Empathy in pregnant women and new mothers: a systematic literature review

Age and parous-experience dependent changes in emotional contagion for positive infant sounds

Introduction

Emotional contagion is achieved by inferring and emotionally resonating with other persons' feelings. It is unclear whether age-related changes in emotional contagion for infant sounds are modulated by the experience of childbirth or childcare. This study aims to evaluate changes in inference and emotional resonance for positive and negative infant sounds (laughter and crying) among women, based on age and parous experience.

Methods

A total of 241 women (60 young nulliparous, 60 young parous, 60 old nulliparous, and 61 old parous) completed a web-based questionnaire. After listening to three types of infant sounds (laughter, cooing, and crying), participants responded with their valence for hearing infant sounds and estimated infant valence on an 11-point Likert scale.

Results

The analysis for emotional resonance revealed that the correlation coefficient between self and estimated infant valences was greater in young parous and old nulliparous women than in young nulliparous women, in laughter and cooing sounds. However, correlation coefficients for crying did not differ among any of the four groups.

Conclusion

The degree of emotional resonance for infant valence increased depending on age and parous-experience for positive infant sounds.

Exploring the key drivers of responsive parenting in mothers and fathers - observed and self-reported responsiveness

BACKGROUND

This article explores parental responsiveness - the ability of a parent to react to a child's needs adequately, promptly, and with tenderness and synchrony. Parental responsiveness can be measured using observational and self-report scales. The purpose of this study was to explore whether individual differences in empathy and attachment in mothers and fathers and their satisfaction with their relationship are predictors of parental responsiveness toward infants. Moreover, self-report and observational measures of parental responsiveness were compared.

PARTICIPANTS AND PROCEDURE

A total of 110 triads (mother, father, and child aged 6-10 months) took part in the free play procedure and parents' behaviors towards their children were assessed using the Ainsworth Sensitivity Scale. Moreover, they filled out a set of questionnaires measuring parental self-reported responsiveness, empathy, experiences in close relationships and romantic relationship satisfaction.

RESULTS

Higher empathic concern was connected with higher responsiveness and this was seen in both individual and partner measures. At the individual level, measures of responsiveness (self-report and observational) were not congruent and probably depended on other variables. In couples, there were positive correlations in three aspects of their family functioning: observed and self-reported parental responsiveness as well as relationship satisfaction.

CONCLUSIONS

This study revealed differences between self-reported and observational measures of parental responsiveness, indicating that their results may not always be congruent and could depend on other variables.

Efficacy of cognitive behavioural therapy for insomnia or sleep disturbance in pregnant women: A systematic review ad meta-analysis

During pregnancy many women may experience negative emotions and sleep disturbances. This systematic review and meta-analysis was conducted to assess the efficacy of cognitive behavioural therapy for insomnia (CBT-I) or sleep disturbance in pregnant women. From the earliest available publications to 15 April 2022, seven electronic literature databases were searched: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database for Chinese Science and Technology Journal. Randomised controlled trials of CBT-I in pregnant women with insomnia or sleep disorders were included. The methodological bias of the included studies was assessed using the Cochrane risk of bias tool. The meta-analysis was performed using RevMan 5.4 software. Stata Statistical Software: Release 15 was used for sensitivity analysis and publication bias. We included eight randomised controlled trials involving 743 pregnant women. Meta-analysis showed that, compared with the control group, CBT-I significantly improved the Insomnia Severity Index (mean difference [MD] = -4.25, 95% confidence interval [CI, -6.32, -2.19], p < 0.001), The Pittsburgh Sleep Quality Index (MD = -3.30, 95% CI [-4.81, -1.79], p < 0.001), sleep onset latency (standardised mean difference [SMD] = -1.25, 95% CI [-2.01, -0.50], p = 0.001), anxiety (SMD = -0.99, 95% CI [-1.32, -0.67], p < 0.001), and depression (SMD = -0.40, 95% CI [-0.72, -0.07], p = 0.02). No significant differences were found in total sleep time (SMD = 0.31, 95% CI [-0.54, 1.17], p = 0.47) and sleep efficiency (SMD = 0.80, 95% CI [-0.53, 2.13], p = 0.24). CBT-I significantly improved pregnant women's sleep quality, insomnia severity, depression, and anxiety. This meta-analysis provides evidence that CBT-I is valid for insomnia or sleep disturbances during pregnancy.

