Parenting satisfaction during the immediate postpartum period: factors contributing to mothers’ and fathers’ perceptions

Support for the Supporter: Paternal Postpartum Loneliness and Social Support During the COVID-19 Pandemic

During the postpartum period, fathers may be at risk of increased stress and loneliness, which may be offset or buffered by the provision of social support. This study aimed to explore fathers' postpartum experiences of loneliness, perceived stress, and social support. A constructivist grounded theory approach was used to inform study design and analysis. Semistructured interviews were conducted to collect data from 12 fathers, living in the Republic of Ireland, who had an infant aged 6 months or younger. A grounded theory entitled "support for the supporter," describing fathers' experiences with social support, and loneliness during the postpartum period, was derived. Participants described experiencing increased financial pressure and having difficulty balancing the role of "breadwinner" with fatherhood. Participants described feeling excluded from maternity care and lacked avenues for information within the Irish health care system. Participants linked their experiences of loneliness to the lack of social support in the postpartum period. This study offers a novel insight into Irish fathers' experiences with maternity care during the COVID-19 pandemic. This study is the first to qualitatively explore paternal postpartum loneliness and provides a good foundation for future research and intervention in this area. Findings suggest that it would be wise to promote social support from other experienced fathers, friends, family, and from partners to reduce paternal postpartum loneliness.

A Longitudinal Examination of Mothers' Early Postnatal Adaptation: Relative Stability Across the First Eight Weeks

OBJECTIVE

Using person-centered analyses, this study examined the trajectories of women's early postnatal adaptation and explored whether there were differences in their trajectories based on women's status as a first-time or more experienced mother.

METHODS

Data were collected from women (N = 137; Mage = 28.6 years, SD = 4.49; 48.2% first-time mothers) at 2-, 4-, 6-, and 8-weeks postpartum. At each wave of data collection, mothers reported on their parenting self-efficacy, parenting satisfaction, anxiety, parenting stress, and depressive feelings.

RESULTS

The creation of an amalgamated measure of postnatal adaptation demonstrated acceptable fit. Latent class growth analysis revealed four distinct trajectories of postnatal adaptation; two revealed stability across the early postnatal period and two had relative stability except for a change between weeks four to six. Women's parity was not associated with differences in their trajectories.

CONCLUSIONS FOR PRACTICE

These findings reiterate the importance of collecting data from women in the early postnatal period and identifying if a woman is struggling in those early weeks, as the women in our sample demonstrated relative stability in their postnatal adaptation across the first eight weeks. Furthermore, the findings suggest that work should be taken to dismantle the commonly held belief that parenting is "easier" after having already navigated the early postnatal period with an infant once before.

Parental stress and life satisfaction: A comparative study of social services users and nonusers from a gender perspective

The psychometric properties of the Spanish version of the Parental Stress Scale (PSS) scale have not been verified on the Spanish population. Similarly, the literature on gender differences and parental stress is inconclusive, and there is little evidence of their relationship with life satisfaction. To analyze the psychometric properties of the Spanish version of the PSS scale, (2) to examine possible gender differences, and (3) to study the relationship between parental stress (PS) and parental rewards (PR) and satisfaction with life (SWL) attending to the possible moderating effect of gender. These objectives were examined in samples comprising Social Services Users (SSU) (N = 525; 78.3% female; Mage  = 38.3) and non-SSU users (N = 421; 41.1% male; Mage  = 37.08). A CFA corroborated a two-factor structure: PS and PR. In the SSU sample, mothers showed higher PS and lower PR. However, PR was also higher in mothers from the non-SSU sample compared to fathers. PR and PS were directly related to SWL in the SSU sample. However, gender moderated the relationship between PR and SWL in the non-SSU sample in the case of mothers. The results are discussed considering gender roles and the characteristics of both samples.

