ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH Exploring Women's Postpartum Sexuality: Social, Psychological, Relational, and Birth-Related Contextual Factors
IntroductionThe purpose of this study was to explore how doulas of color conceptualize both their... more IntroductionThe purpose of this study was to explore how doulas of color conceptualize both their work and how their racial and ethnic identities influence their work within the context of racial disparities in birth outcomes in the United States.MethodsWe conducted semistructured qualitative interviews with doulas of color who had attended at least 3 births as doulas. Participants were recruited from across the United States. The interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to derive themes from the transcribed interviews.ResultsInterviews were conducted with 8 doulas of color, ranging in age from 21 to 47 from across the United States. All participants were either current college students or had earned a college degree. Although many of the doulas identified as being of more than one racial or ethnic group, nearly all participants identified closely with being Black or African American first, and their other racial groups second. F...
Journal of Obstetric, Gynecologic & Neonatal Nursing, 2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Background Bladder health is an understudied state and difficult to measure due to lack of valid ... more Background Bladder health is an understudied state and difficult to measure due to lack of valid and reliable instruments. While condition specific questionnaires assess presence, severity and degree of bother from lower urinary tract symptoms, the absence of symptoms is insufficient to assume bladder health. This study describes the methodology used to validate a novel bladder health instrument to measure the spectrum of bladder health from very healthy to very unhealthy in population based and clinical research. Methods Three samples of women are being recruited: a sample from a nationally representative general population and two locally recruited clinical center samples—women with a targeted range of symptom severity and type, and a postpartum group. The general population sample includes 694 women, 18 years or older, randomly selected from a US Postal delivery sequence file. Participants are randomly assigned to electronic or paper versions of the bladder health instrument alon...
documents/grantacknowledgements.pdf). This publication is the work of the authors and will serve ... more documents/grantacknowledgements.pdf). This publication is the work of the authors and will serve as guarantors for the contents of this paper. We are extremely grateful to all the families who took part in the ASLPAC study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses.
American Journal of Obstetrics and Gynecology, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
BackgroundWater immersion during labor is an effective comfort measure; however, outcomes for wat... more BackgroundWater immersion during labor is an effective comfort measure; however, outcomes for waterbirth in the hospital setting have not been well documented. Our objective was to report the outcomes from two nurse‐midwifery services that provide waterbirth within a tertiary care hospital setting in the United States.MethodsThis study is a retrospective, observational, matched comparison design. Data were collected from two large midwifery practices in tertiary care centers using information recorded at the time of birth for quality assurance purposes. Land birth cases were excluded if events would have precluded them from waterbirth (epidural, meconium stained fluid, chorioamnionitis, estimated gestational age < 37 weeks, or body mass index > 40). Neonatal outcomes included Apgar score and admission to the neonatal intensive care unit. Maternal outcomes included perineal lacerations and postpartum hemorrhage.ResultsA total of 397 waterbirths and 2025 land births were include...
AimsThis analysis explored and characterized adolescent and adult women's lay language and di... more AimsThis analysis explored and characterized adolescent and adult women's lay language and discourse related to bladder health/function.MethodsForty‐four focus groups were conducted across seven United States research centers with 360 adolescents and adult women, organized by six age categories. Multilevel content analyses classified emergent themes. A transdisciplinary lens and inductive approach guided data interpretation. Interpretive insights were validated by a community engagement panel.ResultsA repertoire of bladder function terms emerged, including explicit functional terms, formal and polite euphemistic terms, and informal familiar terms, as well as cultural and regional metaphors and idioms. Terminology usage was historically grounded, developmental, and cumulative across the life course. Lay discourse was contextual and affectively valent, suggesting unspoken, commonly understood, situation‐based “rules” for talking about bladder function. Discourse appeared to be sil...
