Becoming a mother: Predicting early dissatisfaction with motherhood at three weeks postpartum

Adaptation and validation of the Spanish version of the Being a Mother scale

Background

Becoming a mother is a very important process because of the impact it can have on women and their families. Currently, there is no validated questionnaire that evaluates the process of becoming a mother in the Spanish population. Moreover, no consistent results have been obtained to identify significant differences between primiparous and multiparous mothers.

Aim

(1) Linguistic and metric validation of the Being a Mother scale (BaM-13) in the Spanish population, (2) analysis of possible differences between primiparous and multiparous mothers' experience of motherhood.

Methods

Instrumental design. In 2016-2017, a sample of 579 mothers with children between 6 and 11 months of age completed the Spanish version of BaM-13. The instrument was translated using forward and back translation. Construct validity, internal consistency, and criterion validity were empirically analyzed.

Results

Factorial analyses showed that the scale presented two adequate factors. Internal consistency of the global scale (α = 0.818, ω = 0.861), the Postnatal bonding factor (α = 0.773, ω = 0.784), and the Adult's experience factor (α = 0.710, ω = 0.721) was adequate. Significant associations were found with postpartum depression (r = 0.560), parental competence (r =  - 0.584) and postnatal bonding (r =  - 0.327). In terms of parity, primiparous mothers have greater difficulty in postnatal bonding, compared to multiparous mothers (p = 0.006).

Conclusions

The Spanish version of the BaM-13 scale is valid for measuring mothers' experience of motherhood in a wide range of domains. The findings of the study show the importance of considering parity in the experience of becoming a mother, highlighting the approach to postnatal bonding in primiparous mothers. Additionally, we underline that it should not be assumed that multiparous mothers experience fewer difficulties in their motherhood process.

The perinatal health secondary to pandemic: association between women's delivery concerns and infant's behavioral problems

BACKGROUND

COVID-19 pandemic characterised a unique and vulnerable social, emotional, and health environment for pregnancy, with potential long-lasting risks to maternal and child health outcomes. In women who were pregnant at the peak of COVID-19 pandemic, we investigated the association between pandemic-related concerns about pregnancy and delivery and both the parent's (i.e. maternal parenting stress) and the infant's (i.e. emotional-behavioral problems) outcomes 12 months after birth.

METHODS

A sample of 352 Italian pregnant women completed a web-based survey from 8 April to 4 May 2020 and a follow-up at 12 months after delivery. Maternal assessment in pregnancy covered prenatal measures for: pandemic-related concerns about pregnancy and childbirth, COVID-19 stressful events exposure, pandemic psychological stress, and mental-health symptoms (i.e. depression, anxiety). The 12 months' assessment covered post-partum measures of social support, parenting stress and maternal reports of infants' behavioral problems.

RESULTS

The results of the Quasi-Poisson regression models on the association between COVID-19 related influencing factors and parenting stress and infant's behavioral problems showed that the presence of higher pandemic-related concerns about pregnancy and childbirth scores was associated with greater total and internalising behavioral problems but not with parenting stress levels.

CONCLUSION

Perinatal mother-infant health has been sensitively threatened by pandemic consequences with maternal concerns about childbirth in pregnancy being associated with 12 months' children's behavioral outcomes. There is a need to invest in psychological support for perinatal women throughout the transition to parenthood to protect risk conditions before they get chronic or severe and influence offspring development.

Adverse childhood experiences, emotional distress and dissatisfaction with motherhood among first-time mothers: Mediations and child differences

Despite the challenges associated with motherhood, studies have not consistently identified factors contributing to first-time mothers' dissatisfaction with motherhood in resource-limited regions. To fill this research gap, this study investigates how adverse childhood experiences (ACEs) result in first-time mothers' dissatisfaction with motherhood through emotional distress in Nigeria. Results from the partial least square structural equation model suggests that ACEs are associated with dissatisfaction with motherhood ( = 0.092; p < 0.01) and emotional distress ( = 0.367; p < 0.001). There is also a significant association between emotional distress and dissatisfaction with motherhood ( = 0.728; p < 0.001). Indirect path from first-time mothers' ACEs to dissatisfaction with motherhood through emotional distress shows significance ( = 0.267; 95% CI (0.213, 0.323); p < 0.001). In addition, the indirect path from first-time mothers' ACEs to dissatisfaction with motherhood through child emotional closeness showed significant dampening effects ( = 0.044; 95% CI (0.025, 0.066); p < 0.001). No serial impact of emotional distress and child emotional closeness was found in the study. The findings based on child gender indicated that only among first-time mothers of female children are ACEs predictors of dissatisfaction with motherhood. Trauma-informed interventions should be introduced in primary care settings to screen for ACEs and emotional dysfunctions among first-time mothers.

