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The off-label use of the drug misoprostol has effectively turned homebirths in ‘resource-poor’ nations into unmarked and un-enunciated zones of experimentation. Misoprostol has become the public health solution in response to medico-humanitarian discourses that construct homebirths as responsible for high maternal mortality. In the absence of proper safety tests, advocating its routine administration against postpartum haemorrhage in homes around Pakistan functions to erase the distinction between service delivery projects and experimentation. Drawing on ethnographic research in Balochistan, I argue that promoting misoprostol in contexts of structural inequality, particularly where excessive artificial labour induction prevails, constitutes the enactment of a kind of ‘medical relativism’. This medical relativism entails an experimental practice that burdens poor women with undue risk as misoprostol becomes a substitute for required structural and economic transformation of Pakistan's healthcare system. Overall, the paper concludes, the contemporary faith in pharmaceuticals perpetuates a colonial governmentality of bodies, medicines, and healthcare. [ABSTRACT FROM AUTHOR]

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. Awareness of local terminology for its signs and symptoms may improve communication about this illness, what actions to take when symptoms appear, timely care seeking, and clinical outcomes. This formative research aimed to improve recognition and management of postpartum sepsis in Pakistan by eliciting local terms used for postpartum illnesses and symptoms. We conducted 32 in-depth interviews with recently delivered women, their relatives, traditional birth attendants, and health care providers to explore postpartum experiences. Terms for symptoms and illness are used interchangeably (i.e. bukhar, the Urdu word for fever), many variations exist for the same term, and gradations of severity for each term as not associated with different types of illnesses. The lack of a designated term for postpartum sepsis in Urdu delays care-seeking and proper diagnosis, particularly at the community level. Ideally, a common lexicon for symptoms and postpartum sepsis would be developed but this may not be feasible or appropriate given the nature of the Urdu language and local understandings of postpartum illness. These insights can inform how we approach educational campaigns, the development of clinical algorithms that focus on symptoms, and counselling protocols. [ABSTRACT FROM AUTHOR]

The present study intended to explore and compare the mediating role of negative thoughts between the sense of parental competence and postpartum depression in postpartum mothers who gave birth to their baby either through vaginal or cesarean delivery. A purposive sample of 170 women suffering from postpartum depression was recruited from different hospitals in Gujrat, Pakistan. Urdu versions of the Parenting Sense of Competency Scale, Automatic Thoughts Questionnaire, and Edinburgh Postnatal Depression Scale were used to measure the focal constructs of the study. Data were collected from May 2018 to October 2018. Path analysis revealed that parental competence had negative direct effects on postpartum depression (β = −.17, p <.05) and negative thoughts (β = −.27, p <.05) and both of these effects were stronger for women with cesarean delivery (Δβ =.04, p <.001; Δβ =.36, p <.001, respectively). Negative thoughts had a positive direct effect on postpartum depression (β =.43, p <.05) and this direct effect was also stronger among women with cesarean delivery (Δβ = −.12, p <.001). Furthermore, parental competence reduced the negative thoughts, which in turn, lowered the postpartum depression (β = −.12, p <.05), however, this indirect effect was true only for the group of women with cesarean delivery (Δβ =.20, p <.05). Our findings indicate the powerful role of parental competence in reducing the likelihood of postpartum depression through the regulation of negative thoughts and highlight that cesarean delivery may increase mothers' vulnerability to negative thoughts and postpartum depression. [ABSTRACT FROM AUTHOR]