[Postpartum pelvic floor muscle training and abdominal rehabilitation: Guidelines].
Deffieux X,Vieillefosse S,Billecocq S,Battut A,Nizard J,Coulm B,Thubert T
Journal de gynecologie, obstetrique et biologie de la reproduction
OBJECTIVE:Provide guidelines for clinical practice concerning postpartum rehabilitation. METHODS:Systematically review of the literature concerning postpartum pelvic floor muscle training and abdominal rehabilitation. RESULTS:Pelvic-floor rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. At least 3 guided sessions with a therapist is recommended, associated with pelvic floor muscle exercises at home. This postpartum rehabilitation improves short-term urinary incontinence (1 year) but not long-term (6-12 years). Early pelvic-floor rehabilitation (within 2 months following childbirth) is not recommended (grade C). Postpartum pelvic-floor rehabilitation in women presenting with anal incontinence, is associated with a lower prevalence of anal incontinence symptoms in short-term (1 year) (EL3) but not long-term (6 and 12) (EL3). Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C) but results are not maintained in medium or long term. No randomized trials have evaluated the pelvic-floor rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long term. It is therefore not recommended (expert consensus). Rehabilitation supervised by a therapist (physiotherapist or midwife) is not associated with better results than simple advice for voluntary contraction of the pelvic floor muscles to prevent/correct, in short term (6 months), a persistent prolapse 6 weeks postpartum (EL2), whether or not with a levator ani avulsion (EL3). Postpartum pelvic-floor rehabilitation is not associated with a decrease in the prevalence of dyspareunia at 1-year follow-up (EL3). Postpartum pelvic-floor rehabilitation guided by a therapist is therefore not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). No randomized trials have evaluated the effect of pelvic floor muscle training after an episode of postpartum urinary retention or bladder outlet obstruction symptoms, or for the primary prevention of anal incontinence following third-degree anal sphincter tear or in patients presenting with anal incontinence after third-degree anal sphincter tear. The electrostimulation devices used alone were not assessed in this postpartum context (regardless of symptoms); therefore, isolated pelvic floor electrostimulation is not recommended (expert consensus). CONCLUSION:Pelvic floor muscle therapy is recommended for persistent postpartum urinary (grade A) or anal (grade C) incontinence (3 months after delivery).
10.1016/j.jgyn.2015.09.023
The Effect of Psychological Support Intervention Based on Structure-Process-Result Three-Dimensional Quality Assessment on Maternal Role Adaptation and Pelvic Floor Rehabilitation Exercise Compliance of Women in Spontaneous Labor.
Computational and mathematical methods in medicine
Objective:A case-control study was conducted to explore the effect of psychological support intervention based on structure-process-result three-dimensional quality assessment on maternal role adaptation and pelvic floor rehabilitation exercise compliance. Methods:110 parturients who delivered naturally in our hospital from January 2019 to October 2021 were randomly divided into the control group and the study group. Patients in the former group received routine nursing measures, while patients in the latter group received psychological support intervention based on structure-process-outcome three-dimensional quality assessment (intervention group). Psychological intervention measures include health education, cognitive therapy, behavioral therapy, collective psychological intervention, and happiness therapy. The Edinburgh postpartum depression (PPD) scale and general self-efficacy scale were adopted before intervention, on the day of discharge, and 42 days after delivery. Meanwhile, the mother's role adaptation questionnaire was adopted 42 days after delivery. The PPD, the change of self-efficacy, the function of the pelvic floor, the role adaptation of mothers, and the compliance of pelvic floor rehabilitation exercise in the control group and the intervention group were analyzed. Results:There was a significant difference in the EPDS score between the two groups at 42 days after delivery. There was a significant difference in the incidence of depression 42 days after delivery between the two groups ( < 0.05). The score of pelvic floor function in the two groups after intervention was higher than that before intervention, and that in the intervention group was higher than that in the control group ( < 0.05). The score of self-efficacy in the two groups after intervention was higher than that before intervention, and that in the intervention group was higher than that in the control group ( < 0.05). The role adaptation of mothers in the intervention group was better than that in the control group ( < 0.05). The compliance rate of pelvic floor rehabilitation exercise in the intervention group was higher than that in the control group ( < 0.05). Conclusion:Psychological support intervention based on structure-process-result three-dimensional quality assessment can effectively enhance the sense of self-efficacy, pelvic floor function, maternal role adaptation, and pelvic floor rehabilitation exercise compliance of parturients and can effectively reduce the incidence of PPD and play a positive role in the prevention of PPD.
10.1155/2022/8993144
The effect of a comprehensive care and rehabilitation program on enhancing pelvic floor muscle functions and preventing postpartum stress urinary incontinence.
Medicine
This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.
10.1097/MD.0000000000016907
Analysis of the effect of postpartum rehabilitation nursing on the management of postpartum depression.
