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Challenges Faced by New Mothers in the Early Postpartum Period: An Analysis of Comment Data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) Survey

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Abstract

Objective To identify challenges that women face 2–9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS). Methods PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states who answered the PRAMS survey in 2000. Preliminary analysis included a review of the comment data to identify major themes and a demographic comparison of women who commented (n = 3,417) versus women who did not (n = 12,497). Subsequent analysis included systematic coding of the data from 324 women that commented about postpartum concerns and evaluation to ensure acceptable levels of reliability among coders. Results We identified the following major themes, listed in order of frequency: (1) need for social support, (2) breastfeeding issues, (3) lack of education about newborn care after discharge, (4) need for help with postpartum depression, (5) perceived need for extended postpartum hospital stay, and (6) need for maternal insurance coverage beyond delivery. Conclusion The themes identified indicate that new mothers want more social support and education and that some of their concerns relate to policies regarding breastfeeding and medical care. These results can be used to inform programs and policies designed to address education and continuity of postpartum care for new mothers.

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References

  1. American Academy of Pediatrics Committee on Fetus, Newborn, The American College of Obstetricians and Gynecologists Committee on Obstetric Practice. (1997). Guidelines for perinatal care (4th ed.). Washington, DC: American College of Obstetricians and Gynecologists.

    Google Scholar 

  2. Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295.

    Article  PubMed  Google Scholar 

  3. Fowles, E. R. (1998). Labor concerns of women two months after delivery. Birth, 25, 235–240.

    Article  PubMed  CAS  Google Scholar 

  4. Riecher-Rossler, A., & Hofecker Fallahpour, M. (2003). Postpartum depression: Do we still need this diagnostic term? Acta Psychiatrica Scandinavica Supplementum, 418, 51–56.

    Article  PubMed  Google Scholar 

  5. Shakespeare, J., Blake, F., & Garcia, J. (2003). A qualitative study of acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale. The British Journal of General Practice, 53(493), 614–619.

    PubMed  Google Scholar 

  6. Sobotkova, D., & Stembera, Z. (2003). Psychological aspects in perinatal medicine 1980–2000: III. The postnatal period. Ceska Gynekologie, 68(6), 385–389.

    PubMed  CAS  Google Scholar 

  7. Verkerk, G. J., Pop, V. J., Van Son, M. J., & Van Heck, G. L. (2003). Prediction of depression in the postpartum period: A longitudinal follow-up study in high-risk and low-risk women. Journal of Affective Disorders, 77(2), 155–156.

    Article  Google Scholar 

  8. Honey, K. L., Bennett, P., & Morgan, M. (2003). Predicting postnatal depression. Journal of Affective Disorders, 76(1–3), 201–210.

    Article  PubMed  Google Scholar 

  9. Salmela-Aro, K., Nurmi, J. E., Saisto, T., et al. (2001). Goal reconstruction and depressive symptoms during the transition to motherhood: Evidence from two cross-lagged longitudinal studies. Journal of Personality and Social Psychology, 81(6), 1144–1159.

    Article  PubMed  CAS  Google Scholar 

  10. Martinez-Schallmoser, L., Telleen, S., & MacMullen, N. J. (2003). The effect of social support and acculturation on postpartum depression in Mexican American women. Journal of Transcultural Nursing, 14(4), 329–338.

    Article  PubMed  Google Scholar 

  11. Tammertie, T., Tarkka, M. T., Astedt-Kurki, P., Paavilainen, E., & Laippala, P. (2004). Family dynamics and postnatal depression. Journal of Psychiatric and Mental Health Nursing, 11(2), 141–149.

    Article  Google Scholar 

  12. Gross, K. H., Wells, C. S., Radigan-Garcia, A., & Dietz, P. M. (2002). Correlates of self-reports of being very depressed in the months after delivery: Results from the Pregnancy Risk Assessment Monitoring System. Maternal and Child Health Journal, 6(4), 247–253.

    Article  PubMed  Google Scholar 

  13. Crockenberg, S. C., & Leerkes, E. M. (2003). Parental acceptance, postpartum depression, and maternal sensitivity: Mediating and moderating processes. Journal of Family Psychology, 17(1), 80–93.

    Article  PubMed  Google Scholar 

  14. Dearing, E., Taylor, B. A., & McCartney, K. (2004). Implications of family income dynamics for women’s depressive symptoms during the first 3 years after childbirth. American Journal of Public Health, 94(8), 1372–1377.

    Article  PubMed  Google Scholar 

  15. Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C., Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and socio-deomographic correlates of depressive symptoms in Black mothers during the first 18 months postpartum. Maternal and Child Health Journal, 7(3), 157–168.

