The COVID-19 pandemic has led to disruptions in health care in the perinatal period and women's childbirth experiences. Organizations that represent health care professionals have responded with general practice guidelines for pregnant women, but limited attention has been devoted to mental health in the perinatal period during a pandemic. Evidence suggests that in this context, significant psychological distress may have the potential for long-term psychological harm for mothers and infants. For infants, this risk may extend into early childhood. In this commentary, we present recommendations for practice, research, and policy related to mental health in the perinatal period. These recommendations include the use of a trauma-informed framework to promote social support and infant attachment, use of technology and telehealth, and assessment for mental health needs and experiences of violence.

Aims and objectives. To examine the effects of a low cost advanced practice nurse telephone intervention for 2 months postbirth in low-income first time mothers with healthy full term infants. Background. Currently women with non-complicated, healthy full term newborn deliveries receive little to no routine postpartum support. This is problematic if mothers are first time mothers, poor, have problems accessing health care, have language barriers and sparse social support. Design. A two group randomised clinical trial. This study was conducted in an inner city South Florida county hospital. Methods. A control group (n = 69) received routine hospital discharge care. An intervention group (n = 70) received routine hospital discharge care plus APN follow up telephone calls for week 8 postdischarge. Comparison of outcomes included maternal health (stress, social support, physical health), infant health (routine medical visits, immunisations, weight gain), morbidity (urgent care visits, emergency room visits, re-hospitalisations), and health care charges (urgent care visits, emergency room visits, re-hospitalisations). Data were analysed using descriptive statistics and two-sample t-tests. Results. Intervention group mothers had significantly lower perceived stress, significantly greater perceived maternal health and social support; infants had healthier weight gain, fewer emergency room visits; significantly lower total health care charges ($14,333 vs. $70,834) compared to controls. Conclusion. Study results indicate that APN follow up telephone calls to low-income first time mothers with healthy full term infants is an effective, safe, low cost, easy to apply intervention that improved mothers' and infants' health outcomes and reduced healthcare charges. Relevance to clinical practice. APNs are uniquely positioned to conduct follow up interventions aimed at providing continuity of care including APN telephone follow up. This is imperative for vulnerable populations especially during times of major budget cuts that affect health care services.

Objective Healthcare professionals’ empathy have been empirically demonstrated to decrease the risk of medical errors. Medical errors affect patient’s outcomes and healthcare providers’ well-being. Therefore, the purpose of this study was to determine the relationship between patients’ perception of healthcare providers’ empathy, their intention to adhere to treatment, and their perception of medical errors made. An anonymous survey was emailed to staff at a health center and an urban university in Miami, Florida, USA. Results A total of 181 participants were enrolled. Participants rating their healthcare provider as high in empathy had 80% lower odds of reporting errors (CI 0.04–0.6). The intention to follow-up with recommendations or return to the provider were not significantly associated with provider’s empathy. Patients of high empathy providers were no more treatment adherent that those who rated their provider with low empathy but were less likely to perceive medical error. Providers’ empathy significantly affected patients’ perception of medical errors. Our results underscore that healthcare curricula need to address the link between empathy and perception of medical errors, including its potential legal implications.

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Education is needed to raise awareness of risks of prepregnancy weight and excessive weight gain for mother and infant. The need for prenatal nutritional counseling to reduce the intake of calories, fats, sweets, and snacks; increase intake of vegetables, fruits, foods with iron, folate, and fiber.

Understanding the sociocultural determinants of infant-feeding choices is critical to the development of prevention initiatives to eliminate pediatric HIV.

Background Infant feeding practices are imperative for babies’ and mothers’ health and emotional wellbeing. Although infant feeding may seem simple, the decisions surrounding it are complex and have far-reaching implications for women globally. This is an especially difficult concern among mothers living with HIV because breastfeeding can transmit HIV from mother to child. This is further complicated by cultural expectations in case of Black mothers living with HIV. This paper discusses determinants of infant feeding practices among Black mothers living with HIV who were on anti-retroviral therapy (ART) in two North American cites and one African city. Methods A cross-sectional, multi-country survey using venue-based convenience sampling of Black mothers living with HIV was employed. The effective response rates were 89% (n = 89) in Ottawa, Canada; 67% (n = 201) in Miami, Florida, US; and 100% (n = 400) in Port Harcourt, Nigeria, equaling a total sample size of 690. Data were collected in Qualtrics and managed in Excel and SPSS. Multinomial logistic regression analyses were used to determine the factors influencing the mothers’ infant feeding practices (Exclusive Formula Feeding [EFF] = 1; Mixed Feeding [MF] = 2; and Exclusive Breastfeeding [EBF while on ART] =3). Results The results highlight socio-demographics, EFF determinants, and EBF determinants. The statistically significant determinants of infant feeding practices included national guideline on infant feeding, cultural beliefs and practices, healthcare systems, healthcare personnel, infant feeding attitudes, social support, and perceived stress. Mothers’ mean ages were Ottawa (36.6 ± 6.4), Miami (32.4 ± 5.8), and Port Harcourt (34.7 ± 5.7). All sampled women gave birth to least one infant after their HIV diagnoses. Statistically significant (p < .05) determinants of EFF relative to MF were the national guideline of EFF (relative risk [RR] = 218.19), cultural beliefs (RR = .15), received healthcare (RR = 21.17), received healthcare through a nurse/midwife (RR = 3.1), and perceived stress (RR = .9). Statistically significant determinants of EBF relative to MF were received healthcare (RR = 20.26), received healthcare through a nurse/midwife (RR = 2.31), functional social support (RR = 1.07), and perceived stress (RR = .9). Conclusion While cultural beliefs and perceived stress favoured MF over EFF, advice of healthcare workers, and the care received from a nurse/midwife improved EFF over MF. Also while the mothers’ perceived stress favoured MF over EBF, advice of their nurses or midwife and the social support improved EBF over MF. The providers advice was congruent with WHO and national guidelines for infant feeding among mothers living with HIV. These results have implications for nursing, healthcare practice, and policies on infant feeding practices for mothers living with HIV.

Purpose-To (a) describe women's prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor).Design and Methods-Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women's homes. Patients' problems and APN interventions were classified with the Omaha Classification System. Findings-A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1 %). Women with chronic hypertension required significantly more case-management interventions.Conclusions-The categories of women's problems were largely similar across medical diagnostic groups. Interventions to address women's problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies. The literature lacks empirical data for profiles of common problems women encounter during or following high risk pregnancy from the women's perspectives (Kline, Martin, & Deyo, 1998;Leithner et al., 2006). In addition, other than drug or specific medical treatment, few empirical data exist on provider responses to common problems women encounter. Such data are important in targeting health care resources for optimal pregnancy outcomes.This study was conducted to describe women's prenatal and postpartum problems and APN interventions and to determine if women's problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor). Data for this secondary analysis were derived from a two-group randomized clinical trial to examine prenatal maternal and infant outcomes and healthcare costs through 1 year after delivery. In the clinical trial, women in the control group received prenatal care delivered by physicians in the prenatal clinic or the physicians' offices. Women in the intervention group received half of their prenatal care from physicians in the prenatal clinic or the physicians' offices and half of their prenatal care from APNs in the women's homes (Brooten et al., 2001). Postpartum, APNs provided one home visit to the intervention group women. Women ...