Multiple Birth Families With Children With Special Needs: A Qualitative Investigation of Mothers’ Experiences

Prenatal maternal depressive symptoms of Chinese pregnant women and twin newborns' physical health: the moderating role of infant sex

Consequences of prenatal maternal depressive symptoms on infant health are well established. But the results of infants' sex differences of such consequences are mixed. The current study examines whether any association exists between prenatal maternal depressive symptoms and infant physical health different for the sex of newborns. A sample of 84 women pregnant with twins reported depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) in the late gestational stage. The Apgar scores of newborns were assessed by healthcare providers at 1, 5, and 10 minutes after birth. The relationship of maternal prenatal depressive symptoms and newborns' physical health was moderated by infant sex. Higher depressive symptoms were associated with a lower Apgar index among newborn boys but not girls. Fetus environment or biomarkers related to sex may be a key mechanism of the effect of prenatal depression symptoms on newborns' health. Tailored interventions targeting maternal depression symptoms may be warranted.

Parents of extremely and moderately preterm children reported long-lasting impressions of medical care and the hospital environment

AIM

Few studies have examined the parents of moderately preterm children. The aim of this study was to investigate the experiences of parents of both extremely and moderately preterm children.

METHODS

Qualitative telephone interviews were conducted in 2013-2014 with 13 mothers and 10 fathers of extremely preterm children and with 11 mothers and seven fathers of moderately preterm children. The children were born between 2000 and 2003. Data were analysed with a narrative approach.

RESULTS

Parents of extremely preterm children recounted dramatic birth stories that, for most, ended positively. Parents of moderately preterm children presented more neutral birth stories, and most recounted that their children did not receive attention for prematurity from medical staff. Parents from both groups described staff members' treatment in terms of long-lasting impressions, and they were deeply affected by the hospital environment and the other parents and children admitted. Parents whose children died or were disabled recounted dramatic stories and endless fights for support.

CONCLUSION

Parents from both groups reported long-lasting impressions of the medical staff and the hospital environment, which they found important to talk about, even a decade after the birth of their child/children.

Does Birth-Related Trauma Last? Prevalence and Risk Factors for Posttraumatic Stress in Mothers and Fathers of VLBW Preterm and Term Born Children 5 Years After Birth

Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4-6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study "Hamburg study of VLBW and full-term infant development" (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.

Chronic Sorrow in Parents of Children with a Chronic Illness or Disability: An Integrative Literature Review

PROBLEM

This integrative review aims to synthesize the findings of studies on chronic sorrow in parents, to analyze the findings along three specific research questions, and to identify areas for future research.

ELIGIBILITY CRITERIA

Studies of parents, mothers and/or fathers of non-adult children published in peer-reviewed journals that answered the research questions: 1) How does the experience of chronic sorrow differ between mothers and fathers? 2) What factors have been identified to impact the experience of chronic sorrow over time? 3) What strategies by health care providers for helping parents cope with chronic sorrow have been identified to be most and least helpful?

SAMPLE

Nineteen studies from a literature search within the databases of CINAHL, MEDLINE, PsycINFO, Psycarticles and SocIndex were included in the review.

RESULTS

Findings suggest that mothers experience more intense chronic sorrow compared with fathers. Health care crises and developmental milestones are potent triggers for resurgence of chronic sorrow. Helpful strategies by healthcare providers include providing information, helping to procure respite and being empathetic and compassionate.

CONCLUSIONS

Healthcare providers need to understand that chronic sorrow is a normal consequence of having a child with a chronic illness or disability.

IMPLICATIONS

Family-centered interventions should be individualized and aimed at providing increased comfort to parents in times of need. Further research that looks at the effectiveness of interventions is needed.

Maternal Psychological Distress and Mother-Infant Relationship: Multiple-Birth Versus Singleton Preterm Infants

PURPOSE

Multiple preterm birth is associated with more maternal psychological distress and less positive mother-infant interactions than singleton preterm birth. This study's purpose was to compare psychological distress and the relationship with their infants in mothers of multiples and mothers of singletons.

DESIGN

An exploratory secondary analysis of longitudinal data.

SAMPLE

236 mothers and their preterm infants.

MAIN OUTCOME VARIABLES

Maternal psychological distress (depressive symptoms, anxiety, posttraumatic stress [PTS], parenting stress), the mother-infant relationship (worry; child vulnerability; maternal positive involvement and developmental stimulation; and child developmental maturity, irritability, and social behaviors), and the home environment.

RESULTS

Mothers of multiples had greater PTS symptoms at baseline, anxiety at discharge, and depressive symptoms at six months than mothers of singletons. Mothers of multiples also had more positive home environments at six months. Multiple birth was a risk factor for psychological distress but not for less positive mother-infant interactions.