    Article  PubMed  Google Scholar 

  16. Henderson, J. J., Evans, S. F., Straton, J. A., Priest, S. R., & Hagan, R. (2003). Impact of postnatal depression on breastfeeding duration. Birth, 30(3), 175–180.

    Article  PubMed  Google Scholar 

  17. Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6(4), 263–274.

    Article  PubMed  CAS  Google Scholar 

  18. Righetti Veltema, M., Bousquet, A., & Manzano, J. (2003). Impact of postpartum depressive symptoms on mother and her 18-month-old infant. European Child & Adolescent Psychiatry, 12(2), 75–83.

    Article  Google Scholar 

  19. Herrera, E., Reissland, N., & Shepard, J. (2004). Maternal touch and maternal child-directed speech: Effects of depressed mood in the postnatal period. Journal of Affective Disorders, 81(1), 29–39.

    Article  PubMed  Google Scholar 

  20. Ferber, S. G. (2004). The nature of touch in mothers experiencing maternity blues: The contribution of parity. Early Human Development, 79(1), 65–75.

    Article  PubMed  Google Scholar 

  21. Ahluwalia, I. B., Morrow, B., & Hsia, J. (2005). Why do women stop breastfeeding? Findings from Pregnancy Risk Assessment Monitoring System. Pediatrics, 116(6), 1408–1412.

    Article  PubMed  Google Scholar 

  22. Ahluwalia, I. B., Morrow, B., Hsia, J., & Grummer-Strawn, L. M. (2003). Who is breastfeeding? Recent trends from the Pregnancy Risk Assessment Monitoring System. The Journal of Pediatrics, 142(5), 486–491.

    Article  PubMed  Google Scholar 

  23. American Academy of Pediatrics. (1997). Breastfeeding and the use of human milk. Pediatrics, 100(6), 1035–1039.

    Article  Google Scholar 

  24. Morse, C., Durkin, S., Buist, A., & Milgrom, J. (2004). Improving the postnatal outcomes of new mothers. Journal of Advanced Nursing, 45(5), 465–474.

    Article  PubMed  Google Scholar 

  25. Ogrodniczuk, J. S., & Piper, W. E. (2003). Preventing postnatal depression: A review of research findings. Harvard Review of Psychiatry, 11(6), 291–307.

    Article  PubMed  Google Scholar 

  26. Marks, M. N., Siddle, K., & Warwick, C. (2003). Can we prevent postnatal depression? A randomized controlled trial to assess the effect of continuity of midwifery care on rates of postnatal depression in high-risk women. The Journal of Maternal-Fetal Medicine, 13(2), 119–127.

    Article  CAS  Google Scholar 

  27. Brown, S., Bruinsma, F., Darcy, M. A., Small, R., & Lumley, J. (2004). Early discharge: No evidence of adverse outcomes in three consecutive population-based Australian surveys of recent mothers, conducted in 1989, 1994 and 2000. Paediatric and Perinatal Epidemiology, 18(3), 202–213.

    Article  PubMed  Google Scholar 

  28. Reever, M. M., et al. (1998). Early postpartum discharge versus traditional length of stay: Patient preferences. The Southern Medical Journal, 91, 138–143.

    CAS  Google Scholar 

  29. Tran, M., Young, L., Phung, H., et al. (2001). Quality of health services and early postpartum discharge: Results from a sample of non-English-speaking women. Journal of Quality in Clinical Practice, 21(4), 135–143.

    Article  PubMed  CAS  Google Scholar 

  30. Boury, J. M., Larkin, K. T., & Krummel, D. A. (2004). Factors related to postpartum depressive symptoms in low-income women. Women Health, 39(3), 19–34.

    Article  PubMed  Google Scholar 

  31. Matthey, S., Kavanagh, D. J., Howie, P., Barnett, B., & Charles, M. (2004). Prevention of postnatal distress of depression: An evaluation of an intervention at preparation for parenthood classes. Journal of Affective Disorders, 79(1–3), 113–126.

    Article  PubMed  Google Scholar 

  32. Simons, J., Reynolds, J., Mannion, J., & Morison, L. (2003). How the health visitor can help when problems between parents add to postnatal stress. Journal of Advanced Nursing, 44(4), 400–411.

    Article  PubMed  Google Scholar 

  33. Heh, S. S. (2003). Relationship between social support and postnatal depression. The Kaohsiung Journal of Medical Sciences, 19(10), 491–496.

    Article  PubMed  Google Scholar 

  34. Wilkinson, J., Phillips, S., Jackson, J., & Walker, K. (2003). “Mad for Fitness”: Exercise group to combat a high incidence of postnatal depression. The Journal of Family Health Care, 13(2), 44–48.