Parental Stress and Satisfaction in Parents With Pre-school and School Age Children

Parenting is a transforming experience for the life of parents that brings joy and satisfaction as well as challenges, frustration, and demands. The aim of this study was to determine the relationship between “parental stress and satisfaction” and work-home conflict, perceived social support, and global satisfaction with life, and to determine the moderating role of the parent's gender. A sample of 244 participants was studied: 49.6% (121) mothers and 50.4% (123) fathers with children between 2 and 12 years of age. The data was analysed by means of multiple linear regression models and Beta regression for stress and parental satisfaction, respectively, and they were complemented with general and conditional dominance analyses to estimate the relevance of the predictors. Mothers presented higher levels of parental stress and satisfaction than fathers. Being female, having two children, and home-work conflict were predictors of a higher parental stress. Age was also a predictor, as younger parents and also those older than 37 years of age showed more parental stress. Having no partner and being male was associated to lower parental satisfaction. In conclusion, parental stress and satisfaction emerge as clearly differentiated dimensions of parenting experience. The gender gap in parental stress could be linked to the persistence of traditional roles regarding the care of the children, in agreement with the findings in other research.

The Best and Worst of Times: Predictors of New Fathers' Parenting Satisfaction and Stress

This study examined predictors of new fathers' parenting satisfaction and stress using data from 182 fathers in dual-earner couples who were followed across their transition to parenthood. Expectant fathers completed surveys about their personal characteristics (anxiety, belief in maternal essentialism, parenting self-efficacy expectations) and family relationships (confidence in the couple relationship) during the third trimester of pregnancy. At three months postpartum, fathers completed surveys about their family relationships (maternal gatekeeping) and child characteristics (infant negative emotionality, infant gender), as well as their parenting satisfaction and stress. Results of regression analyses indicated that expectant fathers with greater parenting self-efficacy expectations reported less parenting stress and greater satisfaction at three months postpartum. More anxious expectant fathers were at risk of experiencing elevated levels of parenting stress postpartum, as were fathers with lower endorsement of maternal essentialism and infants highly negative in mood. Fathers were more satisfied in their roles as parents when mothers engaged in greater gate-opening behavior, particularly when those fathers expressed less confidence in their couple relationships prior to their child's birth. Results indicate the importance of screening expectant and new fathers for anxiety, strengthening expectant fathers' parenting self-efficacy, and encouraging greater maternal support for engaged fathering.

Mothers' parenting self-efficacy, satisfaction and perceptions of their infants during the first days postpartum

OBJECTIVE

The first aim of this study was to describe mothers' self-efficacy, satisfaction and perceptions when parenting their infants during the first days postpartum. Furthermore, the study aimed to explore the distinct sociodemographic as well as mother and infant related factors that are associated with the above parenting aspects.

DESIGN

A descriptive and cross-sectional study design was used.

SETTING

Three separate postpartum wards 1-7 days after childbirth in one university level hospital in Finland.

PARTICIPANTS

All mothers who gave birth during March 1st to May 20th, 2019 and filled the inclusion criteria, were invited to participate in this study. A convenience sample of 250 mothers with healthy singleton infants agreed to participate.

MEASUREMENTS AND FINDINGS

The following instruments were used: The Parenting Self-Efficacy (PSE) scale, the Evaluation subscale of What Being the Parent of a New Baby is Like-revised (WBPL-R) and the Perception of Infant scale. Mothers' parenting self-efficacy and parenting satisfaction were high during the first days postpartum. Age, marital status, education and type of birth were not associated with parenting self-efficacy nor satisfaction. Mothers who were unemployed or working only part-time reported higher scores across all categories of parenting self-efficacy, compared to full time employed mothers (p < .001). A higher number of children (≥ 3) were positively associated with both parenting self-efficacy and satisfaction. Mothers who reported poor breastfeeding initiation success also reported significantly lower scores in parenting self-efficacy and parenting satisfaction across all categories. Mothers' perceptions of their infants' fussiness were not associated with parenting self-efficacy (p = .113) nor parenting satisfaction (p = .091).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The results of this study can benefit postpartum maternity health care professionals by suggesting factors that could be focused on during the very short period that mothers stay in hospital. Discussing prior mothering experiences, work life before maternity leave, breastfeeding initiation experiences and perception of infant with the mothers after childbirth, may lead to better PSE and PS during the postpartum period.

