First-time mothers' confidence mood and stress in the first months postpartum. A cohort study

'Living in two worlds': A qualitative analysis of first-time mothers' experiences of maternal ambivalence

OBJECTIVE

The aim of this qualitative study was to examine experiences and meanings of maternal ambivalence in first-time mothers with young children.

BACKGROUND

In contrast with normative expectations surrounding contemporary motherhood, there is growing recognition that becoming and being a mother involves ambivalent feelings, and that these feelings are normal and have positive psychological consequences. Yet, little attention has been paid to women's subjective experiences of maternal ambivalence, and capacity to acknowledge and manage ambivalent feelings.

METHODS

Eleven semi-structured online interviews, with first-time mothers, were conducted and analysed using Interpretative Phenomenological Analysis (IPA) methodology.

RESULTS

Two group experiential themes were identified: Crossing boundaries of acceptable mothering feelings and Mothering from a place of 'enough'. Ambivalent mothering feelings challenged participants' expectations about motherhood and themselves as mothers, producing anxiety, self-doubt and feelings of failure. Distress accompanying maternal ambivalence was especially acute when participants perceived their feelings to be unacceptable. Viewing conflicting feelings with compassion, however, helped participants to cope with their diverse and fluctuating emotional mothering experiences, allowing them to mother with a greater sense of equanimity, agency and competence.

CONCLUSION

The study's findings indicate the potential benefits of providing information about the emotional turbulence of early motherhood as part of routine maternity care, as well as the potential value of offering parenting interventions that promote self-compassion to mothers struggling to manage feelings of ambivalence.

First-time parents' perception of midwives' and other healthcare professionals' support behaviours: A qualitative study

PROBLEM

Parents often report not being satisfied with the support received from midwives and nurses during their postpartum hospital stay.

BACKGROUND

Social support is an important protective factor during the transition to parenthood. However, little is known on how first-time parents perceived the behaviours demonstrated by healthcare professionals to support them.

OBJECTIVE

To describe social support behaviours of midwives and nurses as perceived by first-time parents during the early postpartum period.

METHODS

This qualitative study used individual semi-structured interviews to collect data. A purposeful sample of first-time parents staying on the postpartum ward of a Swiss university hospital were included. Thematic analysis was performed to identify themes and sub-themes.

FINDINGS

A total of 26 parents (15 mothers and 11 fathers) were interviewed. Parents reported behaviours perceived either as positive or negative. These behaviours were summarized into five themes: "Welcoming parents on the postpartum ward", "Establishing a partnership with parents", "Guiding parents in acquiring their new parenting role", "Caring for parent's emotions", and "Creating a peaceful environment".

DISCUSSION AND CONCLUSION

This study reported a wide variety of professional support behaviours. Behaviours promoting individualised care and related to empowering parents in their infant care were perceived as helpful by parents. Midwives and nurses should be aware of the way they provide support, as this shapes the early postpartum experience of first-time parents. Being sufficiently staffed and being well-trained, especially in providing interpersonal support, could help midwives and nurses provide better sensitive individualised care.

Postpartum depression and risk factors among working women one year after delivery in Beijing, China: a cross-sectional study

Background

Postpartum depression (PPD) is the most common mental illness affecting women after childbirth, and working mothers may be faced with unique challenges. This study aimed to examine the depression status among working postpartum women in 1 year of childbirth and explore the relationship between occupational factors and PPD in urban Beijing, China.

Methods

A cross-sectional survey of 554 postpartum women was conducted among ten community health service centers in six urban districts of Beijing, China. Sociodemographic, occupational, childbirth and postpartum information were collected. Depression status was obtained using the Edinburgh Postnatal Depression Scale. Prevalence of postpartum depression (PPD) was assessed in relation to occupational characteristics, and influencing factors were analyzed through logistic regression.

Results

Of the postpartum women, 29.42% met the criteria for depression. PPD prevalence was significantly higher among women employed in commercial enterprises (39.81%). The analysis of influencing factors showed that age, family or personal monthly income, maternity leave, feeding methods, and postpartum care affected the psychological health of occupational women after childbirth.

Conclusion

PPD prevalence is notably elevated among women employed in commercial enterprises, and specific risk factors contribute to its occurrence. These findings highlight the need for targeted interventions to address these risk factors and prevent PPD in this population.

Effects of digital parenting interventions on self-efficacy, social support, and depressive symptoms in the transition to parenthood: A systematic review and meta-analysis

BACKGROUND

Parenting self-efficacy is essential for the transition to parenthood. As digital parenting educational interventions are rapidly being developed, their effects have not been examined by pooling available randomized controlled trials (RCTs).

OBJECTIVES

To comprehensively investigate the effects of digital educational interventions on parents' self-efficacy, social support, and depressive symptoms in the first year after childbirth and identify the significant associated factors.

METHODS

This study searched six electronic databases for relevant RCTs examining the efficacy of digital parenting interventions from inception to September 2022. The studied outcomes included changes in parent's self-efficacy, social support, and depressive symptoms observed after participating in a digital parenting program. The random-effects model was used to pool results. Subgroup and moderator analyses were performed.