IntroductionPerineal lacerations during childbirth are common, and suturing the perineal skin dur... more IntroductionPerineal lacerations during childbirth are common, and suturing the perineal skin during repair has been associated with increased postpartum pain. This study sought to test the hypothesis that no difference in postpartum perineal pain exists between 3 methods of skin closure for second‐degree repair: suture, no suture, and surgical glue.MethodsA single‐blind randomized controlled trial of women after vaginal birth who had a second‐degree perineal laceration was conducted at a tertiary care teaching hospital from August 2014 to April 2017. Women were randomized to perineal skin closure with suture, no suture, or surgical glue using a 1:1:1 allocation. Pain was assessed using the short‐form McGill Pain Questionnaire, a 100‐mm visual analog scale (VAS), and Present Pain Index (PPI) at one day, 2 weeks, 6 weeks, and 3 months postpartum. Wound healing was assessed at 6 weeks using the Redness, Edema, Ecchymosis, Drainage, Approximation (REEDA) scale. Pain scores were compare...
AimThe study purpose is to explore adolescent and adult women's experiences, perceptions, bel... more AimThe study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviours related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20–40% of young adult to middle‐aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area.DesignThis focus group study will be implemented across seven geographically diverse United States research centres using a semi‐structured focus group guide informed by a conceptual framework based on the socioecological model.MethodsThe study was approved in July 2017. A total of 44 focus groups composed of 6–8 participants representing six different age categories (...
At present, the maternity care system in the Netherlands is being reorganized into an integrated ... more At present, the maternity care system in the Netherlands is being reorganized into an integrated model of care, shifting the focus of midwives to include increasing numbers of births in hospital settings and clients with medium risk profiles. In light of these changes, it is useful for midwives to have a tool which may help them in reflecting upon care practices that promote physiological childbirth practices. The Optimality Index-US is an evidence based tool, designed to measure optimal perinatal care processes and outcomes. It has been validated for use in the United States (OI-US), United Kingdom (OI-UK) and Turkey (OI-TR). The objective of this study was to adapt the OI-US for the Dutch maternity care setting (OI-NL). Translation and back translation were applied to create the OI-NL. A panel of maternity care experts (n = 10) provided input for face validation items in the OI-NL. Assessment of inter-rater reliability and ease of use was also conducted. Following this, the OI-NL ...
Lower urinary tract symptoms (LUTS) are highly prevalent in women, and are expected to impose a g... more Lower urinary tract symptoms (LUTS) are highly prevalent in women, and are expected to impose a growing burden to individuals and society as the population ages. The predominance of research related to LUTS has focused on underlying pathology, disease mechanisms, or the efficacy of treatments for women with LUTS. Although this research has been vital for helping to reduce or ameliorate LUTS conditions, it has done little to prevent the onset of LUTS. Health promotion and prevention require an expansion of scientific inquiry beyond the traditional paradigm of studying disease mechanisms and treatment to the creation of an evidence base to support recommendations for bladder health promotion and, in turn, prevention of LUTS. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) introduced the concept of prevention as an important priority for women's urologic research as a prelude to supporting the formation of the Prevention of Lower Urinary Tract Symptoms ...
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, Jan 22, 2017
To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary... more To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary cortisol levels across the diurnal curve and throughout gestation, birth, and the postpartum period than women who do not have PTSD. Prospective, longitudinal, biobehavioral cohort study. Prenatal clinics at academic health centers in the Midwest region of the United States. Women expecting their first infants who fit with one of four cohorts: a nonexposed control group, a trauma-exposed control group, a group with PTSD, and a group with the dissociative subtype of PTSD. In the first half of pregnancy, 395 women provided three salivary cortisol specimens on a single day for diurnal data. A subsample of 111 women provided three salivary cortisol specimens per day, 12 times, from early pregnancy to 6 weeks postpartum for longitudinal data. Trauma history, PTSD, and dissociative symptoms were measured via standardized telephone diagnostic interviews with the use of validated epidemiologic ...