Parenting Outcomes and Predictors of Parenting Satisfaction in the Early Postpartum Period

This study examined the relationships among parenting self-efficacy (PSE), social support, postnatal depression (PND), and predictors of parenting satisfaction in the early postpartum period using a cross-sectional exploratory quantitative design. The hypothetical model was tested among interrelated concepts of outcome variables among 250 parents (125 couples). The structural equation model revealed an adequate fit between the hypothesized model and the data. PSE and spousal support were found to be predictors of parenting satisfaction. PSE was also found to be a predictor of social support. PND was not found to be a predictor of parenting satisfaction. None of the obstetric and demographic factors predicted parenting satisfaction. This is the first study that tested interrelations among crucial parenting outcome variables among fathers and mothers in the early postpartum period. It is important to assess interrelated parenting outcomes among both parents so that support can be provided to ultimately influence parenting satisfaction.

Maternal and partner's level of satisfaction on the delivery room service in University of Gondar Referral Hospital, northwest, Ethiopia: a comparative cross-sectional study

Background

Asking patients/clients what they perceive about the care and treatment they have received is one of the important steps towards improving the quality of health care. In the scientific world, a number of efforts have been tried to understand about what laboring mothers perceive about the care provided. However, little is known about the birth experiences of partners in Ethiopia. Therefore, this study was aimed to assess the maternal and partner’s level of satisfaction on the delivery room service in the study area.

Methods

A comparative cross-sectional study was conducted from December 2018 to January 2019 in University of Gondar referral hospital. The birth satisfaction scale is used for the mother, and it was adapted to the partners’ perspective. Paired-samples t tests were used for comparing mothers and partners for the birth satisfaction scales global and thematic scores. A binary logistic regression model was fitted to identify predicting factors for mothers’ and partners satisfaction.

Results

The overall satisfaction of mothers in this study was 47.6%. Whereas, 41.2% of partners were satisfied by delivery room services. There were mean difference between mothers and partners’ birth satisfaction scale (p = 0.02). Maternal satisfaction scale was affected by age [OR = 0.36, 95%CI (0.18, 0.73)], perception [OR = 0.02, 95%CI (0.001,0.09)], waiting time [OR = 0.11, 95%CI (0.001, 0.09)],visiting mode [OR = 0.01, 95%CI (0.001,0.08)], pregnancy status [OR = 0.04, 95%CI (0.01,0.33)] and fatal outcome [OR = 0.001, 95%CI (0.001,0.018)] .whereas, partners satisfaction was associated with age [OR = 0.16,95%CI (0.05 0.49)], occupational status [OR = 0.02, 95%CI (0.001, 0.24), amount of money to pay for service [OR = 2.87, 95%CI (1.07, 7.71), visiting mode of his wife [OR = 0.08, 95%CI (0.01, 0.35)], waiting time [OR = 0.12, 95%CI (0.04, 0.33)], privacy [OR = 10.61, 95%CI (3.00, 37.52)], mode of delivery of his wife [OR = 7.69, 95%CI (3.00, 19.69)].

Conclusion

This finding would alert the health care system to design a client-friendly approach. It will provide insight to hospital administrators and providers in formulating a policy that would enhance the support of partners during labour and delivery process.

Father Involvement in Infant Parenting in an Ethnically Diverse Community Sample: Predicting Paternal Depressive Symptoms

Early paternal involvement in infant care is beneficial to child and maternal health, and possibly for paternal mental health. The purpose of the present study was to examine the relationship between fathers' involvement in early infant parenting and their depressive symptoms during the infant's first year in a sample of 881 low-income Black, Hispanic, and White fathers recruited from five sites in the United States (urban, mixed urban/suburban, rural). Home interviews at 1 month after birth assessed three concepts based on prior research and community input: (1) time spent with the infant, (2) parenting self-efficacy, (3) material support for the baby. Paternal depressive symptoms at 1, 6, and 12 months after the birth of a child were assessed with the Edinburgh Postpartum Depression Scale. Generalized estimating equations tested whether the three indicators of father involvement at 1 month after birth predicted lower subsequent paternal depressive symptoms controlling for social and demographic variables. For fathers, greater time spent with the infant, parenting self-efficacy, and material support were all significantly associated with lower paternal depressive symptoms during the first year. When risk of depression (scores > 9) was examined, only parenting self-efficacy among fathers was associated with higher likelihood of clinical depression. Findings have implications for future research on mechanisms linking paternal involvement and paternal mental health, and for possible paid paternal leave policies in the future.

