Parental perceptions and experiences after childbirth: a comparison between mothers and fathers of term and preterm infants

What influences women's experiences of childbirth in Flanders? - A quantitative cross-sectional analysis of the Babies Born Better survey

OBJECTIVE

Labour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium.

DESIGN

A cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders.

PARTICIPANTS

1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018.

FINDINGS

The majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362-0.817) and post term birth (OR 0.664, 95% CI 0.462-0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 - 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 - 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218-0.463), an instrumental birth (OR 0.318, 95% CI 0.218-0.463) or a planned- (OR 0.349, 95% CI 0.205-0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109-0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth.

KEY CONCLUSIONS

The majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences.

IMPLICATIONS FOR PRACTICE

Women's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

Are women with preterm labour at risk for negative birth experience? a comparative cross-sectional study from Iran

BACKGROUND

The unpredictable nature of preterm labour can be a stressful experience for the mother. The occurrence of preterm birth can lead to the failure of the mother's previous expectations regarding the process of labour and birth leading to negative perception towards birth.

METHODS

This descriptive-analytical cross-sectional study was conducted in Tabriz, Iran. We employed convenience sampling to recruit eligible mothers with term birth (314 women) and preterm birth (157 women). Childbirth Experience Questionnaire 2.0, Preterm Birth Experiences and Satisfaction Scale, and Delivery Fear Scale were used to measure the woman's fear of delivery during labour and birth experience. Data were analysed by general linear model.

RESULTS

The prevalence of negative birth experience in the term and preterm birth groups was 31.8% and 14.3%, respectively. The results of the multivariable general linear model, after the adjustment of demographic and obstetric characteristics, showed that there was no statistically significant difference between the two groups of mothers with term and preterm birth [β (95% CI): -0.06 (-0.22 to 0.09); p = 0.414] in terms of childbirth experience. However, the fear of delivery had a significant relationship with the childbirth experience [-0.02 (-0.03 to -0.01); p < 0.001].

CONCLUSION

There was no statistically significant difference in terms of women's childbirth experience between the mothers with term and preterm births. The fear of delivery during labour was the predictor of childbirth experience. In order to improve women's childbirth experience, interventions should be made to reduce their fear during labour.

How Giving Birth Makes Sense: A Questionnaire Study on Existential Meaning-Making Among Mothers Giving Birth Preterm or at Term

BACKGROUND

Women's reflections on existential meaning-making in relation to giving birth may seem indistinct in maternity services and have not been thoroughly explored in secular contexts. However, research suggests that childbirth accentuates spiritual and existential considerations and needs even in secular contexts highlighting the importance of care for such needs in maternity care practices. The objectives of this study were two-fold: Firstly, to explore how first-time mothers, living in a secular context, experience their first birth in relation to existential meaning-making. Secondly, to describe the relationship between existential meaning-making reflections and gestational week at birth.

METHODS

A nationwide cross-sectional study in Denmark based on the questionnaire "Faith, existence and motherhood" was conducted in 2011. Eight core items related to birth experience informed this study. The cohort was sampled from the Danish Medical Birth Registry and consisted of 913 mothers having given birth 6-18 months previously. Twenty-eight per cent had given birth preterm (PT) and 72% had given birth at full-term (FT). A total of 517 mothers responded.

RESULTS

In relation to the birth of their first child, both FT and PT mothers answered, that they had existential meaning-making reflections. The consent to the 8 items ranged from 17 to 73% among FT mothers and from 19 to 58% among PT mothers. Mothers who gave birth preterm mainly identified the negative aspects of birth, whereas mothers, who gave birth at full-term, to a higher degree identified positive aspects.

CONCLUSIONS

Findings suggest that not only traumatic birth events accentuate existential reflections, but that even normal childbirth to most mothers is an existential event. However, the quality of existential reflections differs when comparing normal and traumatic birth. The study points towards change in education and organization of maternity care to better care for existential needs and reflections specific to every new mother and birthing woman.

Parenting experiences among fathers of prematurely-born children with cerebral palsy in South Korea

PURPOSE

The symptoms and impairments caused by cerebral palsy usually require long-term treatment, resulting in a substantial burden on the family of affected children. This study explored the experiences of fathers with prematurely-born children with cerebral palsy, with a focus on how such experiences influenced their families.

METHODS

A qualitative case study method was used. Nine subjects were recruited from April 2018 to June 2019 at one hospital, and each was interviewed three times by a neonatal nurse.

