Parenting After Infertility: Issues for Families and Infants

Vulnerable Baby Perception of Mothers with Infants in the Neonatal Intensive Care Unit: Relationship with Breastfeeding Self-Efficacy and Bonding

Aim: This study was performed with the aim of investigating the correlation between vulnerable baby perception with breastfeeding self-efficacy and bonding of mothers with infants in the neonatal intensive care unit. Material and Method: The sample for this descriptive and relational search study comprised mothers of 80 healthy infants admitted to the neonatal intensive care unit (NICU) of Ordu University Education and Research Hospital for at least 3 days and at least 1 week past discharge. Collection of data used the Mother and Infant Descriptive Information Form, Vulnerable Baby Scale (VBS), Breastfeeding Self-Efficacy Scale (BSES), and Mother-Infant Bonding Scale (MIBS). Results: The VBS scores for employed mothers were significantly higher than those who were not employed, whereas the VBS scores for mothers with planned pregnancy were significantly higher than those with unplanned pregnancy (p < 0.05). According to the total number of pregnancies, the BSES scores were identified to be statistically significantly different (p < 0.05). The MIBS scores for mothers without mental change related to admission of the infant to NICU were significantly lower than those who were sad/scared (p = 0.015). There was a statistically insignificant correlation between VBS score and BSES score (p > 0.05). There was a positive and very weak statistically significant correlation between VBS score and MIBS score (p = 0.034). As VBS scores increase, MIBS scores increase (higher MIBS = lower bonding). In addition, the effect of VBS score on MIBS score was identified to be statistically significant (p = 0.042). Conclusion: The results of the study found a significant correlation between vulnerable baby perceptions of mothers and mother-infant bonding. As vulnerable baby perceptions increased, mother-infant bonding was identified to decrease. We speculate the breastfeeding self-efficacy and bonding levels of mothers with infants in the NICU should be assessed along with vulnerability perception levels, and necessary support should be provided to reduce vulnerability perceptions by informing mothers about the neonate's status.

Fertility Problems and Parenting Daily Hassles in Childhood: A 7-year Longitudinal Study of Adoptive Parents

Fertility problems are known to exert a negative impact on psychological health. Meanwhile, individuals with fertility challenges often view adoption as a positive healing experience. Yet, a dearth of work has examined the long-term impact that fertility problems have on adoptive parents and their childrearing stress. Here, we investigated how fertility problems related to parenting daily hassle (PDH) trajectories among adoptive mothers and fathers in the Early Growth and Development Study (N = 333). When adopted children were 9 months old, adoptive parents reported whether they had fertility problems prior to their decision to adopt and rated their PDH frequency and intensity on six occasions over the next 7 years. Multilevel models revealed inverse U-shaped curves for PDH among both fertile and infertile parents, such that PDH increased from child age 9 months until about 5 to 6 years and decreased thereafter. Mothers with fertility problems exhibited a steeper PDH incline from 9 months to the peak at child age 5 to 6, but also incurred a swifter subsequent decline. There were no significant differences in fathers' PDH trajectories based on fertility problems. We discuss why fertility problems appear to impact PDH trajectories for mothers rather than fathers.

Narrative Study of the Significance of Infertility and Its Treatment for Maternal Identity

OBJECTIVE

To explore how women who experienced infertility and underwent fertility treatments constructed maternal identities after they successfully gave birth.

DESIGN

Narrative qualitative study.

SETTING

Finland, Scandinavia.

PARTICIPANTS

Twenty-six previously infertile Finnish women who later conceived were recruited via social media, health clinics, and relevant informal support organizations.

METHODS

Narrative analysis was used to process written accounts and individual episodic interviews with each of the 26 women.

RESULTS

Four different identity stories emerged from the data: Fractured Maternity, Pursuing Maternity, Learning Maternity, and Discovering Maternity. Infertility, its treatment, and childbirth were narrated as turning points in the participants' life courses, but the significance of these turning points for maternal identity varied across the four stories.

CONCLUSION

These findings have important implications for nursing practice. Health care professionals should be aware of the effects of previous long-standing infertility on the subsequent experience of motherhood so they can provide women with understanding, sufficient support, and appropriate interventions throughout the transition to motherhood.

The Role of Residential Early Parenting Services in Increasing Parenting Confidence in Mothers with A History of Infertility

BACKGROUND

Mothers with a history of infertility may experience parenting difficulties and challenges. This study was conducted to investigate the role of residential early parenting services in increasing parenting confidence in mothers with a history of infertility.

MATERIALS AND METHODS

This was a retrospective chart review study using the quantitative data from the clients attending the Karitane Residential Units and Parenting Services (known as Karitane RUs) during 2013. Parenting confidence (using Karitane Parenting Confidence Scale-KPCS), depression, demographics, reproductive and medical history, as well as child's information were assessed from a sample of 27 mothers who had a history of infertility and who attended the Karitane RUs for support and assistance. The data were analyzed using SPSS version 19.

