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Background
Effective postnatal care is important for optimal care of women and newborns–to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of w...
Citations
... The reasons for the discrepancy between survey scores and patch use remain unclear. One study 29 suggested that healthy women may perceive postpartum care as lacking value for themselves, which could lead to lower prioritization of tasks like recording patch data. Additionally, considering that 7 of 18 women reported the patch as cumbersome or were indifferent about its usability, the use of a more conveniently worn device, such as a PPG watch, that does not have to be taken off and could send the data without being processed manually could enhance adherence. ...
Introduction
Approximately 53% of maternal mortality occurs in the postpartum period, a time with little monitoring and health surveillance. The objective of this study was to test the feasibility, usability, appropriateness, and acceptability of remote low‐burden physiologic monitoring of Black postpartum women, using a novel soft wearable patch and home vital sign monitoring for the first 4 weeks postpartum.
Methods
A prospective longitudinal cohort feasibility study of 20 Black postpartum women was conducted using home monitoring equipment and a wearable patch with physiologic sensors measuring temperature, pulse oximetry, blood pressure, electrocardiogram (ECG), heart rate, and respiration twice daily during the first 4 weeks postpartum. Feasibility, acceptability, appropriateness, and usability were measured at the end of the study with the Feasibility of Intervention Measure, Acceptability of Intervention Measure, Intervention Appropriateness Measure, and System Usability Scale.
Results
Twenty Black women were recruited and consented to participate in the study. Remote physiologic monitoring using a wearable patch and home monitoring equipment was rated as feasible (93%), acceptable (93%), appropriate (92%), and useable (80%). During the first 2 weeks postpartum, remote home monitoring detected that 60% of the women had blood pressures exceeding 140/90 mm Hg. The wearable patch provided useable data on ECG, heart rate, heart rate variability, pulse oximetry, and temperature.
Discussion
Our research suggests that remote monitoring in the first 4 weeks postpartum has the potential to identify Black women at risk for postpartum complications.
... Hence, greater attention should be paid to providing adequate emergency obstetric and quality newborn care, which can help prevent NMR and MMR to a significant extent. Most maternal and infant deaths occur in the first six weeks after delivery [48], yet uptake of postnatal care is low and inadequate in low-and middleincome countries [49], including India [32,33,50]. Policymakers need to address this issue by incentivising the use of postnatal care and raising awareness about it. ...
India launched the National Health Mission (NHM) in 2005 to reduce maternal and child mortality by providing equitable, affordable, and quality healthcare services. Studies evaluating the impact of NHM primarily focused on the uptake of maternal and child health (MCH) services, revealing a dearth of evidence on related health outcomes. Using annual time-series data, we estimated the population-level (intention-to-treat effect) impact of the NHM on MCH outcomes such as infant mortality rate (IMR), stillbirth rate, neonatal mortality rate (NMR), and maternal mortality ratio (MMR). Our results exhibit strong consensus on the positive impact on IMR in the post-NHM period, with a significant reduction in its rate and regional inequity. Conversely, our estimates show a moderate impact on stillbirth rate and an insignificant impact on NMR and MMR. Our findings inform policy decisions for strengthening the public health system to amplify the positive gains in MCH outcomes.
... This could be due to the high pregnancy rate being recorded among age groups of 25 to 30 years hence majority as having the above children numbers. It doesn't correspond to a finding from a study by Sacks et al. [23] which revealed that lower ANC utilization less than minimum 8 visits among women of higher parity were common but correspond to a finding from a study done by Mandiwa and Namondwe, [24] also studies ANC8+ among pregnant mothers in Malawi where results found mothers with low parity with high ANC8+. According to this study finding, it was revealed that more than a half of the participants 24(54.5%) said ANC should only be attended 4 times during pregnancy. ...
... This is attributed to the fact that majority of them were married. This correspond to a research study in Nepals [23] which found out that woman whose husbands actively participated in ANC activities fully complied with full ANC schedule and services. In this study, it was found out that most 28(63.6%) ...