The effect of maternal empathy on infants' attachment security: Moderation by maternal emotion regulation and infant temperament

This study examined the relationship between maternal empathy and infants' attachment security and tested the moderating effects of maternal emotion regulation and infant negative emotional temperament. Participants were sampled from 215 families whose infants were 6 months old (T1) and from 170 families of the same cohort whose infants were 14 months old (T2). At T1, mothers were measured for their empathy (empathic concern and perspective taking), emotion regulation (reappraisal and suppression), and infant negative emotional temperament (sadness, falling reactivity, fear, and distress to limitations). At T2, mothers were again measured for their emotion regulation, and infant attachment was measured using the Strange Situation Procedure. Maternal empathic concern (EC) and perspective taking (PT) were found to be positively related to infant attachment security, while maternal reappraisal and infant temperamental sadness moderated the relationship between maternal PT and infant attachment security. No significant moderation effects were found between maternal EC and infant attachment security. Simple slope results showed that for infants with higher maternal reappraisal or infant sadness, maternal PT could positively predict infant attachment security. These findings highlight the importance of how the individual characteristics of mothers and infants may interact with maternal empathy during the critical period of infant attachment formation.

Gender differences in brain response to infant emotional faces

Infant emotional stimuli can preferentially engage adults' attention and provide valuable information essential for successful interaction between adults and infants. Exploring the neural processes of recognizing infant stimuli promotes better understandings of the mother-infant attachment mechanisms. Here, combining task-functional magnetic resonance imaging (Task-fMRI) and resting-state fMRI (rs-fMRI), we investigated the effects of infants' faces on the brain activity of adults. Two groups including 26 women and 25 men were recruited to participate in the current study. During the task-fMRI, subjects were exposed to images of infant emotional faces (including happy, neutral, and sad) randomly. We found that the brains of women and men reacted differently to infants' faces, and these differential areas are in facial processing, attention, and empathetic networks. The rs-fMRI further showed that the connectivity of the default-mode network-related regions increased in women than in men. Additionally, brain activations in regions related to emotional networks were associated with the empathetic abilities of women. These differences in women might facilitate them to more effective and quick adjustments in behaviors and emotions during the nurturing infant period. The findings provide special implications and insights for understanding the neural processing of reacting to infant cues in adults.

Midwife empathy and its association with the childbirth experience: a cross-sectional study

BACKGROUND

Although pregnancy and childbirth comprise a life-course that most midwives experience, whether their own experiences of childbirth resonate with other women during childbirth remains to be determined. In this study, we therefore characterized midwives' empathic capabilities and defined their underlying factors.

METHOD

We conducted a cross-sectional study with data from 464 midwives in Guangdong, China, that were collected through the "Chinese version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP)." This questionnaire contains sections related to midwife demographics and delivery characteristics. We then implemented multivariate logistic regression analysis to identify empathy-related factors.

RESULTS

Our analysis revealed 303 (65.3%) participants in the high-empathy group while 161 (34.7%) were in the middle-empathy group. Compared with the reference groups, these results indicated that higher empathy was associated with an elevated educational level (OR, 1.83; 95% CI, 1.04-3.25), high monthly salary (OR, 2.30; 95% CI, 1.11-4.80), and no shift work (OR, 2.89; 95% CI, 1.09-7.63). The odds of a high empathy score were higher for midwives who experienced two childbirths (2.27, 1.11-4.66) and for those who had children under the age of 3 years (2.81, 1.34-5.92).

CONCLUSION

Midwives possess a moderate-to-high level of empathy, and the greater the number of childbirths they experienced and the younger their children, the higher their reported empathy score. This study contributes novel information regarding the empathic behavior of midwives toward women who give birth in China.

Family Needs Checklist: Development of a Mobile Application for Parents with Children to Assess the Risk for Child Maltreatment

Child maltreatment (CM) has been enormously studied. However, a preventive practice still requires comprehensive and effective instruments to assess the risks for CM in a family context. The aim of this study is to describe the development process of an evidence-based CM risk assessment instrument (Family Needs Checklist, FNC) for primary prevention online utilization. This article reports the development process of the checklist and its mobile application, consisting of a systematic literature review, identification of known risk factors using the content analysis method, and generation of the checklist, including a multidisciplinary group in the design and feedback. As a result, a comprehensive and compact checklist was developed to be used by parents or caregivers as a self-referral instrument with an option to be used with professionals as a basis for joint conversations. The FNC consists of parental, family-, and child-related risk factors. Based on the international evidence, the online application consists of knowledge about different CM types, information about risk factors and protective factors as well as recommendations and guidance to support services. The FNC is based on robust evidence on known risk factors causing CM in families. It can be used for primary prevention utilization in the general population.