Predictor role of marital conflict on maternal competency with mediating role of perceived stress and concerns during pregnancy: A structural equation model

AIM

Pregnancy prepares the mother for the transition to motherhood. Maternal concerns during pregnancy cause reduced time spent with the spouse and lack of social support; additional stresses such as marital conflicts could impact maternal competency. This study aimed to assess the predictive effect of marital conflicts with the mediating role of perceived stress and pregnancy concern on maternal competency.

METHODS

This was a longitudinal study. It was done on 250 mothers referred to selected health centers in Alborz province. The sampling method was convenient. Marital conflicts, perceived stress, and pregnancy concerns questionnaires were completed in the third trimester of pregnancy, and the maternal competency questionnaire was completed 6 weeks after delivery. Data were analyzed by SPSS software and smart partial least squares.

RESULTS

The results of structural equations showed that marital conflicts have a negative and significant effect on maternal competency (β = -0.14), marital conflicts have a positive and significant effect on perceived stress (β = 0.42), and marital conflicts have a positive and significant effect on pregnancy concern (β = 0.31). Also, perceived stress negatively and significantly affected maternal competency (β = -0.36).

DISCUSSION

Results of the study showed the necessities for screening and identifying mothers with conflicts and assessing the perceived stress of mothers will improve the mental health of pregnant mothers and consequently increase maternal competency.

Behavioral Inhibition in the Second Year of Life Is Predicted by Prenatal Maternal Anxiety, Overprotective Parenting and Infant Temperament in Early Infancy

Background

Behavioral inhibition, characterized by shyness, fear and avoidance of novel stimuli, has been linked with internalizing personality traits in childhood, adolescence and early adulthood, and particularly later social anxiety disorder. Little is known about the relevance of potential prenatal precursors and early predictors for the development of inhibited behavior, such as infant vulnerability and family risk factors like parental anxiety and overprotection. Pregnancy-related anxiety has been associated with both infant temperament and maternal overprotective parenting. Thus, the aim of this study was investigating the predictive relevance of prenatal pregnancy-related anxiety for behavioral inhibition in toddlerhood, by considering the mediating role of maternal overprotection and infant distress to novelty.

Materials and Methods

As part of a longitudinal pregnancy cohort, behavioral inhibition at 24 months postpartum was assessed in N = 170 mother-child pairs. Maternal pregnancy-related anxiety was examined in the third trimester of pregnancy, and maternal overprotection and infant distress to novelty at 12 months postpartum.

Results

Mediation analysis with two parallel mediators showed that the significant direct effect of pregnancy-related anxiety on child behavioral inhibition was fully mediated by infant distress to novelty p < 0.001 and maternal overprotection (p < 0.05). The included variables explained 26% of variance in behavioral inhibition. A subsequent explorative mediation analysis with serial mediators further showed a significant positive association between distress to novelty and maternal overprotective parenting (p < 0.05).

Conclusion

Results indicate a predictive relevance of both infant and maternal factors for the development of behavioral inhibition in toddlerhood. Mothers who perceived more pregnancy-related anxiety showed more overprotective parenting and had infants with more distress to novelty. Further, mothers being more overprotective reported their child to be more inhibited in toddlerhood. Our findings also indicate the stability of reported infant distress to novelty as one aspect of later behavioral inhibition. Addressing specific forms of parental anxiety from pregnancy on and in interaction with child-related variables seems to be a promising approach for future studies and clinical interventions.

Born Under COVID-19 Pandemic Conditions: Infant Regulatory Problems and Maternal Mental Health at 7 Months Postpartum

BACKGROUND

The SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems (RPs) have been identified as early indicators of child socio-emotional development, strongly associated with maternal mental health and the early parent-infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic.

METHODS

As part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables.