Eight Antenatal Care (ANC8+) contact refers to antenatal care model where a mother is recommended to have at least eight contacts to antenatal care provider as follows: one contact in the first trimester, two contacts in the second trimester and five contacts in the third trimester. A cross-sectional quantitative study conducted among 44 pregnant mothers at Kampala International University-Teaching Hospital and were chosen by convenient sampling method. Data were entered and cleaned using SPSS version 22.0 and analysed and presented in figures, chart and table as frequency and percentages. Out of the 44 participants, 21(47.7%) aged 25 to 34 years, 24(54.5%) had secondary education, 23(52.3%), had 1-3 children, 28(63.6%) were rural dwellers, 32(72.7%) married, 21(48.6%) had less than 50,000=, 24(54.5%) said ANC be attended only 4 times during pregnancy, 38(86.4%) had no ANC insurance coverage, 36(81.8%) had a planned pregnancy, 23(52.3%) were not sure about WHO ANC 8+ contacts, 25(56.8%) started ANC after 12 weeks of gestation, 37(84.1%) had husband's support, 28(63.6%) complained of high cost ANC 30(68.2%) resided within 2 km from health facility, 29(65.9%) said the staffs are always available to work on them, 22(50.0%) mentioned ANC caregiver's attitude was fair. Conclusively, above average of total mothers 63.6% were rural dwellers with 48.6% had an average monthly income of less than fifty thousand shillings only of which 86.4% had no ANC insurance coverage hence 63.6% complaining of high-cost ANC and this hinder their ANC utilization. Poor utilization was also due to most 54.5% mothers were not aware about the WHO ANC 8+ contacts hence majority reporting only 4 times ANC be attended during pregnancy and late first ANC initiation 56.8% hence limiting their 8+ ANC.
... For over two decades, women have reported a lower level of satisfaction with hospital-based postnatal care [3,31,32]. Yet few attempts have been made to understand what women find most beneficial postnatally and the components of care, or the pathways and processes, that currently exist. Moreover, few have aimed to develop and test innovative approaches to improve postnatal care, particularly in hospital. ...
Background
Service gaps continue in hospital and community-based postnatal care despite a high prevalence of physical and mental health concerns reported by women following birth. The aim of this study was to describe the postnatal journey and the care provided to women and their babies who were at low risk for health complications from birth to discharge from the maternity service.
Methods
A mixed methods design was used to map the postnatal journey, for the woman and baby, from birth to discharge from the maternity service. Data were collected through activity diaries completed by 15 women and telephone interviews with the women two weeks after birth.
Results
The average hospital postnatal stay was 70 h and, in this time, the women received on average, a total of 3 h of direct care from a health professional. That is, 4.3% of the in-hospital postnatal stay was spent interacting with a health professional. Approximately 53 min of care in the postnatal unit was directed at the mother’s health, 50 min on the baby’s health needs, 43 min supporting breastfeeding and 20 min on discharge information. Most reported that hospital based postnatal care was helpful, although they reported that staff on the postnatal unit were rushed and mostly the midwife caring for them was unfamiliar to them. Breastfeeding support in the first 12–24 h was limited, with women wanting more one-on-one access to midwives. Some women received home-based midwifery care, and on average each home visit by a midwife was 29 min. Women who received home-based midwifery care reported that this care was very helpful. Women reported that home-based midwives were more likely to engage women in conversations about their social and emotional needs than hospital-based midwives. All mothers were offered a home visit from a child and family health nurse and most visited a general practitioner in the first week.
Conclusions
Women often experience limited time in direct interaction with midwives in the postnatal unit in hospital. Those who received midwifery care at home were more satisfied with this care, Women are requesting more support from professionals in the early postnatal period.
... Studies have shown that women with hearing disability frequently distrust healthcare professionals and services, primarily due to fears of miscommunication [4][5][6][7]. The key areas identified for improvement include the effective dissemination of information, ensuring clear and appropriate communication, building trusting relationships with healthcare providers, and fostering a sense of control among women [4,[8][9][10]. ...