IntroductionImmediate postpartum long‐acting, reversible contraception (LARC)—providing intrauter... more IntroductionImmediate postpartum long‐acting, reversible contraception (LARC)—providing intrauterine devices (IUDs) and contraceptive implants immediately following birth—is an effective strategy to prevent unintended pregnancies and improve birth spacing. We measured US certified nurse‐midwives’ (CNMs') and certified midwives’ (CMs') knowledge, training needs, current practice, and perceived barriers to providing immediate postpartum LARC.MethodsWe invited currently practicing CNM and CM members of the American College of Nurse‐Midwives to complete an online survey about their knowledge and experience with the use of LARC and analyzed eligible questionnaires using descriptive statistics.ResultsOf 4609 eligible midwives, 794 responded (17% response rate). Most were female (99.5%) and non‐Hispanic white (92.1%), with 45.0% attending births in urban settings. Responses revealed multiple knowledge gaps related to IUD expulsion rates and appropriateness of immediate postpartum L...
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
To describe the prevalence and predictors of breastfeeding intent and outcomes in women with hist... more To describe the prevalence and predictors of breastfeeding intent and outcomes in women with histories of childhood maltreatment trauma (CMT), including those with posttraumatic stress disorder (PTSD). Secondary analysis of a prospective observational cohort study of the effects of PTSD on perinatal outcomes. Prenatal clinics in three health systems in the Midwestern United States. Women older than 18 years expecting their first infants, comprising three groups: women who experienced CMT but did not have PTSD (CMT-resilient), women with a history of CMT and PTSD (CMT-PTSD), and women with no history of CMT (CMT-nonexposed). Secondary analysis of an existing data set in which first-time mothers were well-characterized on trauma history, PTSD, depression, feeding plans, feeding outcomes, and several other factors relevant to odds of breastfeeding success. Intent to breastfeed was similar among the three groups. Women in the CMT-resilient group were twice as likely to breastfeed exclus...
To estimate prevalence and assess the association of types of trauma with posttraumatic stress di... more To estimate prevalence and assess the association of types of trauma with posttraumatic stress disorder (PTSD) in a sociodemographically and racially mixed sample of women from both predominantly Medicaid and privately insured settings who are expecting their first infant. Structured telephone diagnostic interview data were analyzed for prevalence of trauma exposure, PTSD, comorbidity, risk behaviors, and treatment-seeking among 1,581 diverse English-speaking nulliparous women. The overall rate of lifetime PTSD was 20.2%, 17% in the predominantly private-payer settings, and 24% in the predominantly public-payer settings. The overall rate of current PTSD was 7.9%, 2.7% in the predominantly private-payer settings and 13.9% in the predominantly public-payer settings. Those with current PTSD were more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher-crime areas. Adjusted odds of having current PTSD were highest among those whose worst trauma exposure was abuse (odds ratio 11.9, 95% confidence interval 3.6 -39.9), followed by reproductive trauma (odds ratio 6.1, 95% confidence interval 1.5-24.4). Health risk behaviors and exposures were concentrated among those with PTSD. CONCLUSION: These findings affirm that PTSD affects pregnant women. Women with PTSD in pregnancy were more likely to have had exposures to childhood abuse and prior traumatic reproductive event, to have cumulative sociodemographic risk factors, comorbid depression and anxiety, and to have sought mental health treatment in the past. Obstetric risk behaviors occur more in women with PTSD.
Aims-Pelvic organ prolapse involves physical changes to the genitals, potentially distressing to ... more Aims-Pelvic organ prolapse involves physical changes to the genitals, potentially distressing to women. We hypothesized poorer genital body image in prolapsed women versus controls and that genital body image would correlate with sexual health. Methods-74 sexually active women, 13 with prolapse, 24 with surgically corrected prolapse, 37 without prolapse, completed the Genital Self Image Scale (GSIS-20), Body Esteem Scale (BES) and Female Sexual Function Index (FSFI). Results-In prolapsed women median GSIS-20 scores were (28/40), women with surgically corrected prolapse (32/40) and never prolapsed (34/40) (x 2 =9.6, p<.01). Post hoc analysis showed significant differences between prolapsed and never prolapsed groups (p<.05). After adjusting for BES, GSIS-20 correlated with overall FSFI (r=.384, p< .01), and its subscales of desire (r=.34, p< .05) and satisfaction (r=.41, p<.01). Conclusions-Women with prolapse are at risk for poorer genital body image and reduced sexual health.