RESULTS

Compared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs.

LIMITATIONS

Due to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis.

CONCLUSIONS

The pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged.

Parents experience a sense of guilt when their newborn is diagnosed small for gestational age, SGA. A grounded theory study in Sweden

BACKGROUND

To become a parent of a child who is born small for gestational age can lead to challenges in addition to the newly acquired parenting role. There is currently a lack of knowledge regarding parents' experiences of having a child born small for gestational age.

PURPOSE

The purpose of this study was to describe the experience of becoming a parent of a child small for gestational age DESIGN AND METHOD: A qualitative inductive approach was chosen with grounded theory as a method, a strategic selection was used and individual interviews with open questions were performed.

RESULTS

The results showed that the parents expressed guilt over the child's size and focused on the ability to nourish their child to keep their unexpectedly small child alive. An experienced concern about the child's food intake could be seen throughout the entire interview material and the need for information was great. A common experience of the parents was that constant feeding of the child dominates their lives.

CONCLUSION

The conclusion is that the unexpectedly small size of the child awakens the parent's instinct to provide life-sustaining care and the parents need increased support and more information around the child's condition. This requires well-trained professionals, because parents to children born SGA often harbour feelings of unpreparedness and guilt.

PRACTICE IMPLICATIONS

Increased understanding and knowledge about the parents' experience of having a child born SGA, healthcare services can optimize the potential for better attachment between parent and child as well as offer appropriate support.

Experience of early motherhood during the first wave of the COVID-19 pandemic in Northern Germany: a single-centre before and after comparison

PURPOSE

To assess maternal mental health during the first weeks after birth including birth experience, postpartum adjustment to early motherhood and the perception of newborn behaviour, and how this may be influenced by the first wave of the COVID-19 pandemic.

METHODS

Ninety women who gave birth after the first enforcement of nation-wide disease control restrictions in Germany between 16 March and 10 May 2020 were surveyed and compared with 101 women who had given birth before the pandemic. Information on maternal mental health and maternal perception of early motherhood and neonatal behaviour were assessed at 3-8 weeks postpartum.

RESULTS

Mothers who gave birth under the COVID-19-associated disease control restrictions did not show significant differences in depression, anxiety and social support scales compared to mothers before the pandemic. Birth experience was similar, while support during birth was perceived to be higher under the COVID-19 restrictions. Confidence in caretaking of the newborn and perception of neonatal behaviour were comparable between the two groups. Mothers expressed significantly higher dissatisfaction with the maternal role during the pandemic.

CONCLUSIONS

Overall, maternal mental health and the perception of the newborn and early caretaking during the first COVID-19 wave did not substantially differ from the perceptions of mothers before the pandemic. A potential influence of the pandemic on higher dissatisfaction with the maternal role may be associated with the pandemic conditions affecting everyday life and should be addressed in postpartum care and in future qualitative and longitudinal studies.

Peripartale psychische Belastung und Auswirkungen auf die frühe Elternschaft

Hintergrund

Peripartale elterliche Angst und Depressivität zeigten Zusammenhänge mit kindlichen emotionalen und Verhaltensauffälligkeiten. Mögliche Erklärungsansätze umfassen pränatal prägende Einflüsse auf das Ungeborene sowie das postpartale Fortwirken psychischer Belastung auf die Eltern-Kind-Beziehung. Dabei kommt dem elterlichen Vertrauen in die eigenen Fähigkeiten eine mögliche protektive Rolle zu, das wiederum durch die eigene psychische Belastung und das kindliche Verhalten maßgeblich beeinträchtigt sein kann.

Fragestellung

Diese Studie untersucht, wie sich pränatale schwangerschaftsspezifische Ängste auf das Vertrauen in die eigenen Fähigkeiten als Mutter in der frühen Elternschaft auswirken und wodurch dieser Effekt vermittelt wird.

Material und Methoden

Als Teil einer prospektiven Längsschnittstudie beantworteten 116 Mütter im letzten Schwangerschaftsdrittel (T0) und der 3. Woche (T1) postpartal Fragebögen zu schwangerschaftsspezifischen Ängsten, mütterlichem Selbstvertrauen, postpartaler Depressivität und kindlicher Irritabilität.