RESULTS

Five core experiences of fathers were identified: regret for an insufficient initial response, confronting my child born as a premature baby, the position of being a dad who can't do anything, the process of treatment like a tunnel with no exit, and a father's getting meaning in life through children. These stories covered an individual's timeline and family interactions.

CONCLUSION

Our findings suggest that fathers of prematurely-born children tend to suppress their emotions; therefore, a novel intervention program to encourage fathers' emotional expression and to support healthier interactions with their families is needed. Moreover, our findings could contribute basic information for the construction of a community-based support system to aid families, including prematurely-born children and other persons with impairments.

The influence of perinatal and maternal factors on physical growth at 12 months in prematurely born infants treated in the neonatal intensive care unit: A retrospective chart review and a prospective cohort study

BACKGROUND

Growth retardation during the first year of life is frequently observed in prematurely born infants. Few reports have considered the effects of maternal emotional distress and perceptions of care burden on the outcomes of these infants.

OBJECTIVES

This study investigated the physical growth trajectories of prematurely born infants treated in neonatal intensive care unit and determined the effects of perinatal factors, maternal emotional distress and perceptions of care burden on growth retardation at 12 months' corrected age.

DESIGN

Retrospective chart review and prospective cohort study.

SETTING

Single neonatal intensive care unit and follow-up outpatient clinics at a maternity and neonatal hospital.

PARTICIPANTS

288 mother-infant pairs in the retrospective chart review and 169 dyads in the prospective cohort study.

METHODS

Medical records of prematurely born infants, perinatal factors and physical growth over a 1-year period were retrospectively reviewed. For the prospective study, mothers completed the Self-Rating Anxiety Scale, Perinatal Post-traumatic Stress Disorder Questionnaire, and Condition Management Effort Scale when infants reached 3 months' corrected age. The generalized linear mixed model was applied to explore effects of maternal emotional disorders and perceptions of care burden on growth retardation at 12 months' corrected age.

RESULTS

The retrospective data showed 13.9%, 10.1%, and 10.1% retardation for head circumference, length, and weight, respectively. Birth weight was negatively associated with physical growth retardation. Delayed breastfeeding initiation, younger mothers, and lower 5-min Apgar score were associated with head circumference retardation. Male sex, higher gestational age, and delayed breastfeeding initiation were risk factors for length retardation; male sex, higher gestational age, and younger mothers for weight. The prospective study showed that head circumference, length, and weight retardation rates were 18.3%, 10.3%, and 16.3%, respectively. Male sex and birth weight, were still significant, while others were not. Moreover, alternative models based on these included factors revealed that maternal perceptions of a higher care burden was a risk factor for overall growth retardation and maternal post-traumatic stress disorder only for a weight problem.

CONCLUSIONS

Physical growth remained a significant problem for prematurely born infants during the first year. This study identified perinatal factors, the level of maternal emotional distress, and perceptions of care burden were related to adverse infant's growth outcomes. Multidisciplinary interventions targeting maternal emotional distress and perceptions of care burden should be developed to promote the growth of prematurely born infants within the first 3 months after birth.

Personality traits and subjective well-being among fathers of preterm infants in Taiwan: a cross-sectional study

OBJECTIVE

This study examined the association of personality traits and paternal/infant background characteristics with subjective well-being (SWB) among fathers of preterm infants.

BACKGROUND

While studies of parental care of preterm infants have focused on mothers or both parents, studies focusing specifically on fathers are relatively rare. In this study, we provide new information on the personality traits and paternal/infant background characteristics and their association with SWB among fathers of preterm infants.

METHODS

This study used a cross-sectional design. Participants included fathers of preterm infants hospitalised in the neonatal intensive care unit, neonatal intermediate care nursery, or postpartum ward of a medical centre in northern Taiwan within 5 days of birth. The Personality Inventory Scale and Subjective Well-being Scale were administered and background characteristics of fathers and preterm infants were measured.

RESULTS

A total of 104 fathers participated, of whom 73.1% showed a moderate level of SWB. Fathers with higher extraversion and openness exhibited higher SWB, while fathers with higher neuroticism exhibited lower SWB. SWB was also predicted by age, infant weight, family structure, and paternal education level. These factors cumulatively accounted for 48% of the variance in SWB.

CONCLUSION

Fathers' SWB was associated with extraversion, openness, neuroticism, age, education, family structure, and infant weight. The personality traits of fathers should be considered when developing plans for family support after following preterm infant birth. In addition to focusing on maternal well-being, programmes to increase paternal well-being would benefit the families of preterm infants.