RESULTS

In total, seven RCTs enrolling 1342 participants were included. The parents who received digital parenting interventions had higher parenting self-efficacy (standardized mean difference [SMD]: 1.06, 95 % confidence interval [CI]: 0.40-1.71, p =.002) and social support (SMD: 2.72, 95 % CI: 0.38-5.07, p =.02) and decreased depressive symptoms at 3 months postpartum (SMD: -0.39, 95 % CI: -0.73 to - 0.04, p =.03). Providing the interventions for ≥ 6 weeks (SMD: 1.62, 95 % CI: 1.18-2.06, p <.001), providing in-person orientation (SMD: 1.88, 95 % CI: 1.32-2.44, p <.001), including a guided curriculum (SMD: 2.00, 95 % CI: 1.78-2.22, p <.001), and conducting interventions in Organisation for Economic Co-operation and Development countries (SMD: 1.98, 95 % CI: 1.78-2.19, p <.001) were identified as significant moderators.

CONCLUSIONS

Digital parenting interventions significantly increase parenting self-efficacy and social support as well as alleviate depressive symptoms for parents during their first year after childbirth. Such interventions can be beneficial for parents who prefer online education. Future studies investigating the long-term effects of these interventions are warranted.

REGISTRATION

The protocol for this systematic review and meta-analysis is registered in PROSPERO (registration number: CRD42021243641).

Does group-based parent support during the transition to parenthood affect child socio-emotional problems and health care utilization? A randomized controlled trial

As government-funded universal programs for new parents continue to expand, it is critical to investigate their short- and longer-term effects. The level of knowledge, especially on the effect of group-based interventions, is sparse. This study is the second report from a large trial of a widely implemented universal group-based parenting program in Denmark and includes outcomes on child socio-emotional problems and use of health services. A sample of 1701 unborn children from families representative within the area, were randomized to intervention or care as usual beginning November 2014. From these families, 1268 mothers and 999 partners (mean age 29.4 and 31.19, respectively; 6% migration background) filled in the Ages and Stages Questionnaire. Intention-to-treat-analyses showed fewer socio-emotional problems in the intervention group (between-group difference - 2.34, 95% CI [0.40, 4.30], d = - 0.13) as reported by mothers, but not partners, when children were 10 months old. This finding was transitory (no longer significant at 19 months). No effects were found on health care utilization. The previous report from this trial showed no effects on measures of parenting. In total, these findings serve the purpose of adjusting future expectations to the size and type of effect to be gained from a universal parent program in a resourceful setting. We conclude that even if the Family Startup Program (DK: Familieiværksætterne) 2 was liked, well implemented, and well attended by the parents, the positive effect on children's socio-emotional problems, was too modest to be the argument that can carry the weight of policy going forward. PUBLIC SIGNIFICANCE STATEMENT: This study examined the effects of the Family Startup Program (DK: Familieiværksætterne), a universal, group-based program to support parents during the transition to parenthood. Results showed a modest transitory preventive effect on children's socio-emotional problems and no effects on health care utilization. These findings adjust down previous expectations to the size and type of effects to be gained from universal group-based parent support in a well-resourced setting.

The effectiveness of mother-led infant massage on symptoms of maternal postnatal depression: A systematic review

INTRODUCTION

Postnatal depression is a significant public health issue which may escalate and lead to adverse outcomes for women, infants, their family and the wider society. The aim of this review was to examine the effectiveness and experiences of mother-led infant massage on symptoms of maternal postnatal depression and to synthesise these findings to inform policy, practice and further research.

METHODS

A systematic search of five academic databases was conducted: CINAHL, MEDLINE, EMBASE, PsycINFO and Allied and Complementary Medicine Database in February 2023 with no date or geographic limiters set owing to the paucity of research on this subject area. Quality appraisal was undertaken using the Joanna Briggs Institute quality appraisal tools and all included RCT's were assessed separately using the Cochrane Risk of Bias Tool. Narrative synthesis was used to analyse the data.

FINDINGS

A total of (n = 323) studies were returned of which (n = 8) met the inclusion criteria for the review. This review identified a total sampling of (n = 521) women with maternal postnatal depression. The results are presented under three themes: 1) the effectiveness of mother-led infant massage on symptoms of postnatal depression; 2) women's experiences of mother-led infant massage; and 3) the effects of mother-led infant massage on the mother-infant relationship.

DISCUSSION

The review highlights women who used infant massage displayed a reduction in symptoms of postnatal depression, improved mother-infant interactions and improved self-efficacy in addition to benefits for infants. Public Health Nurse/Community Midwife-led infant massage may help to relieve such symptoms and empower women.

Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China

OBJECTIVES

The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

DESIGN

A longitudinal study with follow-ups from 42 days to 6 months after delivery.

SETTINGS AND PARTICIPANTS

A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

METHODS

Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

RESULTS

Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms.

CONCLUSIONS

Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

Antepartum and labour-related single predictors of non-participation, dropout and lost to follow up in a randomised controlled trial comparing internet-based cognitive-behaviour therapy with treatment as usual for women with negative birth experiences and/or post-traumatic stress following childbirth

OBJECTIVES

Internet-based interventions are often hampered by high dropout rates. The number of individuals who decline to participate or dropout are reported, but reasons for dropout are not. Identification of barriers to participation and predictors of dropout may help improve the efficacy of internet-based clinical trials. The aim was to investigate a large number of possible predictors for non-participation and dropout in a randomised controlled trial for women with a negative birth experience and/or post-traumatic stress following childbirth.

SETTING

A childbirth clinic at a university hospital in Sweden.

PARTICIPANTS

The sample included 1523 women who gave birth between September 2013 and February 2018. All women who rated an overall negative birth experience on a Likert scale, and/or had an immediate caesarean section (CS), and/or severe postpartum haemorrhage (≥ 2000 mL) were eligible.