    PubMed  Google Scholar 

  35. Mauthner, N. S. (1995). Postnatal depression: The significance of social contacts between mothers. Women’s Studies International Forum, 18(3), 311–323.

    Article  Google Scholar 

  36. Sword, W., & Watt, S. (2005). Learning needs of postpartum women: Does socioeconomic status matter? Birth, 32(2), 86–92.

    Article  PubMed  Google Scholar 

  37. Nichols, M. R., & Roux, G. M. (2004). Maternal perspectives on postpartum return to the workplace. J Obstetric, Gynecologic, and Neonatal Nursing, 33(4), 463–471.

    Article  Google Scholar 

  38. Bernard, H. R. (1994). Research methods in anthropological qualitative and quantitative approaches (2nd ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  39. Shulman, H. B., Colley Gilbert, B., & Lansky, A. (2006). The Pregnancy Risk Assessment Monitoring System (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121, 74–83.

    PubMed  Google Scholar 

  40. Williams, L. M., Morrow, B., Beck, L. F., et al. (2005). PRAMS 2000 surveillance report. Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

    Google Scholar 

  41. MacQueen, K. M., McLellan, E., Kay, K., & Milstein, B. (1999). Codebook development for team-based qualitative analysis. Cultural Anthropology Methods, 10(2), 31–36.

    Google Scholar 

  42. Hruschka, D. J., Schwartz, D., Picone-DeCaro, E., Cobb St. John, D., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16(3), 307–331.

    Article  Google Scholar 

  43. Carey, J. W., Morgan, M., & Oxtoby, M. J. (1996). Intercoder agreement in analysis of responses to open-ended interview questions: Examples from tuberculosis research. Cultural Anthropology Methods, 8(3), 1–5.

    Google Scholar 

  44. Carey, J. W. (2003). Systematic qualitative data collection and analysis: Consideration in choosing software that will meet your needs [presentation]. Atlanta, GA: Centers for Disease Control and Prevention.

    Google Scholar 

  45. Drewett, R., Blair, P., Emmett, P., & Emond, A. (2004). Failure to thrive in the term and preterm infants of mothers depressed in the postnatal period: A population-based birth cohort study. Journal of Child Psychology and Psychiatry, 45(2), 359–366.

    Article  PubMed  Google Scholar 

  46. Ukpong, D. I., Fatoye, F. O., Oseni, S. B., & Adewuya, A. O. (2003). Postpartum emotional distress in mothers of preterm infants: A controlled study. East African Medical Journal, 80(6), 89–92.

    Google Scholar 

  47. Philipp, B. L., Malone, K. L., Cimo, S., & Merewood, A. (2003). Sustained breastfeeding rates at a US baby-friendly hospital. Pediatrics, 112(3 pt 1), e234–236.

    Article  PubMed  Google Scholar 

  48. Merten, S., & Ackermann-Liebrich, U. (2004). Exclusive breastfeeding rates and associated factors in Swiss baby-friendly hospitals. Journal of Human Lactation, 20(1), 9–17.

    Article  PubMed  Google Scholar 

  49. Haider, S. J., Jacknowitz, A., & Schoeni, R. F. (2003). Welfare work requirements and child well-being: Evidence from the effects on breastfeeding. Demography, 40(3), 479–497.

    Article  PubMed  Google Scholar 

  50. Roe, B., Whittington, L. A., Fein, S. B., & Teisl, M. F. (1999). Is there competition between breastfeeding and maternal employment? Demography, 36(2), 157–171.

    Article  PubMed  CAS  Google Scholar 

  51. Koo, V., Lunch, J., & Cooper, S. (2003). Risk of postnatal depression after emergency delivery. The Journal of Obstetrics and Gynaecology Research, 29(4), 246–250.

    Article  PubMed  Google Scholar 

  52. Cohen, M. M., Ansara, D., Schei, B., Stuckless, N., & Steward, D. E. (2004). Posttraumatic stress disorder after pregnancy, labor, and delivery. Journal of Women’s Health, 13(3), 315–324.

    Article  PubMed  Google Scholar 

  53. Merchant, D. C., Affonso, D. D., & Mayberry, L. J. (1995). Influence of marital relationship and child-care stress on maternal depression symptoms in the postpartum. Journal of Pyschosomatic Obstetrics and Gynaecology, 16, 193–200.

    CAS  Google Scholar 

  54. Fowles, E. R. (1998). Labor concerns of women two months after delivery. Birth, 25, 235–240.

    Article  PubMed  CAS  Google Scholar 

  55. Dalby, D. M., Williams, J. I., Hodnett E., et al. (1996). Postpartum safety and satisfaction following early discharge. Canadian Journal of Public Health, 87(2), 90–94.