Access to healthcare significantly impacts the health outcomes of individuals with hearing disability, underscoring the necessity for enhanced accessibility to health services. Despite this situation, there is a paucity of data regarding the provision of postpartum care for women with hearing disability. Understanding the unique experiences and needs of women with hearing disability is crucial for improving not only the health system but also the overall health of their families and, by extension, the broader community. In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology was employed. Comprehensive searches were conducted across several databases, including PubMed/Medline, Scopus, BioMed Central, Cochrane Library, and Google Scholar. A total of 331 article titles and abstracts were screened based on Population/Intervention/Control/Outcome/Study/Time (PICOST) criteria, resulting in 12 articles being included in the final review. Among these, nine were qualitative studies and three were quantitative, which were reviewed using the Caldwell framework. The findings from this systematic review indicate that mothers with hearing disability often face significant inadequacies and misunderstandings concerning the information and care they receive. These inadequacies lead to a tendency to avoid or delay seeking care, or to rely heavily on self-care practices. Additionally, it was found that healthcare professionals generally lack awareness and understanding of the specific needs of mothers with hearing disability. Future research should prioritize examining both the experiences of healthcare providers and mothers with hearing disability to develop interventions that can adequately address the needs of families with mothers with hearing disability. By doing so, the healthcare system can be better equipped to provide appropriate and effective care, ultimately improving health outcomes for these families.
... Limitations were similar to those identified by previous studies relating to maternal mental health needs [57]. Participants were predominantly white and well educated, and studies were primarily undertaken in high income countries. ...
Background
Despite its known benefits, breastfeeding rates among mothers with perinatal mental health conditions are staggeringly low. Systematic evidence on experiences of breastfeeding among women with perinatal mental health conditions is limited. This systematic review was designed to synthesise existing literature on breastfeeding experiences of women with a wide range of perinatal mental health conditions.
Methods
A systematic search of five databases was carried out considering published qualitative research between 2003 and November 2021. Two reviewers conducted study selection, data extraction and critical appraisal of included studies independently and data were synthesised thematically.
Results
Seventeen articles were included in this review. These included a variety of perinatal mental health conditions (e.g., postnatal depression, post-traumatic stress disorders, previous severe mental illnesses, eating disorders and obsessive-compulsive disorders). The emerging themes and subthemes included: (1) Vulnerabilities: Expectations versus reality; Self-perception as a mother; Isolation. (2) Positive outcomes: Bonding and closeness; Sense of achievement. (3) Challenges: Striving for control; Inconsistent advice and lack of support; Concerns over medication safety; and Perceived impact on milk quality and supply.
Conclusions
Positive breastfeeding experiences of mothers with perinatal mental health conditions can mediate positive outcomes such as enhanced mother/infant bonding, increased self-esteem, and a perceived potential for healing. Alternatively, a lack of consistent support and advice from healthcare professionals, particularly around health concerns and medication safety, can lead to feelings of confusion, negatively impact breastfeeding choices, and potentially aggravate perinatal mental health symptoms. Appropriate support, adequate breastfeeding education, and clear advice, particularly around medication safety, are required to improve breastfeeding experiences for women with varied perinatal mental health conditions.
... A survey study conducted in a tribal community in south Indian revealed more than 90% of woman prefer to apply substance(coconut oil, sweet flag , turmeric) to umbilical cord. [124] Indirect evidence from the review suggests that most women appreciate advice and information from health workers about treatments and techniques that optimize infant well-being [125] The acceptance varies from rural to urban considering diverse population in Indian scenario. ...
... However, indirect evidence suggests that lack of personnel, resources, and training may limit the provision of information and counselling on cord care during the postnatal period (moderate confidence in the evidence). [125][126] ...
... Several studies show that parents received insufficient emotional support during their maternity stay (Phang et al., 2015;Wells, 2016). Mothers stated that too much attention was given to physical changes rather than emotional changes (Sacks et al., 2022) and placed a high value on interpersonal rather than technical skills (Llapa-Rodriguez and Abud, 2013). Mothers reported that postpartum wards seemed to lack humanistic care (Coates et al., 2014). ...