METHODS

Demographic, antepartum, and labour-related/postpartum predictors were investigated for non-participation (eligible but denied participation), pre-treatment dropout (prior to intervention start), treatment dropout, and loss to follow-up. Descriptive statistics and logistic regression were used in the data analysis.

RESULTS

A majority (80.3 %) were non-participants. Non-participation was predicted by lower level of education, being foreign-born, no experience of counselling for fear of childbirth, multiparity, vaginal delivery (vs CS and vacuum-assisted delivery) and absence of: preeclampsia, anal sphincter injury and intrapartum fetal distress. Pretreatment dropout was predicted by the absence of severe haemorrhage. Treatment dropout was predicted by vaginal delivery (vs immediate CS), vertex presentation and good overall birth experience. Loss to follow-up was predicted by vaginal delivery (vs immediate CS or vacuum-assisted delivery) and absence of intrapartum fetal distress.

CONCLUSIONS

Mothers with no obstetric complications were more likely to not participate and dropout at different time points. Both demographic, antepartum and obstetrical variables are important to attend to while designing procedures to maximise participation in internet-delivered cognitive-behavioral therapy.

TRIAL REGISTRATION NUMBER

ISRCTN39318241.

Affective well-being of Chinese urban postpartum women: predictive effect of spousal support and maternal role adaptation

Due to shortage of childcare facilities while high social expectations for mothering, becoming a mother is a big life challenge for most women in urban China. The understandings on Chinese postpartum women's affective well-being and its relation with spousal support and maternal role adaptation remain limited. This study aims to investigate the affective well-being (including both positive and negative affect) of Chinese urban postpartum women and how it is associated with spousal support and maternal role adaptation. A cross-sectional survey was conducted in Shanghai, China, between June and July 2019. A total of 498 urban mothers whose babies were 0 to 1 year old participated in this survey. They completed the Postpartum Social Support Questionnaire (PSSQ), the Maternal Role Adaptation Scale, and the Positive and Negative Affect Scale (PANAS), and reported socio-demographic information. Results showed that positive and negative affect of postpartum women were not significantly associated with each other. Positive affect had a positive correlation with spousal support and maternal role adaptation. Negative affect was negatively associated with maternal role adaptation, while not significantly associated with spousal support. Maternal role adaptation partially mediated the relationship between spousal support and positive affect of the participants, controlling for age, household income, education, birth order, and inter-generational support. The findings indicate that intervention programs towards mental health of postpartum women should focus more on positive affect cultivation; moreover, clinical services should help postpartum women to adapt to maternal role by encouraging new fathers' or partners' involvement in daily childcare-giving.

Uptake, Engagement and Acceptance, Barriers and Facilitators of a Text Messaging Intervention for Postnatal Care of Mother and Child in India-A Mixed Methods Feasibility Study

This study aimed to test the feasibility and to identify barriers and facilitators towards adherence of a text messaging intervention for postnatal care in India. Mixed methods research involving both quantitative and qualitative methods were used. A survey questionnaire for feasibility and focus group interviews to identify the barriers and facilitators to the intervention were conducted. The top three reasons for activation of service were: helped the new mother to understand the changes (95%); provided continuation of care (90%) and clarified conflicting information (89%). Over 90% read the messages daily. 80% were happy with the message frequency. About 75% shared the content with others. The main reasons for non-activation were: 30% had technical issues, 15% did not think it would be useful, 17% did not have time to activate and for 5%, husbands made the decision. These findings were triangulated through the qualitative focus groups. The main themes identified via the focus groups were: (1) reliable, current information; (2) issues and themes well aligned with new mothers' needs and priorities; (3) expanded the repertoire of information sources available; and (4) high-quality accessible information. The satisfaction and trust rates were high. This technology may be useful for health information intervention in specific postnatal areas.

Relationship between Edinburg Postnatal Depression Scale (EPDS) Scores in the Early Postpartum Period and Related Stress Coping Characteristics

Despite postpartum depression being a common mental health problem, there is no screening method for it. The only risk assessment used is the Edinburgh Postnatal Depression Scale (EPDS). We investigated the relationship between Brief Scale for Coping Profile (BSCP) subscales performed during pregnancy and EPDS scores. We recruited 353 women with normal pregnancies (160 primiparas, and 193 multiparas) and performed BSCP at 26 weeks of gestation. The EPDS was first performed within one week after delivery (T1), and then after one month (T2). Spearman’s correlation coefficients were calculated for the BSCP and EPDS for the whole and primi/multipara groups. Multiple regression analysis was performed with the EPDS T2 scores as the dependent variable. The EPDS scores were higher in the primipara group compared to the multipara (p < 0.001), and the EPDS T1 scores were higher than the overall T2 score (p < 0.001). In the multiple regression analysis, EPDS T1 and the “seeking help for solution” subscale were selected as significant explanatory variables when analyzed in the whole group; EPDS T1 and “active solution” for the primiparas; and EPDS T1, “changing mood”, and “seeking help for solution” for the multiparas. The BSCP can be used as a screening tool for postpartum depression during pregnancy.