“I thought he was ugly”: Mothers of extremely premature children narrate their experiences as troubled subjects

This article explores the ways in which mothers of extremely premature children make sense of their negative feelings towards their newborn child and their strategies for performing “proper motherhood”. The analysis was guided by discursive psychology and the feminist debate on attachment, mother–infant bonding, and “good motherhood”. The empirical material was created within a sub-study that set out to explore mothers’ and fathers’ experiences of having a premature child and was part of a project investigating the need for support for premature children and their families. Parents were interviewed about the pregnancy, their experiences of the birth and hospital period, the process of going home, the experiences of pre-school and school, and thoughts about the future. The stories of four mothers, which dealt with negative feelings towards their child and the guilt and distress related to this, were selected for analysis. The mothers handled their troubled positions as subjects unable to feel “motherly love” by referring to notions of attachment and bonding, and good motherhood as being loving and caring. Yet, the mothers also talked about motherhood as being socially constructed, as duties that can be performed without the “right motherly feelings”, and as something that men could also perform.

Brief online surveys to monitor and evaluate facilitated peer support groups for caregivers of children with special needs

BACKGROUND

There have been few systematic evaluations of experiences of participating in peer support groups for parents and other caregivers of children with special needs. In Australia, facilitated groups are available to caregivers in community settings, through a nationally funded program, MyTime. Mechanisms for ongoing monitoring and evaluation have not yet been instituted.

AIM

To establish whether brief, online surveys can be used for monitoring and evaluating peer support groups for caregivers of children with special needs.

METHODS

Two brief, online surveys, with both fixed-choice and open-ended questions, were developed. All caregivers who attended any MyTime group during a 1-month period were invited to participate.

RESULTS

Of 89 caregivers who expressed interest in participating, 54 and 31 respondents completed respectively. Respondents represented a variety of backgrounds and circumstances. Responses revealed both positive and negative aspects of group participation. Linked data on expectations and experiences provided important feedback for the program.

CONCLUSION

Brief, online surveys are a suitable mechanism for ongoing monitoring and evaluation of peer support group programs for caregivers.

Raising multiples: mental health of mothers and fathers in early parenthood

The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options.

Families with twins - a systematic review

Parenthood is among the developmental transitions that set major challenges for contemporary families. When there is a twin pregnancy, those challenges increase. Our aims in this study are understanding the parental experience in families with twins and identifying the factors which condition parental experience in such families. It is a literature review focusing on studies published between 2000 and 2012 based on reference data. The articles were analyzed considering the aims, participants, phases of data collection, tools used; and results achieved regarding the dimensions involved in parenting experiences faced by parents of twins. In the 19 studies identified, maternity was the main focus of research. Women with twin children showed lower scores on well-being, higher stress risks, exhaustion and depression. The experience of these families was different, more demanding and complex than singletons' parents. Understanding of this matter becomes crucial to contributing to better health for families.

Identificação dos efeitos dos filhos nas relações familiares

Objetivo: Identificar os efeitos que os filhos têm nas relações familiares e identificar a priorização de preocupações dos pais com e sem filhos gêmeos. Métodos: Estudo transversal com 265 pais com filhos menores, dos quais 143 com filhos gêmeos. Os instrumentos de coleta de dados: escala de impacto familiar de um filho; lista de preocupações parentais. Resultados: As preocupações parentais priorizadas por ambos os grupos de participantes foram: “Falta de horas de sono e cansaço”; “Necessidades econômicas da família”; “Aumento das tarefas domésticas”; “Stresse individual com os papéis e com as responsabilidades”. O impacto familiar dos filhos é maior na dimensão financeira, sendo que esse valor é significativamente maior nas famílias com gêmeos. Conclusão: Os profissionais de enfermagem devem atender as principais dificuldades percebidas pelos pais promovendo estratégias e favorecendo a mobilização dos seus recursos.

Unconscious dynamics in twin pregnancy emerging from the Lüscher color test

OBJECTIVE

To investigate unconscious dynamics in women pregnant with twins, using Lüscher's color test to objectively measure subjective color preferences, and compare them with women with singleton pregnancies.

METHODS

The color test was administered to 50 Italian women with twin pregnancies and 100 women with singleton pregnancies.

RESULTS

Both the twin and singleton pregnancy groups said that violet was their favorite color (50 versus 49%) and brown was their least favorite color (52 versus 44%), indicating that they idealized being pregnant, but also found it physically stressful. The twin pregnancy group chose yellow as their second favorite (28 versus 17%) and were most likely to combine it with their first choice of violet (44 versus 19%, p=0.0006), indicating that they were worried about their relationships with their new babies and wanted to give birth soon. In addition, both groups preferred form 6, the sine curve on a dark background, but rejected the associated brown color 6, revealing that the women felt the need to look after themselves.

CONCLUSIONS

Both groups idealized being pregnant, but also found it physically stressful. However, the twin pregnancy group was afraid of building relationships with their babies and wanted to give birth soon.