Establishing a novel community-focussed lactation support service: a descriptive case series

Background Although breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs. Case series This case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately. Conclusions Stakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.

Evaluation of Mood Changes AmongPeripartum Women at PKDAS Institute of Medical Science, Vaniyamkulam, Palakkad: A Prospective, Observational, Longitudinal Study

Background: The perinatal period is well established as an increased risk for development of serious mood disorders. Maternal mental health in developing countries gets less than its due attention. The present study was undertaken to evaluate mood changes in Peripartum period in our population and to identify demographic, obstetric, social and psychosocial risk factors associated with Peripartum depression using established scales.Material & Methods:A prospective, observational, longitudinal study conducted in PK das institute of medical science, vaniyamkulam, with 387 perinatal women for 12 months (February 2018– January 2019). Various scales EPDS (Edinburgh Postnatal Depression Scale), CMSS (Couple Marital Satisfaction Scale, IMS (Index of Marital Satisfaction), LES (Life Event Scale) were studied in Peripartum Period.Results:Among a total of 387 participants about half 189 (48.8%) were in 19-25 years of Age. Almost 30% and 40% had dissatisfied married life as per the CMS and IMS scales respectively. Just above 42% were screen positive for depression antenatally with EPDS & 39% (n = 151) in the immediate postpartum period. From these 151 screen positive cases in immediate postpartum period, 138 participants were followed up at 4-6 weeks (13 were lost to follow up) and up to 115 of 138 (83.3%) were screen positive for depression (N= 387, 29.7%), which was statistically significant (p<0.001). With EPDS during antenatal period there was no statistically significant relationship of depression with Education (p = 0.195), Occupation (p = 0.651) and pregnancy planned or unplanned (p = 0.223), whereas, Joint family, participants with dissatisfied marital relationship had increased risk of depression as evidenced by IMS and CMSS (p < 0.001). Participants with a previous male gender baby had less risk of developing depression (p< 0.001) & participants with previous 2 female children had increased risk of depression (p< 0.001).Conclusions:This study highlights importance of screening for maternal mental health problems during Peripartum period. Depression in immediate postpartum period is good predictor for increased risk of depression at 4-6 weeks postpartum.

The COVID-19 pandemic impacted maternal mental health differently depending on pregnancy status and trimester of gestation

Introduction: We aimed to measure the impact of the COVID-19 pandemic on maternal mental health, stratifying on pregnancy status, trimester of gestation, and pandemic period/wave.Methods: Pregnant persons and persons who delivered in Canada during the pandemic, >18 years, were recruited, and data were collected using a web-based strategy. The current analysis includes data on persons enrolled between 06/2020-08/2021. Maternal sociodemographic indicators, mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7), stress) were self-reported. Maternal mental health in pregnant women (stratified by trimester, and pandemic period/wave at recruitment) was compared with mental health of women who had delivered; determinants of severe depression were identified with multivariate logistic regression models.Results: 2,574 persons were pregnant and 626 had already delivered at recruitment. Participants who had delivered had significantly higher mean depressive symptom scores compared to those pregnant at recruitment (9.1 (SD, 5.7) vs. 8.4 (SD, 5.3), p=0.009). Among those who were pregnant at recruitment, depressive symptoms were significantly higher in women recruited in their third trimester, and those recruited during the 2nd wave of the pandemic. Maternal anxiety (aOR 1.51; 95%CI 1.44-1.59) and stress (aOR 1.35; 95%CI 1.24-1.48) were the most significant predictors of severe maternal depression (EDPS˃13) in pregnancy. Conclusion: The COVID-19 pandemic had a significant impact on maternal depression during pregnancy and in the post-partum period. Given that gestational depression/anxiety/stress have been associated with preterm birth and childhood cognitive problems, it is essential to continue following women/children, and develop strategies to reduce COVID-19’s longer-term impact.