Information and Communications Technology and Education Customized for Fathers of Preterm Infants

PURPOSE

Although various educational technology interventions have been introduced to support parents of preterm infants, the interventions tend to focus on mothers over fathers. This study aims to advance understanding of the concerns and needs of fathers and seek opportunities of information technology to support them.

DESIGN AND SAMPLE

A convenience sampling method recruited 18 parents (i.e., ten mothers and eight fathers of preterm infants) for interviews. The interview transcripts were analyzed by the inductive content analysis method.

MAIN OUTCOME VARIABLE

The analysis identified two main themes (i.e., customized education, learning styles and tools preferred by fathers) and five subthemes (i.e., infant care, self-care, self-regulated online learning, adaptive user interfaces of online education modules, and hands-on learning with multimedia).

RESULTS

The interviewed parents emphasized the importance of education customized for the fathers of preterm infants, and argued that an e-learning system has the potential to fulfill the fathers' educational needs.

Women's satisfaction with maternity care during preterm birth

BACKGROUND

Women's satisfaction with maternity care is strongly influenced by their sociodemographic characteristics, values, and attitudes. The arrival of a preterm baby is often a traumatic time, with unique factors involved. The Spanish Preterm Birth Experience and Satisfaction Scale (P-BESS) is a robust instrument capable of assessing women's satisfaction during preterm birth. The purpose of this study was to assess women's satisfaction with maternity care during labor and birth with preterm babies in a Spanish-speaking population.

METHODS

This is a cross-sectional study. Participants were 182 women who gave birth within 37 weeks' gestation. Factors associated with satisfaction were studied through univariate and bivariate analyses and through multiple linear regression using the backward elimination method.

RESULTS

Women reported high satisfaction with maternity care overall (average score of 84 out of 95). Women with a university education were generally less satisfied. Women were more satisfied if they were pregnant for the first time. Women who reported a previous premature birth or neonatal death were more satisfied, and women who had prior miscarriages were less satisfied compared with women without these experiences.

CONCLUSIONS

The analysis confirmed that the majority of women surveyed were very satisfied with their childbirth experience. The Spanish P-BESS can be a useful way of prioritizing intervention measures, focusing on those aspects lowest scored by women, such as "information and explanations" and "confidence in staff," to improve maternity services for families experiencing preterm birth.

Translation, adaptation and psychometric validation of the preterm birth experience and satisfaction scale (P-BESS) into Spanish

BACKGROUND

Preterm labour and birth are two of the most important issues in perinatal care. The birth of a preterm baby is often a stressful and traumatic time for parents. Assessment of satisfaction with maternity services is crucial and questionnaires are the most common method as long as they are well-constructed. Only one, The Preterm Birth Experience and Satisfaction Scale (P-BESS), developed in United Kingdom, has been designed for this specific birth type.

OBJECTIVES

To translate, transculturally adapt and assess the psychometric properties of the P-BESS into Spanish.

DESIGN

Cross-sectional study.

SETTING

Maternity unit of a tertiary level hospital in Spain.

PARTICIPANTS

A total of 182 woman who gave birth before 37 weeks of gestation.

METHODS

The instrument was translated and back translated. The P-BESS was tested for face validity and construct validity by carrying out an exploratory/confirmatory factor analysis. Reliability was estimated from the internal consistency, with the Cronbach's alpha (α), and the test-retest, with the  intraclass correlation coefficient (ICC).

FINDINGS

The principal component analysis revealed the presence of three factors with eigenvalues greater than 1, explaining a total variance of 66.6%. A subsequent varimax rotation revealed the presence of strong loadings on each of the three components. Confirmatory factor analysis was performed, offering the model a very good fit to the data: chi-square was χ²_(df=149)=362.727 (p = 0.000); the root mean square error of approximation (RMSEA)=0.089; the normed fix index (NFI )= 0.852 and the comparative fit index (CFI)=0.905. The total scale and subscales had good reliability with all Cronbach´s alpha above the acceptable level of 0.7. The total ICC was 0.994 (CI 95%, 0.988-0.997).

CONCLUSIONS

The Spanish version of P-BESS appears to be a robust, valid and reliable instrument for assessing satisfaction with care during preterm birth.

IMPLICATIONS FOR PRACTICE

the instrument provides a more comprehensive understanding of this complex experience. It allows the detection of areas of intervention in order to empower strategies to cope with preterm births and to maximise feelings of self-confidence and control.

