Marilyn Evans

Social support and online postpartum depression discussion groups: A content analysis

OBJECTIVE Social support has a positive influence on womens childbearing experience and is shown to be a preventive factor in postpartum depression. This study examined the perceived value and types of social supports that characterize the discussions of women who participate in postpartum depression online discussion groups. METHODS A directed content analysis was used to examine 512 messages posted on a postpartum depression online support group over six months. RESULTS The majority of the womens postings illustrated emotional support followed by informational and instrumental support. CONCLUSIONS Online support groups provide women experiencing postpartum depression a safe place to connect with others and receive information, encouragement and hope. PRACTICE IMPLICATIONS Education strategies are needed to address the many questions regarding PPD medical treatment. Recommending vetted links to PPD online support groups will create opportunities for women to share their experiences and obtain support.

Gestational Diabetes: The Meaning of an At-Risk Pregnancy

Being diagnosed with gestational diabetes (GDM) is coupled with the implication that the woman and her fetus are at risk. In this study, the authors use a hermeneutic phenomenological approach to gain an in-depth understanding of GDM as pregnant women meaningfully experience it. They conducted conversational interviews with 12 women who were diagnosed with and being treated for diabetes in pregnancy. Data analysis involved a reflective process consistent with the guidelines of thematic analysis. Four themes identified as characteristic of the women’s pregnancy experience were Living a Controlled Pregnancy, Balancing, Being a Responsible Mother, and Being Transformed. The findings challenge health care professionals to discuss openly and reassess their present models of care for pregnant women and their families.

Health Behaviours of Postpartum Women with a History of Gestational Diabetes

ABSTRACT OBJECTIVES 1) To explore the health behaviours of women with recent gestational diabetes mellitus in the first year postpartum; and 2) to compare their perceived health status with their actual experiences in establishing and maintaining healthy lifestyle changes. METHODS A concurrent mixed method design using semi- structured interviews, supplemented by the Short-Form 36 (SF-36) Health Survey, diet recall and activity-level records collected at multiple intervals. RESULTS A total of 16 women rated their general health (SF- 36) as good or very good, but diets rarely met Canadas Food Guide recommendations. Narratives revealed initial experiences of abandonment and uncertainty with respect to staying healthy and moving on at 1 year. Continuing support and education postpartum were identified as being needed to maintain changes made during pregnancy CONCLUSIONS Participants acknowledged their increased risk for type 2 diabetes and were cognizant of health behaviours that might prevent diabetes; however, sustaining lifestyle changes in diet and activity were described as difficult.

Evidence-Based Recommendations for Depressive Symptoms in Postpartum Women

Postpartum depression is a serious health issue affecting 13% of women from diverse cultures. Despite the well-documented consequences of postpartum depression, it remains difficult to identify, and diverse practices relate to its prevention and treatment. Evidence-based interventions are essential to improve both maternal and infant health outcomes associated with pregnancy. This article describes the development process of an evidence-based practice guideline for postpartum depression and highlights the practice recommendations related to the confirmation, prevention, and treatment of depressive symptoms in postpartum mothers.

Relational Ethics and Genetic Counseling

Genetic counseling is viewed as a therapeutic interrelationship between genetic counselors and their clients. In a previous relational ethics research project, various themes were identified as key components of relational ethics practice grounded in everyday health situations. In this article the relational ethics approach is further explored in the context of genetic counseling to enhance our understanding of how the counselor-client relationship is contextually developed and maintained. Qualitative interviews were conducted with six adult clients undergoing genetic counseling for predictive testing. Engagement, dialogue and presence were revealed as relevant to genetic counselor-client relationships. A relational ethics approach in genetic counseling challenges the concept of nondirectiveness and may enhance the outcome of counseling for both counselor and client.

The Subjective Impact of a Diagnosis of Gestational Diabetes Among Ethnically Diverse Pregnant Women: A Qualitative Study

OBJECTIVE Women diagnosed with gestational diabetes mellitus (GDM) require enhanced medical care, social support and health behaviour changes to reduce the complications of pregnancy and future adverse health outcomes. Little is known about how a GDM diagnosis positively and negatively impacts women, especially those of diverse ethnic backgrounds. This qualitative study sought to gain insight into the reactions and experiences of multiethnic women diagnosed with GDM. METHODS A qualitative descriptive approach was used to analyze semistructured telephone interviews conducted with 19 pregnant women of diverse backgrounds who were diagnosed with GDM. Interviews were recorded and transcribed and then coded and analyzed using content analysis. RESULTS This study identified 2 main themes and several subthemes. First, women reported many negative effects of a GDM diagnosis, including heightened pressure to fulfill multiple roles, financial impact, and a disconnect between diabetes-prevention recommendations and their cultural practices. Second, a GDM diagnosis also had positive effects on many women. Women indicated being motivated to make health behaviour changes after a GDM diagnosis and viewed it as a wake-up call to modify their lifestyles. CONCLUSIONS To help pregnant women with self-management of gestational diabetes, healthcare providers should pay greater attention to the adverse effects of GDM on women, including role expectations, cultural issues and financial barriers. Healthcare providers also need to focus on the positive effects and capitalize on womens motivation to make lifestyle changes to reduce their future risk for diabetes.

Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: Rationale and study design

AIMS Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study. METHODS The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change. CONCLUSIONS Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.

Community awareness of postpartum depression.

OBJECTIVE To explore awareness of postpartum depression and its symptoms and available community resources for women with postpartum depression. DESIGN Cross-sectional surveillance research, using population-based data. SETTING Eight communities in southern and eastern Ontario, Canada. PARTICIPANTS A random selection of adults 18 years of age and older with telephones. METHOD Logistic regression and chi-square test were used to analyze awareness of postpartum depression and its symptoms, the baby blues, and sources of assistance for women with postpartum depression. RESULTS The vast majority of respondents were aware of postpartum depression (90.1% +/- 0.6% confidence interval) (n=8,750) as compared with the baby blues (62.5% +/- 1.1%). Awareness of postpartum depression, its symptoms, the baby blues, and sources of assistance varied according to the demographic profiles of the respondents (family structure, education, and language spoken at home). CONCLUSION Awareness of the term postpartum depression does not necessarily imply awareness of its symptoms or sources of assistance. Public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families. Education should target individuals with lower levels of education and non-English-speaking groups.

Moral distress in the resuscitation of extremely premature infants

Objective: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. Design: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. Setting: A regional, tertiary academic referral hospital in Ontario offering a perinatal program. Participants: A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. Methods: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. Ethical considerations: Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. Results: Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses’ perceived lack of power and influence in the neonatal resuscitation decision-making process. Conclusion: Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration.

Laboring to Mother in the Context of Past Trauma The Transition to Motherhood

The occurrence of interpersonal trauma is a reality for many women, with effects that often persist long after the traumatic events end. The purpose of this feminist grounded theory study was to examine how past trauma shaped the lives of women as they became new mothers. We recruited a purposive sample of 32 women from two Canadian communities and conducted semistructured, dialogic interviews during the second trimester of pregnancy. We analyzed data using thematic content analytic methods, including open coding whereby we read transcripts line by line and applied codes to portions of text that illustrated concepts or themes. The substantive grounded theory, “laboring to mother in the context of past trauma,” describes the exceedingly difficult emotional and cognitive work undertaken by pregnant women with histories of trauma as they anticipate becoming mothers. In this article, we present key components of the theory and offer recommendations for health and social service providers.