    CAS  Google Scholar 

  56. Martell, L. K. (2003). Postpartum women’s perceptions of the hospital environment. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(4), 478–485.

    Article  PubMed  Google Scholar 

  57. Jones, P. M. (1997). Patient satisfaction with home care after early postpartum hospital discharge. Home Care Provider, 2(5), 235–241.

    Article  PubMed  CAS  Google Scholar 

  58. MacArthur, C., Winter, H. R., Bick, D. E., et al. (2002). Effects of redesigned community postnatal care on womens’ health 4 months after birth: A cluster randomized controlled trial. Lancet, 359, 378–385.

    Article  PubMed  CAS  Google Scholar 

  59. Olds, D. L., Henderson, C. R., Kitzman, H. J., Eckenrode, J. J., Cole, R. E., Tatelbaum, R. C., et al. (1999). Prenatal and infancy home visitation by nurses: Recent findings. The Future of Children, 9(1), 44–65.

    Article  PubMed  CAS  Google Scholar 

  60. Weiss, H. B. (1993). Home visits: Necessary but not sufficient. Future Child, 3(3), 113–128.

    Article  Google Scholar 

  61. Duggan, A. K., McFarlane, E. C., Windham, A. M., et al. (1999). Evaluation of Hawaii Healthy Start program. The Future of Children, 9(1), 66–90.

    Article  PubMed  CAS  Google Scholar 

  62. Gomby, D. S., Culross, P. L., & Behrman, R. E. (1999). Home visiting: Recent program evaluations-analysis and recommendations. The Future of Children, 9(1), 4–26.

    Article  PubMed  CAS  Google Scholar 

  63. Berg, C., Danel, I., & Mora, G. (Eds.) (1996). Guidelines for maternal mortality epidemiological surveillance. Washington, DC: OPS.

  64. Edwards, J., Bronstein, J., & Adams, K. (2003). Evaluation of medicaid family planning demonstrations. Centers for Medicare & Medicaid Services.

  65. Gold, R. B. (1999). State efforts to expand medicaid-funded family planning show promise. The Guttmacher Report on Public Policy, 2(2), 8–11. The Alan Guttmacher Institute.

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Acknowledgements

The authors thank Denise Roth Allen and Melissa Federman for their input and assistance with this manuscript. The authors also acknowledge the PRAMS Working Group:

PRAMS Working Group: Alabama: Albert Woolbright, PhD; Alaska: Kathy Perham-Hester, MS, MPH; Arkansas: Gina Redford, MAP; Colorado: Alyson Shupe, PhD; Florida: Helen Marshall; Georgia: Carol Hoban, MS, MPH; Hawaii: Limin Song, MPH, CHES; Illinois: Theresa Sandidge, MA; Louisiana: Joan Wightkin; Maine: Kim Haggan; Maryland: Diana Cheng, MD; Michigan: Yasmina Bouraoui, MPH; Minnesota: Jan Jernell; Mississippi: Linda Pendleton, LMSW; Montana: JoAnn Dotson; Nebraska: Jennifer Severe-Oforah; New Jersey: Lakota Kruse, MD; New Mexico: Ssu Weng, MD, MPH; New York State: Anne Radigan-Garcia; New York City: Candace Mulready, MPH; North Carolina: Paul Buescher, PhD; North Dakota: Sandra Anseth, RN; Ohio: Amy Davis; Oklahoma: Dick Lorenz; Oregon: Ken Rosenberg, MD, MPH; Rhode Island: Sam Viner-Brown; South Carolina: Jim Ferguson, DrPH; Texas: Tanya J. Guthrie, PhD; Utah: Laurie Baksh; Vermont: Peggy Brozicevic; Washington: Linda Lohdefinck; West Virginia: Melissa Baker, MA; CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health.

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Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA

    Sarojini Kanotra, Tanya M. Phares, Brian Morrow, Wanda D. Barfield & Amy Lansky

  2. Science Applications International Corporation (SAIC), San Diego, CA, USA

    Denise D’Angelo

  3. Louisville Metro Health Department of Public Health & Wellness, 400 East Gray Street, Louisville, KY, 40202, USA

    Sarojini Kanotra

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  1. Sarojini Kanotra
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Correspondence to Sarojini Kanotra.

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Kanotra, S., D’Angelo, D., Phares, T.M. et al. Challenges Faced by New Mothers in the Early Postpartum Period: An Analysis of Comment Data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) Survey. Matern Child Health J 11, 549–558 (2007). https://doi.org/10.1007/s10995-007-0206-3

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