Dyadic Transition to Parenthood: A Longitudinal Assessment of Personal Growth among Parents of Pre- and Full-term Infants

This study examined the contribution of birth circumstances (premature and full-term birth) and individual and spousal factors (attachment orientations, parental self-efficacy and perceived infant temperament), measured 1 month post-partum, to the personal growth of first-time parents (n = 121) 1 and 5 months post-partum. The study overcame the limitations of prior research by accurately measuring actor effects while controlling for and assessing partner effects, by applying the actor-partner interdependence model. The findings confirm that becoming a parent, under normative and stressful circumstances, can lead to personal growth and parents of premature babies experience higher levels of growth than parents of full terms. Moreover, 1 month post-partum, actor effects were found for higher attachment anxiety and higher parental self-efficacy. Furthermore, personal growth at 1 month post-partum was found to be the strongest predictor of personal growth 5 months after childbirth. Five months post-partum, a positive partner effect was found for parental self-efficacy. Mothers reported higher growth than fathers only 5 months after the birth. It seems time plays an important role as to which variables contribute to personal growth. In the early stages of parenthood, personal growth is mostly an individual experience. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Maternal and Paternal Knowledge and Perceptions Regarding Infant Pain in the NICU

PURPOSE

To investigate parents' knowledge, self-efficacy, and satisfaction about infant pain in the NICU.

DESIGN AND SAMPLE

A survey was conducted, and 80 parents (57 mothers and 23 fathers) participated in the study.

MAIN OUTCOME VARIABLE

A researcher-developed questionnaire composed of 3 dimensions: parents' knowledge about infant pain, perception of self-efficacy regarding infant pain, and satisfaction with infant pain management.

RESULTS

Most parents had adequate knowledge and moderate to high self-efficacy and were satisfied with infant pain management in the NICU. Mothers and fathers responded differently regarding self-efficacy and satisfaction, and parents' perceptions were correlated with infants' correct age and parents' own age. Most important, most parents wanted to be present and to be given the opportunity to comfort their infant during and after a painful procedure. Parents also preferred to receive formal/written information on infant pain.

Transition From Hospital to Home in Preterm Infants and Their Families

When the day of discharge from a neonatal intensive care unit (NICU) comes for the parents of newborn infants, they are filled with long-awaited joy and happiness. They go home feeling as parents, away from scheduled routines of the hospital, monitor alarms, clinical rounds, numerous tests, and so on. What do we know about what happens after these little patients and their families leave the NICU? What happens from the point of leaving the hospital until when things get settled and life becomes perceived as normal? This article presents a short summary of research conducted with the vulnerable population of high-risk and preterm infants and their families postdischarge. Available evidence suggests that transition to home after hospital discharge, a phenomenon that many families experience, is challenging and requires attention from clinicians and researchers if we are to provide effective, efficient, and high-quality care.

Prayer and meditation among Danish first time mothers-a questionnaire study

Background

Mothers’ existential dimensions in the transition to motherhood have not been described thoroughly. They might experience disruption and new perspectives in existential ways and this may especially be the case in preterm birth. The aim of this study was twofold. First we investigated the existential dimension of motherhood transition in a secularized context, through practices of prayer and meditation. Second we described the relationship between time of birth (term/preterm) and the prayer/meditation practices of the mothers.

Methods

Data were gathered from a nationwide questionnaire survey among first time mothers conducted during the summer 2011. All Danish women who gave birth before the 32^nd pregnancy week (n = 255), and double the number of mothers who gave birth at full term (n = 658) in 2010 were included (total n = 913). The questionnaire consisted of 46 overall items categorized in seven sections, which independently cover important aspects of existential meaning-making related to becoming a mother. The respondent rate was 57 % (n = 517).

Results

Moments of praying or meditation 6–18 months post partum were reported by 65 %, and mothers who responded affirmatively, practiced prayer (n = 286) more than meditation (n = 89), p < 0,001. We did not observe differences in affirmative responses to prayer or meditation between mothers of full term or preterm born children, not even after controlling for perinatal or post partum loss, mode of birth, age, status of cohabiting or education.

Conclusions

In this explorative study we found specific practices of existential meaning-making through prayer and/or meditation among first time mothers, living in a very secularized context. Yet we know only little about character or importance of these practices among mothers, and hardly anything about existential meaning-making among new fathers. Hence the implications of meaning-making practices related to other dimensions of health are difficult to address in a qualified way in care for new mothers and families.

Maternal Role Development in Neonatal Intensive Care Unit Graduate Mothers of Premature Infant

PURPOSE

The aim of this study was to determine the predictive factors for maternal role development for mothers of premature infants.