The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period: A Randomized Controlled Trial

The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.

Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress

This pilot study aimed to (i) evaluate the effectiveness of a neonatal discharge program, (ii) identify relationships between parent and infant factors and parental efficacy and psychological distress, and (iii) identify ways to improve the neonatal discharge program. A quasiexperimental 1-group pretest/posttest design was used. Through consecutive sampling, 42 participants were recruited. Data were collected using self-report questionnaires. Self-administering instruments gathered data on parental efficacy and psychological distress as well as feedback and recommendations on the intervention. A significant increase in parental efficacy and a reduction in psychological distress were observed from pre- to postdischarge intervention. Significant relationships were found between parental efficacy and infants' gestational age, birth weight, gender, and participants' level of education, and a significant relationship was found between psychological distress and number of children from previous pregnancies. Moreover, an Internet-based program, in addition to the face-to-face teaching, was identified as a preferred option to aid in information retention. It is important to evaluate and enhance the neonatal discharge program to suit the parents of today while providing them with informational and emotional support. Future studies should explore parental coping and the long-term effects of their infant's birth and the intervention.

Effects of Implementing the Alexander Technique on Enjoying the Sense of Motherhood in the Postpartum Period

BACKGROUND

The broad concept of maternal well-being includes psychological concepts, social aspects, and aspects of becoming a mother. The present study aimed to investigate the effects of implementing the Alexander technique on enjoying the sense of motherhood.

MATERIALS AND METHODS

This study was a clinical trial conducted in two phases. In the first phase, using the exploratory and confirmatory factor analysis, 226 mothers were asked to undergo a scale test of enjoying the sense of motherhood after childbirth. In the second phase, 88 pregnant women were divided into two experimental groups. The data collection tool was a researcher-made questionnaire about enjoying the sense of motherhood. Independent samples t-test, Mann-Whitney test, Chi-square test, Fisher's exact test, analysis of variance test, Box test, and Levine test were used to analyze the data.

RESULTS

Results of this study showed that the mean scores of the constructs of enjoying pregnancy (P > 0.001), motherhood, and child care satisfaction (P > 0.001) in the experimental group were significantly higher than the control group. Moreover, the construct of trusting their own abilities to cope with maternal duties (P > 0.01) did not show significant differences between the two groups.

CONCLUSIONS

The findings indicated that the Alexander technique can promote mothers' psychological well-being and their pleasure of becoming a mother and the related constructs. Results also revealed that using this technique, educating and recommending pregnant women to use this technique will be beneficial.

Parenting Stress, Mental Health, Dyadic Adjustment: A Structural Equation Model

Objective: In the 1st year of the post-partum period, parenting stress, mental health, and dyadic adjustment are important for the wellbeing of both parents and the child. However, there are few studies that analyze the relationship among these three dimensions. The aim of this study is to investigate the relationships between parenting stress, mental health (depressive and anxiety symptoms), and dyadic adjustment among first-time parents.

Method: We studied 268 parents (134 couples) of healthy babies. At 12 months post-partum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Post-natal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Structural equation modeling was used to analyze the potential mediating effects of mental health on the relationship between parenting stress and dyadic adjustment.

Results: Results showed the full mediation effect of mental health between parenting stress and dyadic adjustment. A multi-group analysis further found that the paths did not differ across mothers and fathers.

Discussion: The results suggest that mental health is an important dimension that mediates the relationship between parenting stress and dyadic adjustment in the transition to parenthood.

Effect of the Postpartum Hospital Environment on the Attainment of Mothers' and Fathers' Goals

OBJECTIVE

To describe mothers' and fathers' goals in the postpartum period and how the hospital environment enables or hinders the attainment of these goals.

DESIGN

A qualitative descriptive design was used to explore participants' perceptions.

