Wendy Anne Hall

Background: Individuals experiencing perinatal loss are entitled to respectful maternity care, but a paucity of research examines respectful care at the time of pregnancy loss. Method: We used data from an online cross‐sectional survey (July 2020–February 2022), where 172 individuals reported on early (miscarriage) and late (late second trimester, stillbirth, neonatal death) losses since 2009. We aimed to explore inequities in respectful care experiences among individuals experiencing a late versus early perinatal loss in Canada. We assessed their experiences using the Mothers' Autonomy in Decision Making (MADM) scale and the Mothers on Respect Index (MORi). We created the Compassionate Disclosure of (perinatal) Loss (CDL) index to measure respectful care at the time of a loss. A single separate item, provider not listening to the individual's expression of concerns during pregnancy, was also analyzed. Results: The early and late loss groups differed in education levels. Individuals who self‐identified as Indigenous/Black/People of Color (IBPOC) had lower odds of scoring in the top quartile on MADM and MORi scales (AOR = 0.31, 95% CI 0.13, 0.75; AOR = 0.34, 95% CI 0.13, 0.86); and higher odds of reporting that providers did not listen to their concerns prior to the loss (AOR = 2.61, 95% CI 1.24, 5.48). Psychometric analysis supported the CDL index. Participants experiencing late loss had higher odds of reporting top quartile CDL scores than those experiencing early loss (AOR = 3.08, CI 1.22, 7.77). Conclusion: Canadian individuals with perinatal loss report disproportionately poorer care when they are experiencing a miscarriage and when they identify as IBPOC.

This paper describes development of an offline app entitled Two-Eyed Seeing for Parents, which promotes syilx Okanagan Territory parents’ knowledge, confidence, and cultural practices for supporting optimal infant development, including exposure to their traditional language (nsyilxcən). “Two-Eyed Seeing” blends Indigenous and Western epistemic principles (syilx traditions complemented and supported by evidence-based content). Elders, members of the səxʷkn̓xitəlx k̓l̓ c̓əc̓málaʔ Early Years Table, and University of British Columbia researchers partnered to develop the offline app. The Table is committed to improving the well-being of syilx Okanagan Territory children. An Elder representing the Table signed a university cooperative research protocol agreement with one researcher. The agreement required signatories to adhere to principles of free, prior, and informed consent and Indigenous ownership, control, access, and possession and specified that the səxʷkn̓xitəlx k̓l̓ c̓əc̓málaʔ Early Years Table retained the exclusive ownership of and right to reproduce Indigenous knowledge in the app. Elders decided on content and organization of the app and crafted additional information to reflect community priorities. The content incorporates some elements of SmartParent, an evidence-based online SMS app. The offline app clusters resources by months of infants’ first years of life and by topic (including parents’ and infants’ emotional, physical, and spiritual needs, and mental and physical aspects of parenting). It contains original recordings of nsyilxcən language and extensive First Nations materials. Memotext created the app architecture. Elders and Table Members approved the final offline app version. The app offers syilx parents continuous access to culturally grounded information and overcomes problems with Internet access and prohibitive data costs to access links.

Perinatal mental illness is a common and significant complication of pregnancy and childbirth. When left untreated, these illnesses are associated with an increased risk of adverse health outcomes for mothers, infants, and families. While early detection and effective management are essential, less than 15% of affected individuals receive timely and appropriate treatment. Integrated care offers a promising approach to addressing complex treatment barriers; however, the core features of integrated perinatal mental health (PMH) care are not well understood. We conducted a scoping review to identify and synthesize evidence on existing models and key elements of integrated PMH, with data extracted according to PRISMA guidelines. The search was conducted across four databases: Ovid MEDLINE, EMBASE, PsycInfo, and CINAHL. We included peer-reviewed articles, published in English between 1990 and 2024, that described models of integrated PMH care. Three reviewers independently screened 4588 articles by title and abstract, with 153 articles selected for full-text review. A total of 45 peer-reviewed articles were retained for analysis. These articles described a wide range of integrated PMH care models, including specialized inpatient units, intensive hospital day programs, outpatient and community clinics, and collaborative and stepped-care frameworks. An analysis of these models identified seven key elements of integrated care: (1) screening, assessment, and triage; (2) integrated care delivery; (3) patient-centred care; (4) a biopsychosocial approach to treatment; (5) PMH-trained clinicians; (6) health promotion and illness prevention; and (7) transition and discharge planning. This evidence suggests that care integration improves the accessibility, continuity, and quality of PMH care. Integrated models of care can take many forms with positive impacts on perinatal individuals and their families. Research is needed to establish consensus on the key elements of integrated care to support implementation.

Background: National legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers. Methods: Childcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents. Results: No statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions’ regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups. Conclusions: Although we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children’s sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children’s developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare.

AimTo describe how women perceived relational autonomy for decision-making during childbirth pain and illuminate influencing factors. BackgroundMost women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. DesignWe used an interpretative description approach to conduct this study. MethodA purposive sample of ten women who reported pain during childbirth participated in semi-structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. ResultsCircumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision-making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision-making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. ConclusionsWomen regarded their relationships and communication with care providers as foundational to relational autonomy in decision-making about pain management during childbirth. Relevance to clinical practiceStudy findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision-making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. Patient or public contributionWomen who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection.