RESULTS

More than half of the women (59.3%) reported a relatively low level of parenting confidence on the day of admission. The rate of low parenting confidence, however, dropped to 22.2% after receiving 4-5 days support and training in the Karitane RUs. The mean score of the KPCS increased from 36.9 ± 5.6 before the intervention to 41.1 ± 3.4 after the intervention, indicating an improvement in the parenting confidence of the mothers after attending the Karitane RUs (P<0.0001). No statistically significant association was found between maternal low parenting confidence with parental demographics (including age, country of birth, and employment status), a history of help-seeking, symptoms of depression, as well as child's information [including gender, age, siblings, diagnosis of gastroesophageal reflux disease (GORD) and use of medication].

CONCLUSION

Having a child after a period of infertility can be a stressful experience for some mothers. This can result in low parenting confidence and affect parent-child attachment. Our findings emphasized on the role of the residential early parenting services in promoting the level of parenting confidence and highlighted the need for early recognition and referral of the mothers with a history of infertility to such centers.

Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis

The aim of this meta-analysis is to provide new evidence on the effects on maternal health of multiple births due to assisted reproductive technology (ART). A bibliographic search was undertaken using PubMed, PsycINFO, CINAHL and Science Direct. Data extraction was completed using Cochrane Review recommendations, and the review was performed following PRISMA and MOOSE guidelines. Meta-analytic data were analysed using random effects models. Eight papers (2993 mothers) were included. Mothers of ART multiple births were significantly more likely to experience depression (standardized mean difference [SMD] d = 0.198, 95% CI 0.050 - 0.345, z = 2.623, P = 0.009; heterogeneity I(2) = 36.47%), and stress (SMD d = 0.177, 95% CI 0.049 - 0.305, P = 0.007; heterogeneity I(2) = 0.01%) than mothers of ART singletons. No difference in psychosocial distress (combined stress and depression) (SMD d = 0.371, 95% CI -0.153 - 0.895; I(2) = 86.962%, P = 0.001) or depression (d = 0.152, 95% CI -0.179 - 0.483: z = 0.901; I(2) = 36.918%) were found between mothers of ART and naturally conceived multiple births. In conclusion, mothers of ART multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.

O father, where art thou? Parental NICU visiting patterns during the first 28 days of life of very low-birth-weight infants

To study the frequency and duration of parental visits to neonatal intensive care units (NICU) during the first 28 days of life of preterm infants in relation to medical variables, sociodemographic factors, and subsequent outpatient follow-up examinations. Retrospective chart review of 127 infants with a birth weight less than 1500 g born between Jan 1, 2009, and Dec 31, 2009, at 2 tertiary NICUs. The average frequency of parental visits during the first 28 days of life declined significantly over time (P < .05) while the duration of visits remained constant. Average frequency and duration of visits per day were consistently lower in fathers than in mothers (median [interquartile range]: 0.6 [0.4-1.0] per day vs 1.1 [0.9-1.4] per day, 72.5 [32.1-108.9 [min/d vs 133.4 [75.4-174.3] min/d). While a history of treatment for infertility was correlated with significantly more frequent and longer parental NICU visits in the first 2 weeks, having older children at home was correlated with shorter visits during the first week. Visiting patterns showed no relation to attendance at follow-up examinations at 6 months corrected age. Mothers spend more time with their preterm infants in NICUs than fathers. We suggest measures to increase paternal involvement with hospitalized preterm infants.

Infertility, infertility treatment and behavioural problems in the offspring

Behavioural patterns in children of infertile couples may be influenced by both the underlying causes of infertility and stress in the couples. Treatment procedures, such as culture media and manipulation of gametes and embryos, may also result in developmental problems. We examined behavioural problems in children as a function of infertility and infertility treatment, using data from three population-based birth cohorts in Denmark (Aalborg-Odense Birth Cohort, Aarhus Birth Cohort and Danish National Birth Cohort). Information on time to pregnancy and infertility treatment was collected during pregnancy. Children aged between 7 and 21 years were assessed using the Strengths and Difficulties Questionnaire (SDQ). The SDQ was completed by mothers in all cohorts and, in addition, by teachers in the Aarhus cohort and by children themselves in the Aalborg-Odense cohort. Children born after a time to pregnancy of >12 months and no infertility treatment had a behavioural pattern similar to children of fertile parents. Teachers reported a higher total difficulties score for children born after infertility treatment, but no significant differences were seen on any subscales of the teachers' report, and neither the mothers nor the children reported any differences on the total difficulties score and the prosocial behaviour score. Our results are thus overall reassuring regarding behavioural problems in children born to infertile couples, regardless of infertility treatment.