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.

While Canadian maternal mortality rates suggest widespread access to high-quality care, perinatal health care outcomes and care experiences among pregnant people in Canada vary widely, particularly among communities that have been historically oppressed, excluded, and marginalized. The lack of patient-oriented research and measurement in perinatal services led to the RESPCCT (Research Examining the Stories of Pregnancy and Childbirth in Canada Today) Study which used a community participatory action research (CPAR) approach to examine experiences of pregnancy and childbirth care. In this paper, we describe co-creation of a person-centered survey instrument that measures respect, disrespect and mistreatment during pregnancy-related care of individuals with diverse identities, backgrounds and circumstances. The study was co-led by a Community Steering Council alongside a multi-disciplinary group of researchers and clinicians, and pilot tested by service users from across Canada. The final survey instrument includes items that assess respectful care across 17 domains, including validated measures of autonomy, respect, mistreatment, trauma, and discrimination. It also captures information about respondents’ identities, backgrounds, circumstances, access to care, provider type, and outcomes. A total of 6096 individuals participated in the survey. We describe how we implemented CPAR best practices, strengths, challenges, and lessons learned for instrument development in reproductive justice research.

Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.

BackgroundNational 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.MethodsChildcare 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.ResultsNo 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.ConclusionsAlthough 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.

Background and Purpose: Consistent measurement of respectful maternity care (RMC) is lacking. This Delphi study assessed consensus about indicators of RMC. Methods: A multidisciplinary panel assessed items (n = 201) drawn from global literature. Over two rounds, the panel rated importance, relevance, and clarity, and ranked priority within 17 domains including communication, autonomy, support, stigma, discrimination, and mistreatment. Qualitative feedback supported the analysis. Results: In Round One, 191 indicators exceeded a content validation index of 0.80. In Round Two, Kendall's W ranged from 0.081 (p = .209) to 0.425 (p < .001) across domains. Fourteen indicators received strong support. Changes in indicator assessment between rounds prevented agreement stability assessment. Conclusion: The indicators comprise a registry of items for use in perinatal care research.

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.

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. 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. 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. 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.

Persistent intense anger is indicative of postpartum distress, yet maternal anger has been little explored after childbirth. Using grounded theory, we explained how and why mothers develop intense anger after childbirth and the actions they take to manage their anger. Twenty mothers of healthy singleton infants described their experiences of anger during the first two postpartum years. Mothers indicated they became angry when they had violated expectations, compromised needs, and felt on edge (e.g., exhausted, stressed, and resentful), particularly around infants' sleep. Mothers described suppressing and/or expressing anger with outcomes such as conflict and recruiting support. Receiving support from partners, family, and others helped mothers manage their anger, with more positive outcomes. Women should be screened for intense anger, maternal-infant sleep problems, and adequacy of social supports after childbirth. Maternal anger can be reduced by changing expectations and helping mothers meet their needs through social and structural supports.

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.

ABSTRACT 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.

Background: Although some women experience anger as a mood problem after childbirth, postpartum anger has been neglected by researchers. Poor maternal and infant sleep quality during the postpartum period has been associated with depressive symptoms; however, links between sleep quality and postpartum anger are unclear. This study aimed to determine the proportions of women with significant anger, depressive symptoms, and comorbid anger and depressive symptoms, and to examine maternal and infant 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 social media. The survey contained validated measures of maternal and infant sleep quality, and maternal 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 high anger levels (≥ 90th percentile on State Anger Scale) while 26% (n = 73) of mothers indicated probable depression (>12 on Edinburgh Postnatal Depression Scale). Women reported a mean of 6.2 hours of sleep (SD = 1.2 hours, range = 4 – 9 hours); over half of the participants rated their sleep as poor (n = 144, 51.8 %). Using robust regression analysis, income (b = -0.74, p < 0.05), parity (b = 2.05, p < 0.01), depressive symptoms (b = 0.59, p < 0.01), maternal sleep quality (b = 0.98, p < 0.05), and maternal anger about infant sleep (b = 0.50, p < 0.01) were significant predictors of maternal anger. Conclusions: Maternal sleep quality and anger about infant sleep are associated with maternal state anger. Clinicians should educate families about sleep pattern changes during the perinatal time frame and assess women’s mood and perceptions of maternal and infant 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 maternal anger and support healthy maternal-infant sleep.

OBJECTIVE:The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS:Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS:While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS:The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Cerebral venous thrombosis (CVT) is a rare cause of stroke that affects ∼1/100,000/year. About 10% of patients experience a fulminant fatal course or are left with marked residual disability. Long term sequellae can include issues with cognition, seizures and focal neurological deficits. We developed a methodology and costing algorithm that could be applied to future randomized controlled trials involving novel treatments for CVT. A micro-costing analysis was carried out using ten years of administrative data (2008-2018) from a Vancouver General Hospital, the quaternary care stroke centre from British Columbia. Each stage of the inpatient journey was mapped alongside additional resource utilization including imaging and other diagnostics. Stages, including emergency department visits and transitions from levels of higher care, were valued using a combination of gross and activity-based costing. Overhead costs including administration and equipment were assigned based on square footage while personnel costs were allocated based on bed day. One hundred and thirty six patient admissions were identified through ICD-9 and 10 codes as having CVT as a primary or secondary diagnosis. Preliminary analysis has revealed a heterogeneity of CVT inpatient journeys with stays in critical care generating the most significant cost burden. Differences in journeys appear to be driven in part by whether CVT was a primary vs. secondary diagnosis (ie. complication of another disease process). Our analysis is ongoing and we will present a detailed analysis of each resource valuation as well as the costs of care for CVT patients. Costing of care for CVT can vary significantly. The differences between patients with primary and secondary diagnoses of CVT should be noted, particularly for future trials examining the cost-effectiveness of interventions that may only target patients with primary diagnoses. Future research should also examine the outpatient costs associated with recovery.

INTRODUCTION:Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available.METHODS:A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options.RESULTS:Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences.DISCUSSION:It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users.

Objectives/background: This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children. Methods: Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences. Results: It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country. Conclusions: Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system. (C) 2018 Elsevier B.V. All rights reserved.