Maternal and infant risks in preterm births and postpartum mental health

Maternal Risk Entity

Is there anything more important to a family -- and to the community of interest around that family -- than the safe and healthy delivery of the brand new baby and its mother? Modern medicine has provided technologies and training to alleviate many of the risks vis-a-vis mother and infant, however there is never going to be a situation absolutely free of potential risks surrounding pregnancy, childbirth, and the post-pregnancy period. Hence, nurses and physicians and other healthcare professionals must stay informed and be fully prepared to come up with solutions when risky situations occur. This paper presents the peer-reviewed literature on several maternal risks and there possible remedies.

Infants' Risks in Late Preterm Births

In the peer-reviewed journal Birth, the authors point out that the preterm birth rate has risen from 10.6 births in 1990 to 12.8% in 2006 -- a twenty percent increase (Kirby, et al., 2010). Meanwhile there has been an increase of 26% in late preterm births (34-36 weeks) between 1990 and 2006; and while it is well-known that babies born before the 34th week of gestation are at risk "for life-long morbidity and early mortality," only recently, the authors assert, have healthcare researchers noted that there are also risks for late preterm babies (Kirby, 169).

What are the risks for late preterm babies, and why is this issue an important topic for a nurse to delve into? The infant born in the late preterm is at an "increased risk" of the following complications: a) respiratory disease; b) brain injuries which result in "long-term neurodevelopmental disorders"; and c) possible "death before the first birthday"; and d) an increased risk of "intensive and prolonged hospitalization" which means high medical bills (Kirby, 169).

The authors want readers to understand that what they are reporting goes against "conventional wisdom" when it comes to pediatric and obstetric practices. Why? Because previously those two above mentioned groups viewed children born late preterm and at term to be "medically similar" -- but Kirby and colleague are suggesting they are not similar vis-a-vis risks to their health. Kirby and colleague don't offer an intervention theory but they do say on page 171 that a more accurate gauge measuring gestational age should be developed. Moreover, they suggest that a new definition for "preterm birth" might be more accurately listed at any birth short of 39 weeks of gestation (171).

Postpartum Negative Moods Present Risks to the Mother and Baby

Postpartum experiences have long been a subject of study in the medical field, and it has been known that the postpartum experience "interferes with maternal-infant bonding" and also can carry with it "long-term negative consequences" (Weisman, et al., 2010). The article in the journal Archives of Women's Mental Health researched a "community cohort of 1,844 low-risk women" who had delivered a singleton term baby.

The research involved a very intense assessment of: a) the quality of the delivery; b) "emotions during labor"; c) attitudes toward the pregnancy and the infant; d) "mood regulation"; and e) postpartum "anxiety and depression" (Weisman, 505). The results of this research, which involved conditions of low risk for the mother and baby, included the following: 20.5% of parturient (those about to give birth) women "reported high levels of depressive symptoms" (Weisman, 505).

For women at low risk -- among the 1,844 who were part of the study -- who had Cesarean Section Delivery, 23% reported that they had high levels of depressive symptoms; for women who had normal vaginal deliveries 19% had depressive symptoms; and for women who had assisted vaginal deliveries, the percentage having high levels of depressive symptoms (Weisman, 505).

When anxiety was measured, it was the highest in Cesarean Delivery and it was the lowest in normal vaginal delivery of the child, Weisman continues. Mothers who went through Cesarean Deliveries reported that their labor experience was the "most negative" and they had the highest somatic symptoms during their last trimester; moreover the Cesarean mothers were "the least efficient" when it came to dealing with their negative mood (Weisman, 505).

This research into postpartum experiences -- which, as mentioned, brings risk for the child and the ability of mother and child to bond in a normal way -- found that the higher the maternal age the greater the chances of: postpartum depression; labor pain; "inefficient mood regulation; somatic symptoms; and moreover, the older the woman the more negative "and less positive perception" of the fetus during the last trimester (Weisman, 505).

What are the clinical implications of this research? Weisman notes that since rates of Cesarean Delivery are on the rise in the West (U.S., UK, Canada, and Mexico) and in Europe and parts of Asia, based on the survey referenced above, there are greater risks in Cesarean deliveries. Why? Because without strong mother-child bonding children can suffer later in life.

Screening for Domestic Violence

Just as important to the nursing field as having midwives understand mental health problems is the fact that all healthcare professionals involved in maternal and child health nursing should cognizant of domestic violence vis-a-vis the expectant mother. In this peer-reviewed article the main point is that nurses need to be knowledgeable about how to screen expectant mothers to see if they have been (or are) victims of domestic violence (Hooker, 2012). The children are at risk, and it seems obvious that expectant mothers should be screened, but Hooker reports that "screening in the health care setting remains controversial" (213). The answer to this issue is the development of "appropriate and ongoing training, education and specific resources" for nurses that are employed in the maternal field. In other words, the idea of screening (for the health and psychological well being of the mother and baby) should not be controversial. And healthcare educational institutions should be training nurses for the screening they should be conducting.

In conclusion, all four of these peer-reviewed articles present commonsense approaches to understanding issues that can have negative outcomes for mothers and their babies. But is simply understanding the problem enough? No, but it is a start that should launch the alert nurse or student nurse into deeper research. Postpartum depression is not a new problem but it is an ongoing problem, and midwives' failure to be trained in mental illness is also not new but it cries out for training. In the same framework, mothers who suffer domestic violence do not open up new doors, but the need to screen them is new. And the first article points out that there should perhaps be a more accurate way to tell how far along a pregnant women is, so that it can be determined the degree of risk for her baby.