SETTING

Mothers and fathers were recruited on the postpartum unit of an urban hospital.

PARTICIPANTS

Ten mothers and eight fathers participated.

METHODS

Semistructured interviews were conducted with mothers and fathers individually. Data analysis occurred concurrently with data collection and informed subsequent interviews.

RESULTS

Mothers and fathers expressed similar goals: developing parenting competence and fulfilling personal needs. Their narratives indicated that the organizational environment with the mission to promote and provide baby-friendly and family-centered care and the human environment of responsive nursing were closely aligned with their goals. In contrast, the routines of the unit and the physical environment were not consistent with parents' goals or the mission of the organization.

CONCLUSION

Nurses have important advocacy roles in ensuring that all dimensions of the postpartum environment support the ability of parents to attain their goals and align with the philosophy of care of the organization.

Antecedents of maternal parenting stress: the role of attachment style, prenatal attachment, and dyadic adjustment in first-time mothers

The transition to parenthood is widely considered a period of increased vulnerability often accompanied by stress. Abidin conceived parenting stress as referring to specific difficulties in adjusting to the parenting role. Most studies of psychological distress arising from the demands of parenting have investigated the impact of stress on the development of dysfunctional parent–child relationships and on adult and child psychopathology. Studies have largely focused on mothers’ postnatal experience; less attention has been devoted to maternal prenatal characteristics associated with subsequent parental stress and studies of maternal prenatal predictors are few. Furthermore, no studies have examined that association exclusively with samples of first-time mothers. With an observational prospective study design with two time periods, the aim of this study was to investigate the role of mothers’ attachment style, maternal prenatal attachment to the fetus and dyadic adjustment during pregnancy (7th months of gestation) and their potential unique contribution to parenting stress 3 months after childbirth in a sample of nulliparous women. Results showed significant correlations between antenatal measures. Maternal attachment style (especially relationship anxiety) was negatively correlated with prenatal attachment and with dyadic adjustment; positive correlations resulted between prenatal attachment and dyadic adjustment. Each of the investigated variables was also good predictor of parenting stress 3 months after childbirth. Findings suggested how these dimensions could be considered as risk factors in the transition to motherhood and in the very beginning of the emergence of the caregiving system, especially with first-time mothers.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis

BACKGROUND

Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety.

METHOD

In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations.

RESULTS

We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction.

LIMITATIONS

This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms.

CONCLUSION

The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.

Predictors of maternal and paternal depressive symptoms at postpartum

OBJECTIVES

Postnatal depression has emerged as a major public health concern, which has deleterious effects on the well-being of the entire family. The aim of this study was to examine the predictive role of prenatal family sense of coherence, stress, social support and family, and marital functioning; the effect that any changes in these factors from pregnancy to postpartum; and partner's depressive symptoms on depressive symptoms at 6 months postpartum.

METHODS

This study used a longitudinal design. A convenience sample of 200 childbearing couples in Hong Kong completed assessments of family sense of coherence, stress, social support, family, and marital functioning and depressive symptoms during pregnancy and at 6 months postpartum. Multiple regression analyses were employed.

RESULTS

The results showed that a low level of family sense of coherence and a high level of depressive symptoms during pregnancy and partner's depressive symptoms were significantly associated with an increase in depressive symptoms for both mothers and fathers at 6 months postpartum. A lack of social support was significantly associated with increased risk of depressive symptoms for mothers, but not for fathers.

CONCLUSION

The results suggest that couple-based interventions that foster a sense of family coherence may be helpful in promoting parental well-being. Well-designed trials to test the effects of such interventions are recommended for future research.