... For example, Ghana has just officially included long-term contraceptive options (such as permanent methods, intrauterine devices (IUDs), implants, and injectables) in the National Health Insurance Scheme benefit package [58]. On the other hand, cultural, social, and normative practices surrounding postnatal care, as well as the lack of awareness of the clinical postnatal care guidelines may partly explain the inconclusive evidence on the use of postnatal care [59,60]. In addition, despite the importance of postnatal care and contraceptive use in reducing maternal mortality [18], few studies have evaluated indicators in these areas and the quality of studies examining contraceptive use was moderate to low. ...
Background
Low- and middle-income countries have committed to achieving universal health coverage (UHC) as a means to enhance access to services and improve financial protection. One of the key health financing reforms to achieve UHC is the introduction or expansion of health insurance to enhance access to basic health services, including maternal and reproductive health care. However, there is a paucity of evidence of the extent to which these reforms have had impact on the main policy objectives of enhancing service utilization and financial protection. The aim of this systematic review is to assess the existing evidence on the causal impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries.
Methods
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search included six databases: Medline, Embase, Web of Science, Cochrane, CINAHL, and Scopus as of 23rd May 2023. The keywords included health insurance, impact, utilisation, financial protection, and maternal and reproductive health. The search was followed by independent title and abstract screening and full text review by two reviewers using the Covidence software. Studies published in English since 2010, which reported on the impact of health insurance on maternal and reproductive health utilisation and or financial protection were included in the review. The ROBINS-I tool was used to assess the quality of the included studies.
Results
A total of 17 studies fulfilled the inclusion criteria. The majority of the studies (82.4%, n = 14) were nationally representative. Most studies found that health insurance had a significant positive impact on having at least four antenatal care (ANC) visits, delivery at a health facility and having a delivery assisted by a skilled attendant with average treatment effects ranging from 0.02 to 0.11, 0.03 to 0.34 and 0.03 to 0.23 respectively. There was no evidence that health insurance had increased postnatal care, access to contraception and financial protection for maternal and reproductive health services. Various maternal and reproductive health indicators were reported in studies. ANC had the greatest number of reported indicators (n = 10), followed by financial protection (n = 6), postnatal care (n = 5), and delivery care (n = 4). The overall quality of the evidence was moderate based on the risk of bias assessment.
Conclusion
The introduction or expansion of various types of health insurance can be a useful intervention to improve ANC (receiving at least four ANC visits) and delivery care (delivery at health facility and delivery assisted by skilled birth attendant) service utilization in low- and lower-middle-income countries. Implementation of health insurance could enable countries’ progress towards UHC and reduce maternal mortality. However, more research using rigorous impact evaluation methods is needed to investigate the causal impact of health insurance coverage on postnatal care utilization, contraceptive use and financial protection both in the general population and by socioeconomic status.
Trial registration
This study was registered with Prospero (CRD42021285776).
... Literature extensively documents the postpartum needs of Black, Latino, and economically disadvantaged childbearing people (Baker et al., 2005;Bellerose et al., 2022;D'Anna et al., 2018;Sacks et al., 2022;Wang et al., 2022;Wouk et al., 2021). However, there is limited US-based research on postpartum care among rural populations. ...
Objectives
Optimal postpartum care promotes healthcare utilization and outcomes. This qualitative study investigated the experiences and perceived needs for postpartum care among women in rural communities in Arizona, United States.
Methods
We conducted in-depth interviews with thirty childbearing women and analyzed the transcripts using reflexive thematic analysis to gauge their experiences, needs, and factors affecting postpartum healthcare utilization.
Results
Experiences during childbirth and multiple structural factors, including transportation, childcare services, financial constraints, and social support, played crucial roles in postpartum care utilization for childbearing people in rural communities. Access to comprehensive health information and community-level support systems were perceived as critical for optimizing postpartum care and utilization.
Conclusions for Practice
This study provides valuable insights for policymakers, healthcare providers, and community stakeholders in enhancing postpartum care services for individuals in rural communities in the United States.
