MOTHER, CHILD, AND FAMILY FACTORS RELATED TO EMPLOYMENT OF SINGLE MOTHERS WITH LBW PRESCHOOLERS

Rethinking stress in parents of preterm infants: a meta-analysis

BACKGROUND

With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress.

METHODS AND FINDINGS

A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants.

CONCLUSIONS

Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.

Child care use by low-income single mothers of preschoolers born preterm versus those of preschoolers born full term

This study describes prewelfare reform child care use by 64 primarily low-income single mothers (65.6% African American) with preschoolers (half born preterm). Forty percent used child care for more than 75% of their children's lives, 20% did when not employed. Preschool children born preterm were more likely to receive child care from nonrelatives throughout their lives than children born full term. Children with health problems used a greater number of child care arrangements. Findings suggest addressing child care issues with both employed and nonemployed mothers and adequacy of child care for children with special needs.

Effects of maternal employment and prematurity on child outcomes in single parent families

BACKGROUND

Effects of maternal employment for preschool children vary based on specific characteristics of the mother's employment, the family's economic status, and the mother's attitudes about employment. However, there is limited research on a growing group of children at developmental risk-those born prematurely and living in a single-parent family.

OBJECTIVE

To examine the effects of maternal employment and prematurity on child cognition and behavior in single-parent families.

METHODS

Sixty preterm and 61 full-term preschool children were recruited through NICU admission records and birth records. Data were collected with the Kaufmann Assessment Battery for Children, Peabody Picture Vocabulary Test, Child Behavior Checklist, Parenting Stress Index, and the Life History Calendar.

RESULTS

Greater hours employed was related to higher achievement and mental processing scores only. Less discrepancy between actual and desired employment was related to higher achievement, mental processing, and language scores and lower behavior scores. Prematurity was not related to child cognitive and behavioral performance. Only the relationship between discrepancy and language remained after statistical control.

CONCLUSIONS

The concerns about negative effects of maternal employment on young children may be overstated, especially in low-income, single-mother families. These findings are especially important in the context of welfare reform.

Employment patterns and timing of birth in women with high-risk pregnancies

OBJECTIVE

To describe the characteristics of employed women with high-risk pregnancies, their pattern of employment prenatally and postpartum, and the relationship of prenatal employment to preterm or full-term birth.

DESIGN

Secondary analysis with a sample of 171 women with high-risk pregnancies.

SETTING

Women's homes and a tertiary care hospital.

PARTICIPANTS

Women who were primarily single, African American, and poor; 33% worked or attended school during their pregnancies.

MAIN OUTCOME MEASURES

Gestational age at birth, employment, and school attendance.

RESULTS

Preterm delivery was not related to when the women stopped working or attending school or were prescribed bed rest. Women employed prenatally were older, had higher incomes, and were more likely to be white or of ethnicity other than African American. Fifty-seven percent of women with a history of prenatal employment and 85% of the women who intended to work after delivery returned to work during the first postpartum year.

CONCLUSIONS

Women employed during high-risk pregnancies are similar demographically to women with low-risk pregnancies in other studies. Most of the women stopped working or attending school because of prescribed bed rest. Bed rest, however, was not related to preterm delivery. Most women who planned to return to work did so. Factors other than the women's high-risk pregnancies, such as attitudes toward employment, employability, and family circumstances, most likely influenced their employment status. Current welfare reform initiatives will increase the number of women working while pregnant. This article provides pre-welfare-reform baseline data concerning patterns and effects of employment for women with high-risk pregnancies. These data will enable nurses to examine the effects of welfare reform on employment during pregnancy and preterm birth.

Factors influencing single mother's employment status

Changes in the welfare system limit the length of time a person can receive welfare benefits, thus mandating employment for many current welfare recipients. Single mothers with young children who do not become employed will lose financial support for housing, food, clothing, and health care and place their own and their children's health and safety at risk. The purpose of this qualitative study was to explore women's experiences of being unemployed and to examine the barriers to employment perceived by single mothers who expressed a desire to be employed. Nine mothers were recruited from a larger sample of single mothers who had participated in a quantitative study about employment conducted 1 to 2 years earlier. Using focus group interviews, mothers were asked what it was like to be a single mother, and then what barriers to their employment they perceived. Two dimensions were identified from the mothers' statements. The first, a sense of obligation, included themes of "being there" for their own and their child's benefit and doing what it takes to optimize the child's growth and development. The second, negotiating the obstacles, referred to problems regarding child care, lack of involvement of the child's father and lack of support from relatives and friends for the mother's efforts toward securing employment. These findings have important implications for welfare reform, namely, that efforts aimed at moving nonemployed single mothers into the workforce will fail if these factors are not considered.

Maternal employment and parent-child relationships in single-parent families of low-birth-weight preschoolers

BACKGROUND

The influence of premature birth of an infant in female-headed, single-parent families together or in conjunction with family environment factors, such as employment of the mother, on the mother-premature child relationship has not been considered in past studies.

OBJECTIVES

To explore differences in parent-child and family relationships for employed and nonemployed single mothers of low-birth-weight (LBW) and full-term preschool children and to describe the relationships of the mother's employment status, employment history, and employment attitude-behavior consistency to parent-child and family relationships.

METHODS

Single mothers with LBW (n = 60) and full-term (n = 61) preschool children provided data on their employment situation, the Parenting Stress Index, the Feetham Family Functioning Survey, and the Home Observation for Measurement of the Environment.

RESULTS

Employed mothers had more positive perceptions and provided more enriching home environments for their children. Greater attitude-behavior consistency was associated with more positive perceptions of the parental role.

CONCLUSION

Thus, in single-parent families, employment and consistency are positive influences on the mother-child relationship.