Testing Models of Associations Between Depression and Parenting Self-efficacy in Mothers: A Meta-analytic Review

Numerous cross-sectional studies confirm the long-theorized association between mothers' depression and lower parenting self-efficacy (PSE) beliefs. However, cross-sectional studies leave unanswered the direction of this association: Does depression predict PSE? Does PSE predict depression? Are both true? Does the strength of the association between depression and PSE, regardless of the direction, generalize across participant characteristics and study design features? How stable is PSE over time? And how effective are interventions at enhancing PSE? To answer these questions, we conducted a meta-analytic review of longitudinal studies. With 35 eligible studies (22,698 participants), we found support for both models: there was a significant pooled effect of both depression on PSE and of PSE on depression, with nearly identical effect sizes (d =   - 0.21 and - 0.22, respectively). The association was stronger in samples with mothers' younger average age and studies that measured PSE among mothers relative to during pregnancy. We found a medium degree of stability in the index of PSE, d = 0.60. Finally, the estimated pooled effect size between being in an intervention group versus control group and PSE was 0.505. Overall, we found support for (1) bidirectional associations between depression and PSE in mothers, (2) the stability of PSE over time, and (3) the strength of the relationship between PSE and depression with intervention. These results suggest the importance of continuing to develop, test, and disseminate interventions to enhance PSE. We interpret these findings in the context of both depression and low PSE having serious consequences for child outcomes and maladaptive parenting.

The effect of Web-based preterm infant care training on mothers' self-confidence

The internet can be used as an alternative method in infant care education for mothers of preterm infants. This study was conducted to examine the effect of the Web-based infant care training program given to mothers of preterm infants on the self-confidence levels of mothers. This nonrandomized controlled study with a posttest design was conducted in Ministry of Health training and research hospital and university hospital. The study group comprised 84 mothers and their infants (intervention group: N = 42; control group: N = 42). Mothers with preterm infants in the intervention group participated in the Web-based program. The self-confidence of the mothers was evaluated before and after the training. The mothers' Pharis self-confidence scale mean scores were higher than the control group, but there was no significant difference. Web-based education program can be an alternative method that can be used in the education of mothers with preterm infants.

Validation of parental stress scale in a Greek sample of mothers with infants from 0 to 12 months

Parenting an offspring is a rewarding, albeit challenging task, often accompanied by high levels of stress. It is important to accurately assess the stress associated with parenting, as severe forms of stress may affect the parent-child dyad and lead to poor child outcomes. The aim of this study was to translate and validate the Parental Stress Scale (PSS) in the Greek population. We implemented forward and back translation and conducted a pilot test. A total of 735 mothers (M_age  = 34.6) with infants aged 0-12 months completed the PSS, the Edinburgh Postnatal Depression Scale, and the Hospital Anxiety and Depression Scale. The Greek PSS-18 showed good internal consistency (Cronbach's α = .83) and adequate convergent validity. Results of exploratory and confirmatory factor analysis revealed two underlying factors: positive aspects of parenting and negative aspects of parenting. Our data confirm the validity of the Greek version of the PSS-18 in mothers with infants aged 0-12 months. The Greek version of the PSS-18 could be a useful tool for professionals and researchers who are interested in perinatal period and the aspects of parenthood.

HAPPY MAMA Project (Part 2)-Maternal Distress and Self-Efficacy: A Pilot Randomized Controlled Field Trial

INTRODUCTION

The aim of the pilot randomized controlled field trial is to assess if a midwifery intervention is able to increase the maternal self-efficacy and reduce the stress level during the first six months after birth.

METHODS

The study was conducted in two different hospitals in Rome, Italy, involving women delivering at or beyond term, aged >18 years old and with normal APGAR scores of the infant. The participants were randomly divided into two groups: "Individual Intervention Group" (they received home midwifery assistance for one month after birth, I) and the "Control Group" (C). A self-administered questionnaire was administered four times: at the baseline about one week after the hospital delivery (T0), after the intervention about one month after the delivery (T1), and at three months (T2) and at six months after birth (T3). The questionnaire included different validated scales needed to assess maternal perceived self-efficacy (KPCS), parental stress scale stress (PSS) and maternal depressive risk symptoms (EPDS).

RESULTS

The study population counted 51 mothers: 28 women in the "C" group and 23 women in the "I" group. The PSS score was statistically higher in the "C" than "I" group at T1 (p = 0.024); whereas the KPCS score was statistically higher in the "I" (p = 0.039) group; EPDS score did not show significant difference between the two groups in the follow-up period. An inverse significant correlation between KPCS and PSS was found during the study window time (p < 0.0001).

CONCLUSIONS

These results potentially give the opportunity to explore this area of focus further, in order to better address maternal individual needs for the successful transition to motherhood. More research in this area is required.

Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma-and-violence-informed care to pregnant women

AIM

To evaluate the impact of a trauma and violence-informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal-infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post-traumatic stress disorder (PTSD).

DESIGN

A mixed-methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program.

METHODS

Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and 'yes/no' questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts.

RESULTS

In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31).

CONCLUSION

The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope.

IMPACT

TVICBT offers an effective, individualized, trauma and violence-informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal-infant bonding, thus filling an existing practice gap of a lack of individualized, trauma-informed care.

A comparative study of cumulative stress patterns within 14 days postpartum in healthy mothers and those with gestational diabetes: A prospective study

Although the number of mothers with gestational diabetes mellitus (GDM) is on the rise, only few studies have examined the cumulative stress associated with breastfeeding after childbirth. GDM mothers are susceptible to stress due to insulin resistance, and their level of stress is associated with breastfeeding. This study aimed to identify patterns of stress change over time in GDM mothers and healthy mothers and to identify the factors influencing those patterns.The participants of this study were mothers within 14 days after childbirth. The GDM group consisted of 32 mothers, and the healthy group comprised 30 mothers. Cumulative stress was measured in terms of heart rate variability, and linear mixed models were used to analyze changes over time.The cumulative stress of healthy mothers was about 8 points higher than that of mothers with GDM (t = -2.95, P = .005). The cumulative stress level was inversely associated with the mother's age (β=-1.20, P = .018), the mother's weight (β=-0.64, P = .008), and the baby's body mass index (β=-3.09, P = .038). Furthermore, an insufficient amount of breast milk was associated with higher stress (β=16.09, P = .007).GDM mothers and healthy mothers experienced different patterns of cumulative stress. Breastfeeding should be started quickly to promote health and stress reduction among mothers who are physically and psychologically vulnerable after childbirth.It is necessary to incorporate programs to promote breastfeeding considering stress levels at an appropriate time according to the mother's health condition.