Are empathic processes mechanisms of pregnancy's protective effect on smoking? Identification of a novel target for preventive intervention

BACKGROUND

Spontaneous cessation and reduction in smoking by pregnant women suggest that concern about others, or empathy, could be a malleable target for intervention. We examined various empathy-related processes in relations to reported and biochemically assessed smoking during pregnancy.

METHODS

Participants were 154 pregnant women (M = 12.4 weeks gestation, SD = 4.6) who were smoking cigarettes immediately prior to pregnancy recognition (85 had quit and 69 were still smoking at enrollment). Empathy-related processes were measured with performance-based paradigms (affect sharing, empathic concern, and theory of mind) and a speech sample (expressed emotion). Smoking was assessed with timeline follow back interviews and urine cotinine assays. Using zero-inflated Poisson regression models, we tested direct and interactive effects of empathy-related processes with respect to biologically verified smoking cessation (zero portion); and mean cigarettes/day smoked after pregnancy recognition among persistent smokers (count portion).

RESULTS

Affect sharing was inversely related to post-recognition cigarettes/day (B(SE) = -0.17(0.07), 95%C.I. -0.30,-0.04, p = .011) and moderated the relationship between pre-recognition smoking and post-recognition smoking consistent with a buffering effect (B(SE) = -.17(0.05); 95%C.I. - 0.28,-0.06; p = .002). Other empathy related processes showed neither direct nor interactive effects on smoking outcomes.

CONCLUSIONS

Further research is recommended to clarify the role of empathy in pregnancy smoking.

Stronger brain activation for own baby but similar activation toward babies of own and different ethnicities in parents living in a multicultural environment

Specific facial features in infants automatically elicit attention, affection, and nurturing behaviour of adults, known as the baby schema effect. There is also an innate tendency to categorize people into in-group and out-group members based on salient features such as ethnicity. Societies are becoming increasingly multi-cultural and multi-ethnic, and there are limited investigations into the underlying neural mechanism of the baby schema effect in a multi-ethnic context. Functional magnetic resonance imaging (fMRI) was used to examine parents' (N = 27) neural responses to (a) non-own ethnic in-group and out-group infants, (b) non-own in-group and own infants, and (c) non-own out-group and own infants. Parents showed similar brain activations, regardless of ethnicity and kinship, in regions associated with attention, reward processing, empathy, memory, goal-directed action planning, and social cognition. The same regions were activated to a higher degree when viewing the parents' own infant. These findings contribute further understanding to the dynamics of baby schema effect in an increasingly interconnected social world.

Computer-based mother-infant interaction analysis and mental functioning in postpartum depression

BACKGROUND

Among mothers suffering from postpartum depression (PD), 10-13% additionally experience a mother-infant interaction disturbance that causes a severe mental health risk for the infant. Besides depressive symptomology, the underlying factors promoting dysfunctional maternal interaction behavior have not yet been sufficiently investigated. Therefore, we examined potential relationships between computer-based mother-infant interaction among postpartum depressed dyads and maternal mental functioning.

METHODS

Mother-infant interaction was video-recorded and evaluated via a computer-based micro-interaction analysis program (INTERACT). We included only 25 hospitalized mother-infant dyads that fulfilled the diagnostic criteria of PD and tested mothers on their mental functioning (empathy, theory of mind, meta-cognition and alexithymia).

RESULTS

Behavioral interaction analyses indicated that mothers with PD were prone to inactive maternal behavior, less positive maternal behavior along with more rejective behavior and also disengaged affect towards the infant. Distortions in mothers' mental functioning may have had an influence on the dysfunctional patterns of mother-infant dyads.

CONCLUSIONS

Cognitive and social functioning could be an influencing factor on dysfunctional maternal interaction behavior. Early detection of distortions of mental processing in expectant mothers might help to inhibit the clinical manifestation of dysfunctional mother-infant bonding and negative child outcome in PD.

Do empathy and oxytocin predict responsiveness to a crying infant simulator in expecting and non-expecting couples? A multilevel study

Infant crying is a strong emotional stimulus that elicits caregiving responses in adults. Here we examine the role of empathy (measured with the Polish version of Interpersonal Reactivity Index) and salivary oxytocin in modulating sensitive responsiveness to a crying infant simulator in two groups of heterosexual couples: 111 expecting or 110 not expecting a baby. Sensitive responsiveness was observed during a standardized procedure using the Ainsworth Sensitivity Scale while participants took care of the infant simulator, both individually and as a couple. Other-oriented empathy predicted elevated levels of individual but not couple sensitive responsiveness. More OT reactivity to crying predicted less responsiveness in non-expecting couples, which might be explained by their stronger focus on task performance. This study uniquely combined hormonal, observational and self-report measures in couples, and showed that personality and hormonal correlates of sensitive responsiveness might be studied before the child's birth with the use of infant simulators.