Research on postpartum sexuality has focused primarily on mothers, though new findings suggest th... more Research on postpartum sexuality has focused primarily on mothers, though new findings suggest that relational perceptions may have a strong influence over sexual desire and behavior. Little investigation exists regarding sexuality in partners of postpartum women. Additionally, recent findings point to the importance of a partner's sexuality for postpartum women's perceptions of their own sexuality in this time. Aims. The goal of this research was to explore women's partners' sexuality in the early postpartum phase taking into account psychosocial context. Methods. Partners (N = 114; 95 men, 18 women, 1 unspecified) of postpartum women completed a retrospective online questionnaire about their sexuality during the 3 months following their youngest child's birth. Main Outcome Measures. Primary measures included sexual desire (Sexual Desire Inventory), latency to sexual behavior, and enjoyment and initiation of sexual behavior. Other psychosocial variables were investigated: partners' perceptions of the birth mother's sexual desire, perceptions of the birth experience (Questionnaire Measuring Attitudes About Labor and Delivery), postpartum stress (Perceived Stress Scale), body image self-consciousness (Body Image Self-Consciousness Scale), social support (Multidimensional Scale of Perceived Social Support), fatigue, and experiences surrounding breastfeeding. Results. Partners reported most frequent engagement in intercourse in the postpartum period, earliest engagement in masturbation, and highest enjoyment of receiving oral sex compared with other sexual activities. Partners' sexual desire was not correlated with the psychosocial variables measured in the study. Findings for partners' sexuality were similar by gender, except for perceptions of social support and likelihood to engage in intercourse. Conclusions. This study provided a novel perspective on the study of postpartum sexuality by investigating physical and psychosocial influences on the experiences of partners of parous women. Given parallels between sexuality reported by partners in this study and by birth mothers in past studies, this study provided evidence that sexuality in the postpartum period may be experienced similarly, highlighting the social and relational nature of the postpartum.
Women's postpartum sexuality can be influenced by factors related to physical, personal, and rela... more Women's postpartum sexuality can be influenced by factors related to physical, personal, and relationship transitions after the newborn arrives. Despite this, many experiential and social factors remain unexplored. Aims. This study aims to (i) investigate a range of variables thought to influence postpartum sexuality; (ii) expand the focus beyond latency to penis-vagina intercourse; and (iii) assess positive aspects of postpartum sexuality. Methods. Via retrospective reporting on the first 3 months postpartum, 304 women completed an online questionnaire. Main Outcome Measures. The main outcome measures were retrospective reports of sexual desire (Sexual Desire Inventory), latency to resumption of sexual activity, and perceptions of partner's sexual desire. Other measures were birth experience (Questionnaire Measuring Attitudes About Labor and Delivery), breastfeeding status, perceptions of social support (Multidimensional Scale of Perceived Social Support), stress (Perceived Stress Scale), and body image (Body Image Self-Consciousness Scale). Results. Significant differences in time to resumption were found. Women performed oral sex on their partners earlier than engaging in masturbation, which was followed by intercourse and then receiving oral sex. Post hoc analyses identified birth experience, social support, importance of partner's sexual fulfillment, and perception of partner's desire as contributors to this pattern. Women's postpartum sexual desire was influenced by their perceptions of their partner's postpartum sexuality and individual's level of fatigue. Results suggested that postpartum desire was not significantly influenced by breastfeeding status, vaginal issues, or psychosocial variables including stress, body image, or social support. Results suggest that women's perceptions of their partner's sexuality impact postpartum sexuality more than the physical factors most commonly studied (e.g., vaginal trauma and breastfeeding). These results portray postpartum sexuality as a multidimensional phenomenon and highlight the need for further research that addresses its social context.
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