Impacts of Neonatal Hospitalization on Families during the 2019 Coronavirus Pandemic

OBJECTIVE

Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19.

STUDY DESIGN

Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness.

RESULTS

Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life.

CONCLUSION

Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being.

KEY POINTS

· Impact of infant hospitalization in the context of COVID-19 is largely unknown.. · In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.. · Greater impacts were reported by parents with lower income, confidence, and very premature infants..

Influence of parity and infant age on maternal self-efficacy, social support, postpartum anxiety, and postpartum depression in the first six months in the Maritime Provinces, Canada

BACKGROUND

After giving birth, women experience significant changes related to maternal self-efficacy and social support and are at risk of experiencing postpartum anxiety and depression.

PROBLEM

No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context.

AIM

To explore the relationship between parity and infant age on perceived maternal self-efficacy, social support, postpartum anxiety, and postpartum depression.

METHODS

Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim.

FINDINGS

A total of 561 women (56.5% primiparous, 55.1% infant 0-3 months) participated. There were significant main effects for both parity (P < .001) and age of infant (P < .001), but no significant interaction (P = .463). Primiparous women had lower maternal self-efficacy (P = .004) and higher postpartum anxiety (P = .000) than multiparous women. Women with younger infants had more perceived social support (P = .002). Women with older infants had higher levels of postpartum anxiety (P = .003) and depression (P = .000).

DISCUSSION

The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six-week follow-up period.

CONCLUSIONS

Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well-being and address postpartum needs.

Determinants of changes in women's and men's eating behavior across the transition to parenthood: a focus group study

Background

During the pregnancy and postpartum period, both women and men experience physiological and psychological changes, which may negatively impact their eating behavior. A clear understanding of determinants of changes in eating behavior during this period is needed to facilitate the development of targeted family-based interventions countering unfavorable dietary changes during this critical life period.

Methods

Thirteen focus group discussions targeting determinants of changes in eating behavior during pregnancy and postpartum were conducted, involving a total of 74 expecting and first-time parents. A semi-structured question guide was used to facilitate the discussions. An inductive thematic approach was used to derive main and sub-categories of determinants from the data. The Determinants of Nutrition and Eating (DONE)-framework was employed to systematically organize and label the categories and determinants.

Results

Two frameworks were developed; one for the pregnancy and one for the postpartum period, comprising determinants of changes in eating behavior in both women and men. Three main levels of determinants were identified: (1) the individual level, including psychological (e.g., ‘health consciousness’), situational (e.g., ‘effort and convenience’) and biological (e.g., ‘discomfort’); (2) the interpersonal level (e.g., ‘social influence’) and (3) the environmental level, including micro- and meso/macro (e.g., ‘home/environment food availability’). Determinants acting as barriers (e.g., ‘time constraints’) or facilitators (e.g., ‘being a role model’) were identified. Many determinants were mentioned during both (e.g., ‘food knowledge’) or just one investigated period (e.g., ‘physiological changes’ during pregnancy, ‘influence of the baby’ postpartum). Finally, some were described by both parents (e.g., ‘self-regulation’), whereas others were mentioned by women (e.g., ‘(perceived) food safety’) or men (e.g., ‘other priorities’) only.

Conclusion

The developed frameworks set the foundation for the development of future family-based interventions and may be used already by healthcare providers to provide dietary guidance and support for women and men transitioning into parenthood. A focus on the interplay of individual factors at the biological and psychological level together with situational difficulties during pregnancy is recommended. Postpartum, focus should go to support first-time parents to obtain balance of both maintaining one’s own health and taking care of the baby, on improving self-regulation skills, and on coping with related situational constraints.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01137-4.

Postpartum Stress and Neural Regulation of Emotion among First-Time Mothers

Early parenting relies on emotion regulation capabilities, as mothers are responsible for regulating both their own emotional state and that of their infant during a time of new parenting-related neural plasticity and potentially increased stress. Previous research highlights the importance of frontal cortical regions in facilitating effective emotion regulation, but few studies have investigated the neural regulation of emotion among postpartum women. The current study employed a functional neuroimaging (fMRI) approach to explore the association between perceived stress, depressive symptoms, and the neural regulation of emotion in first-time mothers. Among 59 postpartum mothers, higher perceived stress during the postpartum period was associated with less self-reported use of cognitive reappraisal in everyday life, and greater use of emotion suppression. While viewing standardized aversive images during the Emotion Regulation Task (ERT), mothers were instructed to experience their natural emotional state (Maintain) or to decrease the intensity of their negative emotion by using cognitive reappraisal (Reappraise). Whole-brain analysis revealed a two-way interaction of perceived stress x condition in the right dorsolateral prefrontal cortex (DLPFC) at p < .05 cluster-wise corrected, controlling for postpartum months and scanner type. Higher levels of perceived stress were associated with heightened right DLPFC activity while engaging in cognitive reappraisal versus naturally responding to negative stimuli. Higher right DLPFC activity during Reappraise versus Maintain was further associated with elevated parenting stress. Findings suggest that stress and everyday reappraisal use is reflected in mothers' neural regulation of emotion and may have important implications for their adaptation to parenthood.