Social support, family functioning and parenting competence in adolescent parents

Depression is known to mediate the association between low social support and parenting competence in adult mothers, but this relationship is rarely assessed in adolescent mothers and fathers. The primary aim of this study was to identify the association between social support, family functioning and social capital on parenting competence, including self-efficacy and satisfaction in adolescent mothers and their partners. Secondary aims included identifying potential partner effects (e.g. whether a partner's social support influenced the respondent's parenting efficacy). Data was obtained from a subset of participants from a longitudinal study of pregnant adolescent females and their partners. Couples completed individual structured interviews via audio computer-assisted self-interview during pregnancy and at 6 months postpartum. To measure the influence of support on parenting outcomes, multi-level modeling was used to assess the Actor-Partner Interdependence model, which examines responses from both members of a dyad in a single analysis. Greater social support was associated with increased parenting self-efficacy (B = 0.062, p = 0.006) and parenting satisfaction (B = 0.111, p < 0.001). Higher family functioning was also associated with greater parenting satisfaction (B = 0.05, p = 0.035). Greater partner family functioning was associated with higher parenting satisfaction (B = 0.047, p = 0.026). This study found the importance of a strong support structure during pregnancy on perceived parenting competence in the early postpartum period for young mothers and fathers. Both social support and family functioning during pregnancy were associated with a greater sense of parenting competence, and these associations were mediated by parental depression. The results of this study underscore the importance of providing social support for young expectant fathers as well as mothers.

Validity and reliability of breastfeeding advice and coping with breastfeeding instruments

PURPOSE

To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings.

DESIGN

Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments.

SAMPLE

Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland.

MAIN OUTCOME VARIABLES

The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues.

RESULTS

Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.

Translating research-based knowledge about infant sleep into practice

PURPOSE

Review infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well-being during nighttime care.

DATA SOURCES

This review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns.

CONCLUSIONS

Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families.

IMPLICATIONS FOR PRACTICE

NPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.

Parental groups during the child's first year: an interview study of parents' experiences

AIMS AND OBJECTIVES

To highlight what was important to parents with respect to consultation groups at well-child clinics.

BACKGROUND

Parents managing of their role as parents affect the child's health and are therefore an important priority for public health. Well-child clinics in Norway practise consultations in groups to support parents and to facilitate social network; however, few studies explore parents' perspective of this kind of groups.

DESIGN

Grounded theory.

METHODS

We used classical grounded theory with a generative and constant comparative approach. Data were collected through seven focus groups and two individual interviews with the parents of children aged 8-15 months.

RESULTS

The parents were most concerned about how to achieve connection without accountability and how to obtain relevant health information. They managed this by 'multipositioning', encompassing the strategies of: (1) practising conditional openness, (2) seeking to belong, (3) awaiting initiative and (4) expecting balanced health information. The use of these strategies explains how they resolved their challenges.

CONCLUSION

Parental groups seem to be popular and have great potential to establish a social network; however, underestimating the need for structure and continuity in the groups might cause this opportunity to be missed.

RELEVANCE TO CLINICAL PRACTICE

Understanding parents' perspectives will be useful when planning strategies to strengthen parental groups at well-child clinics and that the engaged organisers will account for this need to ensure public health work of high quality and effectiveness for parents.

Primiparous and multiparous mothers' perceptions of social support from nursing professionals in postnatal wards

OBJECTIVE

the study aimed at evaluating primiparous or multiparous mothers' perceptions of social support from nursing professionals (SSNP) in postnatal wards and factors associated with SSNP.

DESIGN

a cross-sectional and correlational design was used.

METHODS

data was collected in 2007-2008 in two maternity hospitals with a convenience sample of Finnish-comprehending primiparous and multiparous mothers (N=1300). Multiple-birth and early discharge mothers were excluded. The amount of SSNP including affection, affirmation and concrete aid was measured. Questionnaires were returned from 754 mothers (58%). Fisher's exact test, t-test, Pearson's correlation coefficients, ordinal regression and multiple regression were used in the analyses.

FINDINGS

mothers perceived the amount of SSNP as moderate. The amount of affirmational support was perceived as the highest compared with concrete and affectional support. Multiparas received statistically significantly less concrete aid compared with primiparas. The number of mother- and infant-related factors was substantial and their association was stronger among primiparas. Depressive symptoms were a significant factor among multiparas. Advice from nursing professionals, parenting self-efficacy, mother's age and infant age explained 54.0% of the variation in SSNP for primiparas. Correspondingly, advice from nursing professionals, state of mind on hospital discharge and family functioning explained 49.3% of the variation in SSNP for multiparas.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

primiparas that are vulnerable for a scarce amount of SSNP were easier to recognise on the basis of their background information, infant characteristics, childbirth-related factors, and sense of efficacy. Challenges lie in taking into account the whole family, especially among multiparas, and in developing professionals' guidance skills. Among primiparas the model of postpartum care may matter. Our results give professionals a better understanding of the resources and challenges faced by mothers in order to develop postnatal SSNP.

