Conectar
by Elizabeth O. Bodunde, Fergus P. McCarthy, Karen O’connor, Karen Matvienko-Sikar, Ali S. Khashan
IntroductionLimited evidence exists on the association between mode of birth and long-term depression and/or severe anxiety in mothers. We aimed to examine the association between mode of birth and depression and/or severe anxiety by 14 years postpartum.
MethodsWe used data from the Millennium Cohort Study. Data on mode of birth were collected when mothers were 9 months postpartum, and categorized as spontaneous vaginal birth (VB), assisted VB, induced VB, emergency cesarean section (CS), planned CS, and CS after induction. Depression/severe anxiety were collected as one variable and self reported by mothers at 9 months, 3, 5, 7, 11, and 14 years postpartum based on a doctor diagnosis. The primary outcome measure was a diagnosis of depression/severe anxiety up to 14 years postpartum. We used multivariable logistic regression models to estimate crude and adjusted odds ratios (OR) for the association between mode of birth and depression/severe anxiety by 14 years postpartum.
ResultsThere were 10,507 singleton mothers included in our analyses. Fully adjusted odds ratio (aOR)for the association between mode of birth and depression/severe anxiety by 14 years postpartum was induced VB, (aOR, 1.13 [95% CI], 1.01–2.28), assisted VB (aOR, 1.03 [95% CI], 0.89–1.19), Emergency CS, (aOR, 1.08 [95% CI], 0.92–1.27), planned CS (aOR, 1.09 [95% CI], 0.93–1.27), and CS after induction (aOR, 1.08 [95% CI], 0.91–1.28). Fully adjusted models did not report any significant association between mode of birth and depression/severe anxiety at other postpartum time points.
ConclusionsThe present findings provide support for association between induction of labor and the risk of long-term depression/severe anxiety by 14 years postpartum. The findings provide no evidence to support association between other modes of birth and maternal depression/anxiety.
Women and men/partners who experience miscarriage often report poor care experiences within health services around the time of miscarriage and beyond; less is known about recurrent miscarriage (RM) care. Research is needed to explore the potential targets for improvement, in addition to identifying factors that support or hinder service improvement efforts and the implementation and/or sustainment of desired models of RM care. This study aimed to explore the views of knowledge users regarding RM services and supports; specifically: (a) practices and experiences and (b) facilitators and barriers to providing desired services and supports.
We adopted a qualitative study design underpinned by constructivism, incorporating semistructured interviews. Data were analysed using reflexive thematic analysis.
Participants were recruited across the Republic of Ireland, incorporating perspectives from different geographical areas, hospital types and RM services.
We interviewed 13 women and 7 men/partners who had experienced ≥2 consecutive miscarriages, and 42 people involved in the delivery and/or management of RM services and supports, between June 2020 and February 2021.
We generated three themes from the data: (1) dedicated staff; (2) dedicated space and time and (3) dedicated funding and support—prioritise RM. Our analysis supports the need for a standardised, dedicated and adequately resourced and supported service. One in which people experiencing RM are offered appropriate, individualised, timely and accessible care and support—beginning following the first miscarriage, and following a graded model. Implementation requires several multilevel actions, including prioritising RM care, adequately funding and resourcing services, enhancing health professional education and support, care coordination within and between hospitals and primary care and improving public awareness of, and addressing stigma surrounding, miscarriage.
Our analysis provides context to ‘good’ and ‘poor’ care experiences and identifies what facilitators and barriers exist to affecting change in RM care within healthcare and broader systems. In light of recent debates regarding how best to deliver RM care, and changing international guidelines, this work provides timely and important knowledge that should be harnessed to inform service improvement efforts in the Republic of Ireland and beyond.
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