Ergebnisse

Es zeigte sich, dass der Zusammenhang zwischen pränatalen Ängsten und mangelndem mütterlichen Selbstvertrauen nicht über das Erleben kindlicher Irritabilität, sondern entscheidend über das Erleben postpartaler Depressivität vermittelt wurde. Die mütterliche Parität spielte ebenfalls eine Rolle.

Schlussfolgerung

Pränatale schwangerschaftsspezifische Ängste können postpartaler Depressivität vorausgehen und so indirekt das mütterliche Vertrauen in die eigenen Fähigkeiten beeinträchtigen. Die Wachsamkeit für elterliche psychische Belastung und die Weiterentwicklung von Behandlungsansätzen mit Beginn in der Schwangerschaft sind notwendig und erfordern eine enge interprofessionelle Zusammenarbeit zwischen eltern- und kindbezogenen Disziplinen.

The effects of midwifery care provided to primiparous mothers during the postpartum period on maternal attachment and post-traumatic growth

AIM

This study was conducted to determine the effects of midwifery care provided to primiparous mothers during the postpartum period on maternal attachment and post-traumatic growth.

METHOD

The study was conducted based on a quasi-experimental model with a pre-test/post-test control group. The population of the study was composed of primiparous mothers who gave birth in a public hospital located in eastern Turkey, and the sample consisted of 128 postpartum women (64 women in the control group and 64 women in the experimental group); the sample size was determined via power analysis. Midwifery care was provided to the mothers in the experimental group throughout their hospitalisation in accordance with the Postpartum Care Management Guidelines (PCMG) published by the Republic of Turkey's Ministry of Health. In addition, 3 home visits were carried out between the postpartum 2^nd and 5^th days, 13^th and 17^th days and 36^th and 42^nd days. The mothers in the control group were not subjected to any intervention. The data were collected using a personal information form, the Maternal Attachment Inventory (MAI) and the Post-traumatic Growth Inventory (PTGI). Statistical analyses were conducted using percentage distribution, arithmetic mean, standard deviation, chi-square testing, independent samples t-testing and dependent samples t-testing.

RESULTS

Based on the mean MAI and PTGI pre-test scores, it was determined that the mothers in the experimental and control groups were similar in terms of maternal attachment and post-traumatic growth characteristics (p>0.05). The mean MAI post-test score was 101.85±2.85 in the experimental group and 98.68±5.91 in the control group, and the difference between the groups was statistically significant (p<0.001). The mean PTGI post-test score was 86.21±20.39 in the experimental group and 79.54±22.32 in the control group, and the difference between the groups' mean scores was statistically significant (p<0.05). The mean post-test score of the PTGI Change in Philosophy of Life subscale was 19.37±6.04 in the experimental group and 16.17±6.83 in the control group, and the difference between the mean scores was statistically significant (p<0.05).

CONCLUSION

It was determined that the midwifery care provided to primiparous mothers during the postpartum period had a positive effect on levels of post-traumatic growth and maternal attachment.

Anxious Attachment Mediates the Associations Between Early Recollections of Mother's Own Parental Bonding and Mother-Infant Bonding: A 2-Month Path Analysis Model

Parental bonding (recollection of own parents' parenting), adult attachment, and mother-infant bonding are all closely related yet distinct concepts of the parent-child relationship, sometimes used interchangeably in the literature. This study aimed to examine the associations between these concepts in a longitudinal path analysis design. A total of 262 postpartum women who gave birth at the maternity ward of a large tertiary health center in Israel completed a demographic questionnaire, the Experiences in Close Relationships Scale (ECR), the Parental Bonding Instrument (PBI) at 1-4 days postpartum, and the Postpartum Bonding Questionnaire (PBQ) at 2 months postpartum. Parental care factor (PBI) was found to be associated with mother-infant bonding (PBQ), directly and indirectly through insecure anxious attachment (ECR). Denial of autonomy factor (PBI) was found to be associated with mother-infant bonding (PBQ) only through insecure anxious attachment (ECR). Encouragement of behavioral freedom factor (PBI) was found to be associated with mother-infant bonding (PBQ) in a simple correlation but not in the complete model. The results highlight the intergenerational aspects of parenting and suggest that early childhood interventions with parents may have a long-term impact on child-rearing though generations, and by that on children's development.