Zhang Shulin,Lu Zhenhua,Kang Xiaoqin,Zhang Xianfang
JPMA. The Journal of the Pakistan Medical Association
OBJECTIVE:To study the effect of postpartum rehabilitation nursing on the management of postpartum depression. METHODS:A total of 100 primiparas were randomly selected in this study. They were divided into postpartum nursing intervention group (50 cases) and control group (50 cases). The data from prenatal and postpartum women were collected through questionnaires. The Edinburgh postpartum depression scale, social support scale, general self-efficacy scale, and mother's role adaptation questionnaire were distributed to 100 pregnant women. By collecting the results of these questionnaires, the differences between the nursing intervention group and the control group were compared. RESULTS:The results showed that the proportion of postpartum depression in 50 primiparas after postpartum rehabilitation nursing was significantly lower than that of the control group. The physiological and psychological changes of primipara after childbirth would be significant, and would be subject to tremendous pressure from all aspects. CONCLUSIONS:This change and pressure were the main causes of postpartum depression in primipara. Postpartum rehabilitation nursing can effectively alleviate primipara's postpartum depression.
Postpartum care indications and methodological quality:a systematic review of guidelines.
Zeitschrift fur Gesundheitswissenschaften = Journal of public health
Background:The coverage of postpartum care is not ideal, and has not been used very well due to not enough attention being paid to the puerperal women and newborns, especially in developing countries. Practice guidelines on postpartum care provide beneficial practice guidance and help to reduce maternal mortality. However, little is known about the credibility and consistency of those guidelines. This systematic review was conducted to summarize main postpartum care indications and appraise methodological quality of guidelines. Methods:Seven literature databases and guideline development institutions and organizations of obstetrics and maternity care were searched. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesized consistent and non-consistent recommendations using the content analysis approach. Results:Twenty-nine guidelines were included and a total of eight postpartum care indications were identified. Most guidelines focused on care indications and interventions including exclusive breastfeeding, maternal nutrition, home visit, infant or newborn care and sexuality, contraception, and birth spacing. However, indications such as pain or weight management, pelvic floor muscle training, abdominal rehabilitation, and mental health got less attention. Additionally, the overall quality of all involving postpartum care guidelines is relatively good and acceptable. Conclusions:Guidelines developed by NICE, RANO, and WHO indicated higher methodological quality. For postpartum care indications, most guidelines are incomplete. Variation in practice guidelines for postpartum care recommendations exists. In the future, implementation research into shared decision-making, as well as further high-quality research to broaden the evidence base for postpartum care indications is recommended. Supplementary Information:The online version contains supplementary material available at 10.1007/s10389-021-01629-4.
10.1007/s10389-021-01629-4
Postpartum care promotion based on maternal education needs: A mixed study.
Nazari Sakineh,Hajian Sepideh,Abbasi Zohreh,Majd Hamid Alavi
Journal of education and health promotion
BACKGROUND:The postpartum period can be considered as one of the most sensitive stages of life in different countries; however, it is inadequate in many developed and developing countries. We aimed to determine the educational needs of mothers in the postpartum period in Bojnourd. MATERIALS AND METHODS:This study was conducted in Bojnourd 2019 with two parts: a qualitative part using the content analysis method and a quantitative part using the descriptive cross-sectional method. Data were collected 45 interviews with women, spouses, and key informants. All content was recorded and fully transcribed on paper. MaxQda10software was used for the data management. A simultaneous descriptive cross-sectional study was done including 250 pregnant in the third trimester (25.6%), in the first 48 h after delivery (24.4%), in the first 6 months after delivery (24.4%), and in the second 6 months after childbirth (25.6%) who referred to five health centers in Bojnourd to receive midwifery care. Quota sampling was performed for each center according to the population covered, and convenient sampling was done in each center. RESULTS:In the qualitative study, educational needs were classified into four main categories, including "maintaining and restoring physical health," "sexual health needs," "mental health needs," and "educational barriers." In the quantitative study, according to the findings, the most educational needs among mothers were self-care and breastfeeding and the best time for teaching was during the pregnancy, and the best method was face-to-face training and the best source of information was midwives and gynecologists. CONCLUSION:Attention to the educational needs of each region can be done through various training courses and continuous retraining to promote health provider and should be considered in the planning officials.
10.4103/jehp.jehp_1554_20
Design and psychometric evaluation of the maternal perception of postpartum care in comprehensive health centers.
Boletin medico del Hospital Infantil de Mexico
BACKGROUND:Mothers' perceptions of the quality and quantity of care they have received and their relationship with healthcare personnel significantly impact continuity of care and future referrals. This study evaluated the psychometric dimensions of the Iranian version of the Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers. METHODS:We conducted a cross-sectional study in which the questionnaire was administered to 250 women from different comprehensive health centers. First, the questionnaire was translated verbatim from English to Persian. Then, we evaluated the face, content, structural validity, and reliability of the questionnaire. RESULTS:The results showed that this questionnaire's face, content, structure validity, and reliability were adequate. Cronbach's alpha coefficient for the entire questionnaire was 0.668. The interclass correlation coefficient was 0.688, which confirmed divergent validity. CONCLUSIONS:Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers is valid and reliable for measuring maternal perception of these vital services.