Postpartum Depression and Early Predictors of Lower Maternal Confidence at 12 to 15 Months after Delivery

The objective of the present study is to assess the association of early postpartum depression and maternal confidence with low maternal confidence at 12-15 months after delivery. Prospective study performed from 2013 to 2015 with 358 postpartum women who had participated in a cluster trial to treat their depression during pregnancy. At 6-8 months after birth, we reviewed socio-demographics, obstetric data and Postpartum Depression (PPD) with the Patient Health Questionnaire-9. Maternal Confidence (MC) was assessed at 6-8 and 12-15 months after birth with the Maternal Confidence Questionnaire. Low and High MC was defined using 50% percentile. The crude and adjusted Odds Ratios (OR) with the 95% Confidence Interval (CI) were calculated using Poisson regression with robust variance. Multivariate models estimated the ORs between postpartum depression and LMC at 12-15 months adjusted for socio-demographic variables, maternal characteristics and previous LMC. Statistical analysis was performed with STATA12 and the significance level was considered equal or lower than 5%. Among a sample of women who were depressed during pregnancy, 19% had probably moderate to severe depression, at the beginning of the child' second year of life. Low maternal confidence was associated with previous low maternal confidence (OR = 1.71; 95% CI 1.33:2.20, p = <0.001) and vaginal delivery but not with previous PPD. Based on our findings, detection and treatment of women presenting confidence problems at the first months after delivery may prevent later mother self-efficacy problems.

Effect of education on the readiness levels of primigravida women to hygienic care practices of the newborn with the use of QR code

The researcers planned this study to determine the effect of the education on the hygienic care of the newborn with the use of QR Code on readiness levels of primigravida women to hygienic care practices of the newborn. A total of 68 primigravida women constituted of this interventional study. After the intervention group completed their education on newborn care, mobile application and QR codes were introduced to the pregnant women. The control group received routine newborn care training. It was observed that the education of hygienic care to the newborn, which was provided to pregnant women with the use of QR Code, was effective on their readiness to care. Pediatric nurses can provide QR code supported training to prepare pregnant women for the hygienic care of the newborn.

HAPPY MAMA Project (PART 1). Assessing the Reliability of the Italian Karitane Parenting Confidence Scale (KPCS-IT) and Parental Stress Scale (PSS-IT): A Cross-Sectional Study among Mothers Who Gave Birth in the Last 12 Months

The purposes of this study were: (1) to adapt two validated questionnaires used to evaluate maternal confidence (KPCS-IT) and maternal stress (PSS-IT) to the Italian context, in order to (2) measure the stress level and the self-efficacy in an Italian sample of mothers. The validation process has provided the construction of an online questionnaire. It was administered on a convenience mothers sample with at least a child aged 0–12 months, twice (T0 and T1) with a two day interval. Assessment of instrument stability over time was estimated by applying test–retest reliability between T0 and T1, and the Cronbach’s alpha coefficient. A cross-sectional study was carried out to assess the second aim. Italian mothers with at least one child living at home aged between 0–12 months were recruited. Statistical reliability methods were applied to assess the internal validity of the two questionnaires. PSS-IT was analyzed using univariate and multivariate statistical analyses in order to study the association between KPCS-IT, demographic and maternal characteristics. Statistical significance was established as p < 0.05. The Cronbach’s alpha reported a good level of internal consistency of the questionnaires: PSS-IT alpha = 0.862; KPCS-IT alpha = 0.801. 32% of the mothers declared low maternal confidence and the mean value of PSS-IT was 35.4 (SD = 8). The significant inverse correlation was found between the PSS-IT and the KPCS-IT (coeff = −0.353; p < 0.001): this means that a high level of perceived self-efficacy reduces the maternal stress level. The study identifies that interventions on maternal confidence can be useful to support mothers in the first months after delivery in order to prevent stress risk: the perceived self-efficacy is as a modifiable factor and the results of the study indicate that it significantly reduces the PSS-IT and EPDS scores. In future, more field trials are necessary in order to assess the realistic and feasible interventions on maternal confidence and competence to prevent maternal distress.

Postpartum during COVID-19 pandemic: Portuguese mothers' mental health, mindful parenting, and mother-infant bonding

Background

Millions of people worldwide have been diagnosed with coronavirus disease 2019 (COVID‐19), which has impacted maternal mental health and mother–infant relationships during the postpartum period.

Objectives

To explore how mothers' anxious and depressive symptoms, parenting stress, mindful parenting, and mother–infant bonding vary as a function of the moment of the baby's birth (pre‐COVID‐19 or post‐COVID‐19) and to examine the contribution of those variables to mother–infant bonding.

Methods

The sample was recruited online and comprises 567 mothers (18–46 years) with an infant aged between 0 and 12 months old.

Results

Approximately 27.5% of the mothers presented clinically significant levels of anxious and depressive symptoms. Mothers who gave birth during the COVID‐19 pandemic presented lower levels of Emotional Awareness of the Child and a more impaired mother–infant bonding than mothers who gave birth before the pandemic started. Approximately 49% of the mother–infant bonding variance was explained by parenting stress and by several dimensions of mindful parenting.

Conclusion

Our findings provide important insights into the impact of COVID‐19 on maternal mental health and parenting.