Impact of an internet-based intervention on Finnish mothers' perceptions of parenting satisfaction, infant centrality and depressive symptoms during the postpartum year

OBJECTIVE

this study evaluates how an internet-based intervention affects mothers' parenting satisfaction, infant centrality and depressive symptoms.

DESIGN

a quasi-experimental design and repeated measures were used.

SETTINGS

this study was conducted in two Finnish public maternity hospitals (intervention/control).

PARTICIPANTS

a convenience sample (N=1300) of primiparous and multiparous Finnish-speaking mothers were invited to participate. Multiple-birth and early discharge mothers receiving home visits were excluded. The analysis included 760 mothers.

INTERVENTION

the intervention offered online support for parenting, breast feeding and infant care beginning from the middle of pregnancy. It consisted of an information database, a peer discussion forum and expert advice.

MEASUREMENTS

Outcomes were measured by the Evaluation and Infant Centrality subscales of the What Being the Parent of a New Baby is Like-Revised, and the Edinburgh Postnatal Depression Scale after childbirth, and six weeks, six months and 12 months post partum. Age, parity, parenting self-efficacy, and perception of infant and family functioning were used as the covariates.

FINDINGS

during the first postpartum year, mothers' parenting satisfaction increased significantly, whereas infant centrality and depressive symptoms decreased within groups. However, these changes were not linear. The mean difference between groups in parenting satisfaction and depressive symptoms was not significant within any of the four assessments. The mean difference in infant centrality between control and intervention mothers was significant only at six weeks post partum. Primiparas scored significantly higher in infant centrality and significantly lower in depressive symptoms than multiparas.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

an internet-based intervention did not significantly affect mothers' perceptions of parenting satisfaction and depressive symptoms, but intervention mothers experienced higher infant centrality compared with control mothers at six weeks. Parenting self-efficacy was a significant covariate for all measures. Parity needs to be taken into account when infant centrality and depressive symptoms are used as outcome variables in intervention studies. More research is needed to study the potential of information data bank, professional, and peer online support. This study also highlights the need to pay more attention to the selection of the target population, the selection of outcome measures, and implementation issues in intervention research.

Parenting self-efficacy: links with maternal depression, infant behaviour and adult attachment

BACKGROUND

This study examined predictors of parenting self-efficacy (PSE) in a sample of first-time mothers during the first year after childbirth and evaluated the effect of a brief, intensive, mother-infant residential intervention on PSE and infant behaviour.

METHODS

83 primiparous women with infants aged 0-12 months admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis of depressive and anxiety disorders and completed questionnaires assessing psychological distress, adult attachment and childhood parenting experiences. During their residential stay, nurses recorded infant behaviour using 24-hour charts.

RESULTS

Results showed PSE to be inversely correlated with maternal depression, maternal anxiety and attachment insecurity. Low levels of parental abuse during childhood, avoidant attachment, male infant gender and depressive symptom severity were found to predict low PSE. Major depression mediated the relation between attachment insecurity and PSE, but there were no links between PSE and infant behaviour. After the intervention, there was a significant improvement in PSE, with abusive parenting during childhood and depressive symptom severity being predictive of change.

CONCLUSIONS

This study highlights the links between maternal psychopathology and maternal background factors such as childhood parenting experiences and attachment style in the development of postnatal PSE. Directions for future research are discussed.

Development and validation of a neonatal intensive care parent satisfaction instrument

OBJECTIVE

To develop and test the psychometric properties of the EMPATHIC-N (EMpowerment of PArents in THe Intensive Care-Neonatology) questionnaire measuring parent satisfaction.