Maternal Mental Health under COVID-19 Pandemic in Thailand

Numerous nations have implemented lockdown measures in response to the COVID-19 pandemic. As a consequence of the lockdown on daily living, social participation, and health service accessibility, vulnerable people, for example, new mothers, may experience an increase in mental health problems. This cross-sectional survey was conducted to investigate the impact of the COVID-19 pandemic lockdown on Thai new mothers and the variables affecting their mental health. The survey data were collected from 903 Thai mothers with infants aged 0–12 months using an online platform and a face-to-face interview questionnaire survey between 17 July and 17 October 2020, during the first nationwide COVID-19 lockdown period. For the final analysis, there were 862 participants who completed all of the questions. The full exploratory analysis was performed by multivariable linear regression to identify the variables influencing maternal mental health. Our study demonstrated that new mothers reported feeling a high extent to some extent of worry (44.9%), increased appetite (40.4%), becoming easily annoyed or irritable (39.1%), and feeling down (33.5%), whereas 82.7% felt able to cope with the first lockdown situation. Practiced relaxation techniques were associated with positive maternal mental health (adjusted β = 1.05, 95% CI 0.57 to 1.52, p < 0.001). The perceived impact of the COVID-19 lockdown was on the household’s ability to pay for rent, to make mortgage payments (adjusted β = −1.59, 95% CI −2.87 to −0.36, p = 0.011), the household’s ability to pay for other essentials, such as utilities and medication (adjusted β = −1.99, 95% CI −3.16 to −0.81, p = 0.001), household crowding after lockdown (adjusted β = −3.46, 95% CI −4.86 to −2.06, p < 0.001), and not going outside or doing outdoor activities (adjusted β = −2.22, 95% CI −3.35 to −1.08, p < 0.001). These impacts were significantly associated with negative mental health. In conclusion, our results emphasize the critical need for continuous monitoring of maternal mental health and developing an effective response strategy and activity for promoting maternal mental health under the stress of repetitive lockdowns and increased economic pressures.

Birth Experience, Postpartum PTSD and Depression before and during the Pandemic of COVID-19 in Russia

The aim of the study is to investigate the changes in the maternal healthcare system during the pandemic and their associations with maternal mental health in Russia. A sample of Russian women who gave birth during the first year of the COVID-19 pandemic (n = 1645) and matched controls, i.e., women who gave birth before the COVID-19 pandemic (n = 611), completed an anonymous Internet survey about recent childbirth. They were assessed for childbirth-related posttraumatic stress disorder (PTSD) and postpartum depression (PPD). Clinically relevant symptoms of PPD and PTSD were high before the pandemic and showed no significant change during the pandemic (p = 0.48 and p = 0.64, respectively). We found a notable increase in the frequency of obstetric violence (p = 0.015) during the pandemic, which, in turn, has a strong correlation with birth-related PTSD and PPD. The problem of ethical communication with patients among maternal healthcare professionals is acute in Russia, and it has been exacerbated by the pandemic. Family and doula support during labor can be a potential protective factor against obstetric violence.

Hubungan Dukungan Sosial Dengan Self-EfficacyIbu Postpartum

Maternal self-efficacy is part of the concept of self-efficacy which is the mother's belief in her Maternal self-efficacy is part of the concept of self-efficacy which is the mother's belief in her ability to carry out her role as a parent, one of which can be influenced by social support. Social support arises because of interactions with other people who make a person feel cared for and appreciated, if social support is not obtained by postpartum mothers, the possibility of mothers experiencing postpartum depression will increase. The crisis period in the midst of the COVID-19 pandemic raises concerns, especially for postpartum mothers because of limited access to formal and informal support which will increase maternal mental health problems. The research design used was cross sectional. The population of this study, namely all postpartum mothers in the Pejuang Health Center Work Area, Bekasi City, amounted to 132 people and obtained a total sample of 116 respondents through a sampling technique, namely accidental sampling. Data analysis used chi-square at 95% confidence level. The results of this study showed a significant relationship between social support and MSE (p = 0.038). It is hoped that health services can increase their participation in providing counseling based on family support for postpartum mothers by including the family to have a positive effect on the bond between mother and baby.

Effects of COVID-19 on maternal anxiety and depressive disease: a literature review

The coronavirus SARS-CoV-2 (COVID-19) infection is a public health emergency of international concern. Pandemics pose a challenge to psychological resilience and can have an adverse impact on mental health. The impact of the ensuing social isolation and loneliness imposed by quarantine along with the worries about the risks of the infection and its economic fallout would appear likely to affect the mental health of the population. It has been reported that women are more likely to experience anxiety and depression symptoms during COVID-19 than men. COVID-19 pandemic had a profound impact on the level of anxiety and depression of pregnant women according to their basal level and pregnancy characteristics. Antenatal mental disorders may be a risk factor for maternal mental health problems such as an increased likelihood of postnatal depression and adverse obstetric and developmental outcomes. Effective coping strategies are associated with better psychological wellbeing during the COVID-19 pandemic, including reduced anxiety and depression. The increased risk of mental disorders due to COVID-19 requires policies to be developed to address prenatal and postpartum care to promote maternal-child wellbeing outcomes.