No abstract

Objective To compare the emotional responses of mothers of late-preterm infants "(34 0/7 to 36 6/7 weeks gestation) with those of mothers of full-term infants. Design A mixed method comparative study. Setting A southeastern tertiary academic medical center postpartum unit. Participants Sixty mothers: 29 mothers of late-preterm infants and 31 mothers of full-term infants. Methods Measures of maternal emotional distress "(four standardized measures of anxiety, postpartum depression, posttraumatic stress symptoms, and worry about infant health) and open-ended semistructured maternal interviews were conducted in the hospital following birth and by phone at one month postpartum. Results Mothers of late-preterm infants experienced significantly greater emotional distress immediately following delivery, and their distress levels continued to be higher at one month postpartum on each of the standardized measures. Mothers of late-preterm infants also discussed the altered trajectories in their birth and postpartum experiences and feeling unprepared for these unexpected events as a source of ongoing emotional distress. Conclusion Mothers of late-preterm infants have greater emotional distress than mothers of term infants for at least one month after delivery. Our findings suggest that it may not be a single event that leads to different distress levels in mothers of late-preterm and full-term infants but rather the interaction of multiple alterations in the labor and delivery process and the poorer-than-expected infant health outcomes. In the future, researchers need to examine how and when mothers’ emotional responses change over time and how their responses relate to parenting and infant health and development.

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version.If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting). Your paper will be maintained in active status for 21 days from the date of this letter. If we have not heard from you by Jul 09, 2019, we will assume you wish to withdraw the manuscript from further consideration. REVIEWER COMMENTS:Reviewer #1:1. Title. The study is about racial disparities in the evaluation and treatment of postpartum pain. Data were obtained from an electronic medical record, but the study is not about "using the electronic medical record" per se. The EMR is not mentioned in the results. Would consider revising the title. Precis.Suggest summarizing what you found rather than writing that you found something.3. Abstract. This is a faithful summary of the manuscript. a. Might include a sentence in the results about the number of women studied (1751), and something about the number of times pain was assessed, as there were > 31K pain scores. b. Line 59. Would define OTE. c. Lines 62-63. Would delete or revise this sentence, because the reader may infer that your study is not novel, e.g. convey that the previous studies were not postpartum women. 4. Introduction. a. Lines 67-68. Higher perinatal morbidity and mortality among fetuses and infants of black women, or higher morbidity and mortality among black women? b. Lines 82-84. This appears to be the objective, but it is not a complete sentence. Minor, but the authors aren't comparing EMR data with other data, so does this merit being part of the study objective? c. Lines 84-87. The authors hypothesized that black women would undergo fewer pain assessments and receive less pain medication. That is fine, but if perhaps the authors (instead) didn't think they were denying women needed pain medication but thought it would be an important question to investigate, could rephrase accordingly. 5. Methods. a. Generally the inclusion and exclusion criteria go in the methods. The Ns are considered results. b. Line 103. What is the Carolina Data Wearhouse? c. Line 118-129. Were the EMR data (pain scores and other variables evaluated) recorded per protocol in a table or other method of data-entry that was readily searchable in aggregate, or did investigators need to sort...