Lower levels of OT were observed in women who had PPD at 8 weeks and who had stopped breastfeeding their infant by 8 weeks postpartum. Future studies should investigate the short- and long-term effects of lower OT levels and early breastfeeding cessation on maternal and child well-being.

Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, and educational obstacles to health care and then mitigate these barriers to facilitate complete and timely access to health services. For example, to assist a woman with Medicaid who is seeking postpartum care, a patient navigator could help her schedule an appointment before her insurance benefits change, coordinate transportation and child care, give her informational pamphlets on contraception options, and accompany her to the appointment to ensure her questions are answered. Existing studies examining the efficacy of patient navigation interventions show particularly striking benefits in the realm of cancer care, including gynecological oncology; patient navigation has been demonstrated to increase access to screening, shorten time to diagnostic resolution, and improve cancer outcomes, particularly in health disparity populations, such as women of color, rural populations, and poor women. Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care. We review the concept of patient navigation, offer potential roles for patient navigation in obstetrics and gynecology, and discuss areas for further investigation.

The migration of working-aged men from Mexico to the United States fractures the family-centered support structures typical of Latin America and contributes to high levels of depression in women left behind in migratory sending communities in Mexico. Mujeres en Solidaridad Apoyandose (MESA) was developed to improve depression in women through social support in a resource poor setting. MESA is a promotora intervention that trains women in the community to lead social support groups over a five-week period. The MESA curriculum uses a combination of cognitive behavioral theory techniques, psychoeducation, and social support activities aimed at alleviating or preventing depression in women. Results from this pilot efficacy study (n = 39) show that depressed participants at baseline experienced declines in depression as measured by the Center for Epidemiologic Studies Depression Scale at follow-up. Other findings demonstrate the complexity behind addressing social support and depression for women impacted by migration in different ways.

Context Breastfeeding duration and exclusivity among Latinas fall below recommended levels, indicating a need for targeted interventions. The effectiveness of clinical breastfeeding interventions for Latinas remains unclear. Objective To systematically review the documented effectiveness of clinical breastfeeding interventions on any and exclusive breastfeeding among Latinas. Data Sources English-language publications in MEDLINE, CINAHL, and Embase were searched through May 28, 2015. Study Selection Fourteen prospective, controlled studies describing seventeen interventions met inclusion criteria. Data Extraction Extracted study characteristics include study design, population characteristics, intervention components, timing and intensity of delivery, provider type, control procedures, and outcome measures. Results Random-effects meta-analyses estimated risk differences (RD) between breastfeeding mothers in intervention and control arms of each study and 95% prediction intervals (PI) within which 95% of intervals cover the true value estimated by a future study. Interventions increased any breastfeeding at 1-3 and 4-6 months (RD, 0.04 [95% PI, -0.15 to 0.23] and 0.08 [95% PI, -0.08 to 0.25], respectively) and exclusive breastfeeding at 1-3 and 4-6 months (RD, 0.04 [95% PI, -0.09 to 0.18] and 0.01 [95% PI, -0.01 to 0.02], respectively). Funnel plot asymmetry suggested publication bias for initiation and 1-3 month any breastfeeding. Estimates were slightly larger among interventions with prenatal and postpartum components, 3-6 patient contacts, and delivery by an International Board Certified Lactation Consultant or lay provider. Limitations The published evidence for Latinas is limited and studies have varying methodologic rigor. Conclusions Breastfeeding interventions targeting Latinas increased any and exclusive breastfeeding compared with usual care.