DESIGN

A psychometric study testing the reliability and validity of a parent satisfaction questionnaire by applying confirmatory factor analysis including standardized factor loadings and subsequently Cronbach's α reliability estimates across time, congruent validity, and nondifferential validity testing.

SETTING

A 30-bed neonatal intensive care unit in a university hospital.

PATIENTS

Two cohorts with a total of 441 parents whose child was admitted to the neonatal intensive care unit, January to December 2009.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In the first cohort, 220 of 339 (65%) parents responded; in the second cohort, 59 of 102 (58%) parents responded. Structural equation modeling and confirmatory factor analysis resulted in a sufficient model fit of 57 statements within five domains: Information, Care & Treatment, Organization, Parental Participation, and Professional Attitude. Standardized factor loading of these statements were between 0.58 and 0.91. Reliability measures, Cronbach's α, of the domains ranged from 0.82 to 0.95. Reliability across time showed no evidence of statistically significant differences between the domains. Congruent validity was confirmed by a good correlation (p = .01) between the domains and four general satisfaction questions. Nondifferential validity showed no significant effect sizes between the infants' characteristics and the domains, except between ventilated infants and parent participation statements and infants ≥30 wks gestational age and organizational statements.

CONCLUSIONS

The EMPATHIC-N questionnaire is a valid quality performance indicator to measure the delivered care as perceived by parents.

Postpartum care: evaluation and experience among care providers and care receivers

INTRODUCTION

There have been substantial alterations in the structure of postpartum care over the last several decades. Our aim was to investigate the perceived quality of, and satisfaction with, postpartum care among caregivers and care receivers in the maternity ward of a community hospital in Norway with about 2600 births per year.

METHODS

We conducted a cohort study of women giving birth and the caregiving staff in the maternity ward during a 7-month period. A questionnaire, with a Cronbach α coefficient above 0.8, was filled in anonymously, both by the staff in the ward and by the women. The questionnaire explored the respondents' evaluations of the information offered by the staff; the teaching of skills in child care and establishment of breastfeeding; assistance with practical tasks like making beds, serving meals, and keeping order in the room; visiting rules; level of noise in the ward; whether the pediatric service was adequate; length of the stay; and to what extent caregivers were able to respond to the individual needs of the mothers. Finally, the questionnaire explored the degree of kindliness communicated by the staff. Five extra questions in the women's questionnaire explored their personal experiences in the ward.

RESULTS

The care receivers' evaluations of the maternity ward did not differ significantly from that of the caregivers in questions related to overall care and service. However, the mothers rated the importance of assistance with child care during the night significantly higher than did the staff. Responses to questions addressing noise in the ward demonstrated a higher tolerance among the mothers compared with the staff. In addition, mothers tended (but not a statistically significant result) to rate the quality of the teaching of child-care skills lower, compared with the staff's ratings.

DISCUSSION

By exploring both the caregivers' and care receivers' evaluations and expectations of the actual services in the maternity ward, areas for enhancement of the quality of the ward and its services can be detected and carried out. The present study revealed 2 areas needing further focus: assistance with child care during the night and teaching of child-care skills during the stay. We believe that investigations that collect data from both caregivers and care receivers, by using adapted and validated questionnaires to gather information on quality and satisfaction with the maternity ward, are mandatory for improvement and continuous adaptation of health services.

Confidence in breastfeeding among pregnant women

Little is known about prenatal breastfeeding confidence, although such knowledge is necessary for developing the content of counseling and tailoring it for individuals. The purpose of this study was to describe women's prenatal breastfeeding confidence and how their sociodemographic characteristics, breastfeeding knowledge, and attitudes relate to it. The electronic confidence scale was used in data collection, and 123 Finnish women filled in the questionnaire. The mean confidence score was 83.88 when the maximum possible score was 120. Confidence scores varied when parity, breastfeeding knowledge, and attitudes were involved. Variables regarding breastfeeding as difficult, regarding breastfeeding as exhausting, and parity explained 38.1% of the variation of the breastfeeding confidence scores. Pregnant women need information about managing potential breastfeeding problems and the physiology of breastfeeding. Interventions designed to promote breastfeeding confidence need to be focused on primiparas and women with a lack of breastfeeding knowledge.