10.24875/BMHIM.21000181
A Systematic Review of Breast Care for Postpartum Mothers.
Korean journal of women health nursing
PURPOSE:The purpose of this study was to identify nursing interventions for the postpartum breast care of mothers and determine the effectiveness of interventions for breast pain and engorgement by systematic review. METHODS:Eight national and international databases were reviewed to retrieve and collect randomized controlled trial and controlled clinical trial literature published up to March 2015. Two reviewers independently selected the studies and performed data abstraction and validation. The risk of bias was assessed using Cochrane criteria. A meta-analysis of the studies was performed to analyze the data. RESULTS:The meta-analysis showed that breast massage, along with routine breast care, resulted in a 3.52-point reduction in pain on a 10-point visual analogue scale. Meta-analysis of therapy with cold cabbage leaves and routine breast care showed a pain reduction of 0.54 points. Meta-analysis of cold cabbage leaf application in the experimental group versus cold compress therapy in the comparison group showed a pain reduction of 0.44 points. Meta-analysis of cold cabbage leaf application and routine breast care showed an engorgement reduction of 0.67 points. CONCLUSION:The results of the analysis of 12 articles showed that hot and cold compresses, breast massage, and cabbage application were effective for postpartum breast pain and engorgement.
10.4069/kjwhn.2019.25.3.258
ACOG Committee Opinion No. 736 Summary: Optimizing Postpartum Care.
Obstetrics and gynecology
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contracep-tion, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their obstetrician-gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician-gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit. Obstetrician-gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new paradigm for postpartum care.
10.1097/AOG.0000000000002628
Exploring the experiences related to postpartum changes: perspectives of mothers and healthcare providers in Iran.
Asadi Mahboobeh,Noroozi Mahnaz,Alavi Mousa
BMC pregnancy and childbirth
BACKGROUND:Numerous changes occur in different aspects of women's lives in the postpartum period. Women's adjusting with problems and taking advantage of this opportunity can develop their personality. In this regard, accurate knowledge of their experiences and feelings is necessary to help them to benefit from this period. Therefore, the present study aimed to explore the experiences related to postpartum changes in women. METHODS:In the present qualitative study, 23 participants, including women of childbearing age who gave birth and healthcare providers (midwives and obstetricians) in Isfahan, Iran were selected using purposive sampling with a maximum variation strategy. Data were collected through in-depth semi structured interviews, field notes, and daily notes, and simultaneously analyzed using the conventional qualitative content analysis. RESULTS:The data analysis results led to the extraction of three main categories including "feeling of decreased female attractiveness" (with two sub-categories of " feeling of decreased beauty" and "feeling of decreased sexual function"), "feeling of insolvency and helplessness" (with two sub-categories of "physical burnout", and "mental preoccupations") and "beginning a new period in life" (with three sub-categories of "changing the meaning of life", "feeling of maturity" and "deepening the communication"). CONCLUSIONS:Findings of this study can provide a good context for designing interventions to improve the women's quality of life by explaining and highlighting their experiences in the postpartum period. In this regard, providing sufficient empathy, social and psychological support from family members (especially husband), performing appropriate educational interventions and also regular assessment of women's psychological state by healthcare providers in postpartum period can reduce their concerns and help to improve their health.
10.1186/s12884-020-03504-8
Postpartum program actions in primary health care: an integrative review.
Baratieri Tatiane,Natal Sonia
Ciencia & saude coletiva
Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study aimed to systematize the knowledge produced on postpartum care programs actions within PHC at both national and international levels. This is an integrative review of the literature in databases LILACS (Latin American and Caribbean Health Sciences Literature), BDENF (Nursing Database), SciELO (Scientific Electronic Library Online) and PubMed (US National Library of Medicine). Search was performed in the period April-May 2017. Forty-three papers met the selection criteria. Results indicate that PHC has the physical structure to provide puerperae with care, but has a shortage of human and material resources; there is low postpartum consultation coverage and home visits; there is a good evaluation of the incentive for breastfeeding, but focused on the child; international screening of Postpartum Depression through the Edinburgh Postnatal Depression Scale and care shortage for this condition in Brazil. Postpartum care still focuses on care for the newborn and is mostly restricted to the immediate and late puerperium.
10.1590/1413-812320182411.28112017
ACOG Committee Opinion No. 736: Optimizing Postpartum Care.
Obstetrics and gynecology
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their obstetrician-gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician-gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit. Obstetrician-gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new paradigm for postpartum care.
10.1097/AOG.0000000000002633