnaire and medical record review. RESULTS 24.9% of mothers had moderate and 1% severe anxiety. Higher anxiety was observed among young, unmarried, primiparous mothers with male infants, and anxiety correlated with medical and negative social life events, stress, history of depression, and duration of postpartum stay. Inverse correlations were observed with maternal education and household income, pregnancy planning, prenatal class attendance, infant healthcare provider identification, and with all resiliency factors. In multivariate models, pre-discharge anxiety was significantly associated with medical life events and the maternal perception of perinatal stress, and negatively associated with mastery, marital satisfaction, and choice of infant healthcare provider. CONCLUSION Moderate maternal anxiety is common prior to perinatal hospital discharge, especially among women with low mastery and marital satisfaction, stressful perinatal courses, and failure to identify an infant healthcare provider.

Neonatal nurse practitioner and physician use on a newborn resuscitation team in a community hospital

INTRODUCTION Neonatal nurse practitioner (NNP) and physician (NCP) use in a community hospital was evaluated to test the hypothesis that NNP availability would result in changing patterns of NCP attendance at newborn resuscitations. METHOD Records were reviewed for consecutive years before (pre-NNP) and after (post-NNP) NNP employment for frequency of NNP and NCP attendance at moderate-, high-, and very high-risk deliveries, together with rates of low Apgar scores and resuscitation guideline compliance. RESULTS Pre-NNP, NCPs attended 39.5% o of moderate-risk and 91.6% of high-risk deliveries; these figures fell to 2.1% and 6.0%, respectively, during post-NNP (chi square: df = l, p < .0001). Post-NNP, NNP attendance at moderate- and high-risk deliveries was 88.6% and 99.2% higher than NCP attendance during pre-NNP (chi square: df = l, p < .01). No difference was observed between periods in rates of Apgar scores less than 7 at 5 minutes or the percentage of resuscitations that complied with current guidelines. DISCUSSION In community hospitals NNPs may be used instead of NCPs for moderate- and high-risk deliveries. They may also be used more than NCPs in the absence of NNPs.

Global Satisfaction With Perinatal Hospital Care: Stability and Relationship to Anxiety, Depression, and Stressful Medical Events:

To evaluate the stability of global maternal satisfaction with perinatal hospital care during the post-partum period and its relationship to anxiety, depression, and stressful medical events, a cohort study of 300 mothers delivering at a university hospital was performed during the first month postpartum. Satisfaction, measured on a 4-point Likert scale (0-3), declined from 2.75 ± 0.03 (mean ± standard error) before hospital discharge to 2.48 ± 0.04 at 1 month postpartum ( P = .000), and only 69.5% of mothers very much satisfied predischarge remained so at 1 month ( P = .000). Predischarge satisfaction declined with greater medical events (adjusted odds ratio [AOR] = 0.85, 95% confidence interval [CI] = 0.74, 0.97, P < .05) and with concomitant anxiety (AOR= 0.92, CI= 0.89, 0.95, P < .001); reduced satisfaction at 1 month was associated with high anxiety (AOR = 0.97, CI = 0.95, 0.98) and depression (AOR = 0.96, CI = 0.93, 0.99) at that time. Thus, perinatal satisfaction may be time-dependent and associated with contemporaneous medical and psychological changes.

Pre-discharge anxiety among mothers of well newborns: Prevalence and correlates: Maternal postpartum anxiety

Objective: To explore the prevalence and correlates of maternal postpartum anxiety. Methods: 422 of 973 invited mothers (43%) were screened for anxiety before hospital discharge with the State‐Trait Anxiety Inventory (STAI). Recent medical and social life events, stress, resiliency (mastery, social support, and marital satisfaction), length of stay, discharge readiness, anticipatory medical care, and history of psychiatric illness and depression were assessed by questionnaire and medical record review. Results: 24.9% of mothers had moderate and 1% severe anxiety. Higher anxiety was observed among young, unmarried, primiparous mothers with male infants, and anxiety correlated with medical and negative social life events, stress, history of depression, and duration of postpartum stay. Inverse correlations were observed with maternal education and household income, pregnancy planning, prenatal class attendance, infant healthcare provider identification, and with all resiliency factors. In multivariate models, pre‐discharge anxiety was significantly associated with medical life events and the maternal perception of perinatal stress, and negatively associated with mastery, marital satisfaction, and choice of infant healthcare provider.