Background: Although some women experience anger as a mood problem after childbirth, postpartum anger has been neglected by researchers. Mothers’ and infants’ poor sleep quality during the postpartum period has been associated with mothers’ depressive symptoms; however, links between mothers’ sleep quality and postpartum anger are unclear. This study aimed to determine proportions of women with intense anger, depressive symptoms, and comorbid intense anger and depressive symptoms, and to examine mothers’ and infants’ sleep quality as correlates of postpartum anger.Methods: This cross-sectional survey study was advertised as an examination of mothers’ and babies’ sleep. Women, with healthy infants between 6 and 12 months of age, were recruited using community venues. The survey contained validated measures of sleep quality for mothers and infants, and fatigue, social support, anger, depressive symptoms, and cognitions about infant sleep.Results: 278 women participated in the study. Thirty-one percent of women (n= 85) reported intense anger (≥ 90th percentile on State Anger Scale) while 26% (n= 73) of mothers indicated probable depression (>12 on Edinburgh Postnatal Depression Scale). Over half of the participants rated their sleep as poor (n= 144, 51.8%). Using robust regression analysis, income (β= -0.11, p < 0.05), parity (β= 0.2, p < 0.01), depressive symptoms (β= 0.22,p< 0.01), and mothers’ sleep quality (β= 0.10,p< 0.05), and anger about infant sleep (β= 0.25,p< 0.01) were significant predictors of mothers’ anger.Conclusions: Mothers’ sleep quality and anger about infant sleep are associated with their state anger. Clinicians can educate families about sleep pattern changes during the perinatal time frame and assess women’s mood and perceptions of their and their infants’ sleep quality in the first postpartum year. They can also offer evidence-based strategies for improving parent-infant sleep. Such health promotion initiatives could reduce mothers’ anger and support healthy sleep.

Theory about how mentorship is supposed to work, its goals, and what “makes it work” is abundant. It is rarer to encounter empirical information about processes and implications when mentoring is a problem. Graduate students experience significant psychological, physical, financial, and relational challenges and likely have expectations about the ameliorating effects of mentorship. Limited qualitative literature has described graduate students’ perceptions about problems with mentorship and students’ outcomes. The descriptive qualitative study used secondary analysis to describe students’ perceptions of problematic mentorship. Graduate student research assistants conducted 12 recorded focus group interviews and transcribed them. The authors used inductive content analysis to develop themes. Fifty-four participants were recruited, including masters’ (n=19), PhD (n=34), and a graduate student not enrolled in a specific faculty (n=1). The students represented multiple disciplines. The major theme identified was “falling through the cracks.” The subthemes included missing mentorship, students’ difficulties accessing mentorship, university structures undermining mentoring, and damage to mentees. Falling through the cracks highlights students’ struggles with accessing mentorship, effects of missing mentorship, and students’ solutions for modifying structural features that inhibit mentoring. Quantitative work could compare psychological outcomes associated with present and missing mentoring.

Background: Challenges with engaging in postnatal physical activity can negatively affect the health of women and their families. This study investigated women’s physical activity decision-making processes and strategies to support their physical activity as part of a healthy postpartum transition. Methods: Thirty healthy women with infants aged 2.5–12 months completed 3-day activity diaries and an individual interview. Using Glaser and Charmaz’s grounded theory methodology, the core category, reconciling relationships with physical activity, was constructed, which explained women’s processes of postnatal physical activity decision-making. Results: Through reconciling relationships with physical activity, women discerned the types of physical activity they were comfortable pursuing at various points in the postpartum transition. Based on the meaning physical activity held for participants and their views about risks, supports, and resources, women gauged their capacity and the workability of their physical activity desires. Most women were uncertain of their capacity (physical, emotional) to return to physical activity and viewed the achievement of several or all of their desired physical activities as unworkable. Only a small group of women fully pursued the desirable physical activities they viewed as important for their well-being. Women adjusted the strategies they used to achieve physical activity when their expectations of capacity and workability did not align with their experiences. Some women lacked access to resources or supportive messaging about postpartum physical activity and downgraded their physical activity pursuit after negative personal physical or childcare experiences. Conclusions: Women can benefit from discussions about physiological birth recovery and navigating community and peer resources to support physical activity access and the safe return to physical activity following birth.

Graduate student mentoring is a key component of successful university experiences, specifically, improved student retention, completion, and satisfaction. Tensions in application of existing mentoring frameworks create difficulties with university-wide approaches. We used a descriptive qualitative study design to explore graduate students’ perspectives about mentoring. We interviewed 54 Canadian participants in 12 focus groups, including masters’ (n= 19), unclassified (n= 1), and PhD (n= 34) students from multiple disciplines. Focus groups ranged in size from two to seven students. After transcribing interviews, we used inductive content analysis to develop themes. Students described mentoring as a transformative experience because mentors smoothed their paths. Receiving mentoring required students to advocate for themselves and access university structures that promoted mentoring. Transformative mentoring supported students’ aspirational goals. Mentoring strengthens institutional supervisory practices and graduate student retention and success but it requires systematic approaches.