Nursing diagnoses of the self-perception domain in women in the puerperium

PURPOSE

During puerperium, women experience changes that may be responsible for disorders in the phenomenon of self-perception. Thus, the present study aims to analyze the nursing diagnoses of the self-perception domain of NANDA International Taxonomy II in puerperal women.

METHODS

Descriptive, cross-sectional, and quantitative study. The sample consisted of 153 women on puerperium followed in a University Hospital in a Brazilian capital. Data were collected through interviews with the application of an instrument. Data analysis was performed using descriptive and inferential statistics. The study was approved by the Research Ethics Committee (CAAE: 02849818.0. 0000.5208).

FINDINGS

The most prevalent Nursing Diagnosis of the self-concept class was Readiness for enhanced self-concept, which presented statistically significant associations with two defining characteristics. The risk for situational low self-esteem was the most prevalent Nursing Diagnosis in the Self-esteem class and presented associations to two risk factors. The Nursing Diagnosis Disrupted body image, present in the Body Image class, showed associations with 11 significant defining characteristics.

CONCLUSIONS

The analysis of the Nursing Diagnosis of the Self-Perception domain can assist in planning interventions directed to the specific needs of women in the puerperium.

IMPLICATIONS FOR NURSING PRACTICE

This study may contribute to the development of specific interventions to the reality of the puerperal, encouraging the nursing professional to implement the Nursing Process in the clinical practice. It may also contribute to the refinement of the NANDA-II taxonomy and the advancement of nursing research, in addition to providing safe clinical practice grounded in scientific knowledge for planning educational actions in puerperal women in order to minimize the negative perceptions experienced by them.

The Relationship Between Maternal Self-confidence and Postpartum Depression in Primipara Mothers: A Follow-Up Study

This follow-up study was performed in order to determine the relationship between maternal self-confidence and postpartum depression in primipara mothers over time. It was conducted between February and December 2017 with 82 primipara mothers. Data was collected using Participant information forms, The Pharis Self-confidence Scale (PSCS), and The Edinburgh Postpartum Depression Scale (EPPDS) in three phases in the 6th postpartum week (1st follow up), 10th week (2nd follow up), and 14th week (3rd follow up) and was evaluated using independent t test, Pearson correlation analysis, the Cochran's Q test, and Repeated Measures ANOVA. The mean PSCS scores were found to be 42.6 ± 6.27 in the 1st follow up, 50.3 ± 5.12 in the 2nd follow up, and 55.9 ± 4.05 in the 3rd follow up. EPPDS mean scores were found to be 8.98 ± 5.04 in the 1st follow up, 5.18 ± 3.63 in the 2nd follow up, and 2.09 ± 2.12 in the 3rd follow up. A negative and strong relationship between maternal self-confidence and postpartum depression continuing across follow up phases was found.

What are the effects of supporting early parenting by newborn behavioral observations (NBO)? A cluster randomised trial

BACKGROUND

Professional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions. The objective was to investigate the effect of health visitors' use of the Newborn Behavioral Observations system in new families.

METHODS

A cluster-randomised study was conducted in four Danish municipalities. Health visitors' geographical districts constituted the units for randomisation (n = 17). In the intervention group, 1332 families received NBO from 3 weeks after birth; in the comparison group, 1234 received usual care. Self-administered questionnaires were collected at baseline one to two weeks after birth, and at follow-up three and nine months postpartum. The outcomes were change over time measured by The Karitane Parenting Confidence Scale (KPCS), The Major Depression Inventory (MDI), The Ages and Stages Questionnaire: social-emotional (ASQ:SE) and The Mother and Baby Interaction Scale (MABIC). Data were analysed with mixed-effects linear regression using the intention-to-treat approach.

RESULTS

At baseline, no significant differences between the two groups were seen regarding maternal and infant factors. At follow-up three and nine months after birth, the change in maternal confidence and mood, infant's socio-emotional behaviour, and early parent-infant relationship moved in a slightly more positive direction in the intervention group than in the comparison group, though not statistically significant. The only significant effect was that the intervention mothers reported higher level of knowledge about infant's communication skills, response to cues, and how to sooth and establish a relation with the infant, compared to the comparison group.

CONCLUSIONS

We found no effect of the NBO system delivered in a universal context to all families in a community setting. The only significant difference between groups was a higher maternal degree of knowledge regarding early parenting in the intervention group.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03070652 . Registrated February 22, 2017.

Effect of newborn bathing training with the swaddled and tub bathing methods given to primiparous pregnant women on the mother's experience, satisfaction and newborn's stress during the first bathing of the newborn at home: A mixed method study

AIM

The aim of this study is to compare the effect of two different bathing methods training given during pregnancy on the mother's experience, satisfaction and newborn's physiological and behavioral parameters during the first bathing of the newborn at home.

METHODS

A mixed methods research was used in this study. The groups were determined as swaddled bathing (SB) (n = 31) and tub bathing (TB) (n = 31). After training given to the groups, the first bath of the newborn in both groups was built by the mothers. The body temperature, heart rate, oxygen saturation, respiration rate, crying times, stress parameters of the newborns and mother satisfaction in both groups were evaluated. The open-ended questions were used to determine mothers' experiences.