Validation of the Parental Responsiveness Scale

BACKGROUND

Parental responsiveness is a parent's predisposition to react to their child's verbal and non-verbal cues promptly and adequately. There is no self-report scale that measures this type of behavior. The aim of this study was to construct a valid and useful scale to measure this construct as subjectively reported by parents of young children.

PARTICIPANTS AND PROCEDURE

Two hundred and fifty parents (including 186 mothers) of young children aged from 1 to 18 months (Mage = 8.60, SDage = 4.06) took part in the study. To confirm the external validity of the tool, participants filled in the following questionnaires: the Parental Responsiveness Scale, the Empathic Sensitivity Scale, and the Experience in Close Relationships-Revised Scale - short version.

RESULTS

The confirmatory analysis verified the one-dimensional structure and that the model has a good fit. Moreover, the results of external validation indicated satisfactory correlations between parental responsiveness and empathic concern (r = .30, p < .01), perspective-taking (r = .31, p < .01), and avoidance (r = .23, p < .01) in relationships.

CONCLUSIONS

The Parental Responsiveness Scale is valid and reliable. This scale could be useful in research on family and child development, and on individual differences between parents, but can also be of use in practice.

Brain Responses to Emotional Infant Faces in New Mothers and Nulliparous Women

The experience of motherhood is one of the most salient events in a woman’s life. Motherhood is associated with a series of neurophysiological, psychological, and behavioral changes that allow women to better adapt to their new role as mothers. Infants communicate their needs and physiological states mainly through salient emotional expressions, and maternal responses to infant signals are critical for infant survival and development. In this study, we investigated the whole brain functional response to emotional infant faces in 20 new mothers and 22 nulliparous women during functional magnetic resonance imaging scans. New mothers showed higher brain activation in regions involved in infant facial expression processing and empathic and mentalizing networks than nulliparous women. Furthermore, magnitudes of the activation of the left parahippocampal gyrus and the left fusiform gyrus, recruited during facial expression processing, were positively correlated with empathic concern (EC) scores in new mothers when viewing emotional (happy-sad) faces contrasted to neutral faces. Taken together, these results indicate that the experience of being a mother affects human brain responses in visual and social cognitive brain areas and in brain areas associated with theory-of-mind related and empathic processing.

The unique social sense of puerperium: Increased empathy and Schadenfreude in parents of newborns

Pregnancy and puerperium are typified by marked biobehavioral changes. These changes, which are traceable in both mothers and fathers, play an important role in parenthood and may modulate social cognition abilities. However, the latter effects remain notably unexplored in parents of newborns (PNs). To bridge this gap, we assessed empathy and social emotions (envy and Schadenfreude) in 55 PNs and 60 controls (childless healthy participants without a romantic relationship or sexual intercourse in the previous 48 hours). We used facial electromyography to detect physiological signatures of social emotion processing. Results revealed higher levels of affective empathy and Schadenfreude in PNs, the latter pattern being accompanied by increased activity of the corrugator suppercilii region. These effects were not explained by potential confounding variables (educational level, executive functioning, depression, stress levels, hours of sleep). Our novel findings suggest that PNs might show social cognition changes crucial for parental bonding and newborn care.

Enlarged representation of peripersonal space in pregnancy

Our ability to maintain a coherent bodily self despite continuous changes within and outside our body relies on the highly flexible multisensory representation of the body, and of the space surrounding it: the peripersonal space (PPS). The aim of our study was to investigate whether during pregnancy - when extremely rapid changes in body size and shape occur - a likewise rapid plastic reorganization of the neural representation of the PPS occurs. We used an audio-tactile integration task to measure the PPS boundary at different stages of pregnancy. We found that in the second trimester of pregnancy and postpartum women did not show differences in their PPS size as compared to the control group (non-pregnant women). However, in the third trimester the PPS was larger than the controls’ PPS and the shift between representation of near and far space was more gradual. We therefore conclude that during pregnancy the brain adapts to the sudden bodily changes, by expanding the representation of the space around the body. This may represent a mechanism to protect the vulnerable abdomen from injury from surrounding objects.