METHODS

A descriptive correlational study was conducted. A total sample of 121 mothers of premature infants following discharge from the neonatal intensive care unit were recruited using two strategies; an internet-based survey and an in-person data collection in a tertiary university hospital in Korea. A self-report questionnaire was used to collect data regarding personal, birth variables, marital intimacy, maternal attachment, maternal identity and maternal role development.

RESULTS

A hierarchical multiple regression analysis indicated that parity, maternal attachment, marital intimacy and maternal identity were predictors for maternal role development for mothers of premature infants, accounting for 70% of the variance. Among these variables, maternal attachment is the most powerful predictor for maternal role development.

CONCLUSION

Nursing interventions during hospitalization to post-discharge education that includes parents of premature babies with positive interaction between couples strengthening marital intimacy and promotes maternal attachment that leads to integrate maternal identity should be considered by priority. Community-based family services such as home visits should be focused on maximizing the predictive factors for maternal role development in transition to motherhood that can contribute to maternal health as well as optimal growth and development of premature infants.

The experience of premature birth for fathers: the application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample

Aim: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through confirmatory factor analysis.

Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU).

Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory factor analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers.

Conclusion: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.

The assessment of parental stress and support in the neonatal intensive care unit using the Parent Stress Scale - Neonatal Intensive Care Unit

PROBLEM

Parental stress in the neonatal intensive care unit (NICU) has been reported, however identifying modifiable stress factors and looking for demographic parent factors related to stress has not been well researched.

AIM

This study aims to identify the most stressful elements for parents in the neonatal intensive care unit.

METHODS

Parents of babies in an Australian neonatal intensive care unit (N=73) completed both the Parent Stress Scale - Neonatal Intensive Care Unit and a survey of parent and baby demographic and support experience variables (Parent Survey) over an 18-month period.

FINDINGS

Older parental age, very premature birth and twin birth were significantly associated with a higher Parent Stress Scale - Neonatal Intensive Care Unit score. Having a high score in the Relationship and Parental Role scale was strongly associated with attendance at the parent support group.

CONCLUSION

These results indicate the variables associated with stress and this knowledge can be used by teams within hospitals to provide better supportive emotional care for parents.

Systematic and Meta-Analytic Review: Triggering Agents of Parental Perception of Child's Vulnerability in Instances of Preterm Birth

OBJECTIVE

Parental perception of a child vulnerability (PPCV) to illness, not justified by medically noticeable symptoms, is a situation well known to medical and paramedical staff. It is still disputed whether PPCV is triggered by the child's health problems or by parental emotional status. This review is aimed to clarify the etiology of PPCV in instances of preterm birth.

METHOD

PRISMA guidelines were followed. MEDLINE and Scopus indexes were searched. Of the 70 articles yielded by the search, 14 met the inclusion criteria for the systematic review, of which 10 could be included in the meta-analysis.

RESULTS

Children's physiological factors and parents' psychological factors were both found to significantly influence PPCV, in different ways, at different ages of the child.

CONCLUSION

PPCV etiology appears to mostly depend on parents' psychological factors. A better understanding of PPCV etiology could help protect children from distorted parental interaction and reduce parental demands for unnecessary medical care.

Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study

PURPOSE

The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) ("birth asphyxia") in Uganda.

METHODS

Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software.

FINDINGS

Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences.

CONCLUSION

Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking. Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants.

Existential meaning among first-time full-term and preterm mothers: a questionnaire study

Research indicates that childbirth is a time when a woman might experience existential disruptions and gain new perspectives on life. The 2-fold aim of this study was to investigate whether attitudes related to existential meaning among first-time mothers intensify and whether they differ between mothers who gave birth at full term and those who gave birth preterm. All first-time mothers who gave birth in Denmark in 2010 before the 32nd week of pregnancy and twice that number of full-term mothers (randomly sampled) were invited to participate in a national cross-sectional survey. Five core items concerning meaning in life, vulnerability of life, responsibility, thoughts about life and death, and "something bigger than oneself" were analyzed to compare mothers' attitudes on existential meaning. The overall response rate was 57% (517/913). Contrary to the hypothesis, attitudes related to existential meaning intensified to the same degree among mothers of full-term and preterm infants, with no statistically significant differences in terms of age, marital status, educational level, or birth method. Danish first-time mothers' attitudes related to existential meaning measured in 5 core items were intensified and almost similar, regardless of whether they gave birth full-term or preterm.