RESULTS

There was a statistically significant difference between the groups in terms of oxygen saturation, respiration rate, crying time, face/forehead grimacing, unrest and maternal satisfaction. Four categories and 14 subcategories made up the qualitative part of the study which includes the experiences of the mother about two different bathing methods. "The feelings and worries of the mothers about first bathing" refers to the participants in both groups how they feel during the first bathing; "Positive aspects of this method compared to other bath method" and "Negative aspects of this method compared to other bath method" refers to positive and negative aspects of different bathing methods applied to groups; "Difference between the applied bathing method and other methods" refers to differences they observed when compared to other bathing methods. The mothers in the SB group had less fear of drowning hazard and injuring the newborn, and the fear of uneasiness and the newborn slipping down from hands were more frequent in the TB group.

CONCLUSION

It was determined that both bath methods reduced body temperature, the SB method decreased the stress of newborns and had a positive effect on mother satisfaction and experience.

"I was worried about not being good enough". Experiences and perspectives on pregnancy, childbirth and parenthood when living with a neuromuscular disorder - an exploration of everyday life challenges

PURPOSE

The aim of this study was to explore the everyday life experiences and perspectives on challenges related to pregnancy, childbirth and parenthood when living with neuromuscular disorders (NMDs) and identify important elements to take into consideration for parents and their health professionals.

MATERIALS AND METHODS

In all, 27 people (17 with a NMD and 10 partners without a NMD) were included in this study. The participants were all parents or expecting parents. Both mothers and fathers and ambulant and non-ambulant participants were included to broaden the perspective. Three types of semi-structured interviews were applied. The analysis was guided by the Interpretive Description methodology and Antonovsky's Sense of Coherence theory.

RESULTS

The findings illuminated insights to ongoing challenges in the everyday lives of parents with NMD. Enforced Dilemmas represented guilt and dilemmas on the possibility of passing on the NMD. Reflections on Bodily Ability symbolized the effect that pregnancy and parenthood had on the body. Concept of Normality signified the concerns the parents had about "not being normal enough." Experience of Dependency addressed being dependent on others and No One to Emulate how the rarity of the NMD made it difficult to find peers or seek advice.

CONCLUSION

The study emphasizes the importance of the professionals providing counseling and support on pregnancy, childbirth, and parenthood either during consultations, online or in structured professional and peer-support rehabilitation groups for expecting parents or for new parents with a NMD.IMPLICATIONS FOR REHABILITATIONProfessionals must provide knowledge and counselling on pregnancy, childbirth, and parenthood to support families with NMD who are expecting a child or have already become parents and address the illusion of normal.Professional centralized and specialized units where people with NMD can get advice on pregnancy and give birth should be an option.Structured professional and peer-support rehabilitation groups (physical meetings or online) on pregnancy, childbirth, and parenthood may be of value for the parents due to the rarity of the diagnosis.Online information and knowledge on pregnancy, childbirth, and parenthood and NMD should be widely available.Health professionals and peers can help ensure and support an experience of comprehensibility, manageability, and meaningfulness among the parents with NMD and develop rehabilitation services that meet the needs and preferences of people considering getting a child or who are already parents with NMDs or other disabilities.

Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial

Introduction

Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations.

Methods

This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations.

Results

The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed.

Discussion

The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care.

Trial registration

ClinicalTrials.gov ID: NCT02581800.

Maternal appraisals of the birth of a child: Portuguese version of the Stress Appraisal Measure

Objective: We assessed (1): the factorial and convergent validity of the Portuguese version of the Stress Appraisal Measure (SAM); (2) maternal primary and secondary appraisals of the birth of a child; and (3) the influence of appraisals on stress.Background: Parental stress is common during transition to parenthood and may be detrimental for parents and infants. Following Lazarus and Folkman's transactional model, the degree of stress is influenced by cognitive appraisals of an event, which are assessed by the SAM.Methods: This was an observational, cross-sectional study. Two hundred and forty-five women with a child of up to 24 months of age filled out several self-report measures, in an online platform.Results: The SAM factorial structure included three primary (Threat, Centrality, and Challenge) and two secondary (Controllable-by-Self and Controllable-by-Others) appraisals. All subscales had adequate internal consistency. The birth of a child was mainly perceived as a challenge, and seldom appraised as a threat. Threat and centrality appraisals positively predicted stress.Conclusion: Assessing maternal appraisals of the birth of a child is relevant to foster adaptation to parenthood. The SAM is an adequate assessment tool. As cognitive appraisals are modifiable, women with higher threat appraisals should be targeted for psychological interventions.

Development of parenting self-efficacy in mothers of high-risk infants

PURPOSE

The aim of this prospective, longitudinal study was to (1) examine the development of parenting self-efficacy (PSE), (2) explore the influence of contextual factors (e.g., family functioning, family centered care, and infant medical caregiving complexity) on PSE development, and (3) whether PSE and contextual factors predict parent and infant health outcomes in a high-risk infant population.

METHOD

Mothers (n = 67) of infants diagnosed with a complex medical condition following birth were enrolled within 3 weeks of their infant's diagnosis and admission to intensive care. Participants completed an online study survey at study enrollment (T1), infant discharge (T2), and 3 months after discharge (T3). Change in PSE was examined using mixed modeling and predictors of parent and infant health outcomes were explored using multiple regression.

RESULTS

PSE significantly increased over time (b = 2.08, p < .0001). Family functioning was the only significant contextual factor, where worse family functioning at enrollment was associated with lower confidence over time. Mothers who were older and had more than one child were significant predicators of higher PSE. Interestingly, being married, compared to being single, was associated with decreased PSE. Higher PSE was also predictive of positive maternal psychological wellbeing at 3 months after discharge and a decrease in infant's medical complexity was associated with higher maternal psychological well-being.

CONCLUSION

These are important findings given that PSE is known to contribute to infant development and health status.