Refugee, asylum seeking, non-refugee, and immigrant new mothers with depressive symptoms, were interviewed in a qualitative study to better understand their (a) experiences and attributions of depressive symptoms, (b) their experiences with health care providers and support services, (c) factors that facilitated or hindered help seeking, (d) factors that aided recovery or (e) were associated with women continuing to experience symptoms of depression. Ten immigrant new mothers who scored 10 or over on the Edinburgh Postpartum Depression Scale shortly after giving birth, participated 12 to 18 months later in postpartum semi-structured interviews which were taped, transcribed and analyzed using a constant comparative approach. Many women attributed their depressive symptoms to social isolation, physical changes, feeling overwhelmed and financial worries. They had poor knowledge of community services. Barriers to care included stigma, embarrassment, language, fear of being labeled an unfit mother, or the attitude of some staff. Facilitators to recovery included social support from friends, partners and family, community support groups, "getting out of the house", or personal psychological adjustment. Personal and systematic barriers exist in new immigrant mothers obtaining care for symptoms of depression. Suggestions for improvements are offered.

Newcomer mothers have an increased risk for PPD symptoms. Social support interventions should be tested for their ability to prevent or alleviate this risk.

BackgroundMaternity health care available in Canada is based on the needs of women born in Canada and often lacks the flexibility to meet the needs of immigrant women. The purpose of this study was to explore immigrant Chinese women’s experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada.MethodsThis descriptive phenomenology study used in-depth semi-structured interviews to examine immigrant Chinese women’s experiences. Fifteen participants were recruited from the Chinese community in Toronto, Canada by using purposive sampling. The interviews were digitally recorded and transcribed verbatim into written Chinese. The transcripts were analyzed using Colaizzi’s (1978) phenomenological method.ResultsSix themes were extracted from the interviews: (1) preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, (2) strategies to deal with the inconvenience of the Canadian healthcare system (3) multiple resources to obtain pregnancy information, (4) the merits of the Canadian healthcare system, (5) the need for culturally sensitive care, and (6) the emergence of alternative supports and the use of private services.ConclusionsThe findings provide new knowledge and understanding of immigrant Chinese women’s experiences in accessing maternity health services within a large metropolitan Canadian city. Participants described two unique experiences within the themes: preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, and the emergence of alternative supports and the use of private services. Few studies of immigrant maternity service access have identified these experiences which may be linked to cultural difference. Further investigation with women from different cultural backgrounds is needed to develop a comprehensive understanding of immigrant women’s experiences with maternity care.

Excess gestational weight gain is associated with short‐ and long‐term pregnancy complications. Although a healthy diet and physical activity during pregnancy are recommended and shown to reduce the risk of complications and improve outcomes, adherence to these recommendations is low. The aims of this study were to explore women's view of nutrition and physical activity during pregnancy and to describe barriers and facilitators experienced in implementing physical activity and nutrition recommendations. In a substudy of the Be Healthy in Pregnancy randomized trial, 20 semistructured focus groups were conducted with 66 women randomized to the control group when they were between 16 and 24 weeks gestation. Focus groups were recorded, transcribed verbatim, coded and thematically analysed. The results indicate that women felt motivated to be healthy for their baby, but competing priorities may take precedence. Participants described limited knowledge and access to information on safe physical activity in pregnancy and lacked the skills needed to operationalize both physical activity and dietary recommendations. Women's behaviours regarding diet and physical activity in pregnancy were highly influenced by their own and their peers' beliefs and values regarding how weight gain impacted their health during pregnancy. Pregnancy symptoms beyond women's control such as fatigue and nausea made physical activity and healthy eating more challenging. Counselling from care providers about nutrition and physical activity was perceived as minimal and ineffective. Future interventions should address improving counselling strategies and address individual's beliefs around nutrition and activity in pregnancy.

Background:The Two-Eyed Seeing approach has been advocated for use in research with Indigenous people as it creates a space for Western and Indigenous ways of knowing to come together using the best of both worldviews to aid understanding and solve problems. Foundational literature presents its use as a promising way to promote ethical exchanges between Indigenous and non-Indigenous people, but the practical application of its concepts to research remains vague.Method:This integrative review, using the Whittemore and Knafl approach, describes the state of the literature pertaining to the interpretation and application of Two-Eyed Seeing. Following a search of the literature, 37 articles were selected for inclusion, and primary studies ( n = 11) were critiqued for quality. Data were extracted, analyzed, and synthesized into themes.Results:Three themes were compiled from the literature including (a) defining characteristics of Two-Eyed Seeing, (b) suggested attributes of those engaging with Two-Eyed Seeing, and (c) the application of Two-Eyed Seeing in research.Conclusions:This review demonstrates inconsistencies in how to date researchers have interpreted and applied Two-Eyed Seeing in research with Indigenous people. The collection of key attributes of researchers and application procedures to research discussed in this review present a new standard for the application of Two-Eyed Seeing to research with Indigenous people. Researchers using Two-Eyed Seeing should thoroughly describe their application of its concepts to promote its maturation into a well-defined framework for research with Indigenous people.

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.

No abstract

BackgroundFew studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday.MethodsA qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently.ResultsThe mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent.ConclusionsOur findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation.