Postpartum Partner Support, Demand-Withdraw Communication, and Maternal Stress

Measurement instruments for parental stress in the postpartum period: A scoping review

BACKGROUND

Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured.

OBJECTIVES

This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties.

METHODS

We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0-12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively.

RESULTS

From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments.

DISCUSSION

There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments' psychometric properties is slight. There is a need for further research.

In Their Own Words: A Qualitative Investigation of the Factors Influencing Maternal Postpartum Functioning in the United States

During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother’s level of postpartum functioning not only impacts her experience as a mother but also the infant and family unit. However, efforts to bolster functioning are lacking, and previous literature has identified a gap between what experts recommend and what mothers desire during the postpartum period. To address this, we conducted structured interviews with a diverse sample of 30 postpartum mothers to identify factors that mothers report are most influential to their postpartum functioning. In total, we identified 23 clinically actionable factors, all of which are backed by existing literature. In addition to an in-depth presentation of the qualitative findings, we also present a heat map to visualize the relevance of these factors to each of seven established domains of maternal functioning. Lastly, based on our findings, we offer a taxonomy of interventional strategies that could bolster maternal functioning during this critical period.

Regulation between daily exhaustion and support in parenting: A dyadic perspective

The current article serves a dual purpose: to highlight the overlooked and recent concept of parenting-related exhaustion and to propose a specific methodology to test concurrent variations of the parent’s exhaustion with the partner’s exhaustion and her or his perceived and given support. Questionnaire data were collected from 97 mother–father couples over the course of 5 consecutive days. Results from multilevel model analyses revealed day-to-day dyadic variations as well as day-to-day regulation occurring in parental couples. The dyadic variations were shown by the fact that over the week, on the days when one parent felt more exhausted, the other parent’s exhaustion was also high. Dyadic regulation meant that greater exhaustion felt by one parent was associated with greater support from her or his partner. Partner’s extra support was both perceived by the exhausted parent and reported by the support provider (i.e., the partner).

Women's experiences of positive postnatal partner support

OBJECTIVE

To explore women's experiences of support from their partners in the first year and a half post-baby and identify the particular attitudes and behaviours they considered helpful.

BACKGROUND

Becoming a mother brings major life changes that impact on maternal mental health. Partner support can have a protective effect during this transition period, although there is currently a gap in the research regarding specific examples of partner support that women find helpful.

METHODS

Six mothers who self-identified as receiving positive partner support took part in semi-structured interviews. Data were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three superordinate themes emerged: role navigation, emotional support and teamwork. Role navigation included an attitude of respect and appreciation of the mother role, as well as a shift in the father's priorities to include the whole family. Specific behaviours such as communicating with the mother in an empathic way, offering praise and demonstrating reliability and a willingness to help were seen as emotionally supportive. Teamwork included notions of fairness and equality.

CONCLUSION

The present study extends upon previous research by providing clear examples of what women consider helpful from their partners, including an attitude of respect, placing family first, contributing fairly to household responsibilities, flexibility during the changing stages of child development, and facilitating personal time for mothers. These findings may assist to support new parents through the often difficult transition to parenthood.

Psychometric Properties of Newly Translated Creole Perceived Stress Scale and Daily Hassles Scale

BACKGROUND

Mothers with postpartum stress have increased maternal/infant morbidity and mortality. Haitians, a growing minority excluded from most studies because of the lack of instruments in Creole. The Perceived Stress Scale (PSS) and the Daily Hassles Scale (DHS) measuring stress are not available in Creole.

PURPOSE

To test the psychometrics of the newly translated Creole instruments.

METHODS

A convenience sample of 85 Haitian mothers completed 2 instruments in Creole and English, 2 weeks apart using the process of cross-cultural adaptation.

RESULT

Internal consistency reliability and stability were strong for both instruments (.80-.94). Reliability and validity support the translated Creole with this sample of Creole speaking mothers.

CONCLUSION

Psychometric findings suggest the newly translated versions are good representations of the English versions and are ready for use.

Postpartum social support of women in Singapore: A pilot study

This pilot study aimed to identify the levels of support expected and received by postpartum women in Singapore. Another objective was to compare the different subdomains of social support. A descriptive design was adopted using a self-administered questionnaire comprising demographics and the Postpartum Support Questionnaire. The study took place at a subsidized obstetrics and gynaecology clinic at a restructured hospital in Singapore from the end of December 2009 to the end of February 2010. The 25 participants were 6 to 8 weeks postpartum and had delivered healthy term infants. They were recruited via convenience sampling. Data were analysed using descriptive statistics and inferential statistics. The overall support needs of the participants were met. Only their informational support needs were unmet. Assessing the needs of postpartum women and teaching them how to convey and manage expectations are recommended initiatives for health-care practitioners to consider.

Stability and antecedents of coparenting quality: the role of parent personality and child temperament

This investigation explored how parent personality and infant temperament were associated with the development and stability of coparenting over the first 3 years of life. We examined the stability of supportive and undermining coparenting from 13 months to 3 years and whether infant difficult temperament moderated the stability of coparenting. We also examined how two dimensions of parent personality, communion and negative emotionality, were directly associated with coparenting quality and how these personality variables interacted with infant difficult temperament in predicting subsequent coparenting quality. Both supportive and undermining coparenting demonstrated moderate stability; however, stability in undermining coparenting was present only for families with less difficult infants. Fathers' communion and negative emotionality were associated with higher and lower coparenting quality, respectively, but only for families with an infant with a more challenging temperament. Mothers' negative emotionality was associated with higher coparenting quality. The results of this study suggest that parents' and children's characteristics are associated in direct and interactive ways with the development of the coparenting relationship across the first few years of a child's life.

Mother and father adjustment during early parenthood: the roles of infant temperament and coparenting relationship quality

We explored how parent gender, infant temperament, and coparenting dynamics worked together to shape mothers' and fathers' depressive symptoms, stress, and parental efficacy during early parenthood. We were interested in the coparenting relationship as a context that shapes how parents respond to their infant's temperamental qualities. Participants were 139 couples who had recently given birth to their first child. Parent reports of temperament were collected when the infant was 4-8 months old and reports of coparenting and parent adjustment were collected at 13 months. Two-level random intercept models revealed interactions between temperament and coparenting, highlighting the family system as a context for how men and women adapt to their parenting role. There was little evidence for mother-father differences in these associations.

The role of family and friends in providing social support towards enhancing the wellbeing of postpartum women: a comprehensive systematic review

BACKGROUND

Maternal postpartum health is a neglected area both in research and practice. This aspect warrants more attention as the health of postpartum mothers has a considerable influence on her infant and also other family members. Social support provided by family and friends has been identified as a buffer against the many stressors faced by the women. Outcomes such as self-esteem, stress, postnatal depression, breastfeeding levels, infant care, and maternal adaptation have been studied and found to be significantly related to social support. The need to understand the role of social support provided by family and friends provide the impetus for conducting this review.

OBJECTIVES

The objective of this systematic review was to appraise and synthesise the best available evidence which discusses the impact of social support from family and friends on enhancing the wellbeing of postpartum women.

INCLUSION CRITERIA

This review includes women who were within their first year postpartum period, with any number of children, and had given birth to healthy infants. Mothers who had co-existing morbidities such as depression were excluded. Mothers from low socio-economic groups were excluded.This review considered any study that involved the provision of social support by family and/or friends. Interventions provided by peer counsellors were also considered.The six outcomes were stress, self esteem, breastfeeding levels, mental health in relation to postnatal depression, infant care and maternal adaptation.Quantitative This review considered any randomised controlled trials that examined the effectiveness of social support from family and friends on the well being of the postpartum women. As it was not likely to find RCTs on this topic, this review also considered observational studies (cohort, case control, quantitative descriptive studies such as surveys).Qualitative This review considered any interpretive studies that drew on the experiences of social support from family and friends in postpartum women including, but not limited to, designs such as phenomenology, grounded theory and ethnography.The search was conducted only in published literature in English. A search was conducted in the following databases: PsycINFO, MEDLINE, CINAHL, SCOPUS, THE COCHRANE LIBRARY, BMJ Clinical Evidence, Wiley Interscience, ScienceDirect and MEDNAR.Each paper was assessed independently by two reviewers prior to critical appraisal using Joanna Briggs Institute-System for the Unified Management, Assessment and Review of Information (JBI-SUMARI) developed by Joanna Briggs Institute (JBI).

DATA COLLECTION/EXTRACTION

Qualitative and quantitative data were extracted using the tools from the JBI-SUMARI DATA SYNTHESIS: Qualitative data was synthesised using QARI (Qualitative Assessment and Review Instrument). Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form.

RESULTS

This review included 24 quantitative articles, comprising of two RCTs and 22 descriptive studies. From these studies, social support was shown to have a significant positive correlation with outcomes such as breastfeeding, infant care, maternal adaptation, and self esteem. In addition, social support was shown to have a negative correlation with the levels of stress and postnatal depression. This indicated that increasing the social support of postpartum women will promote breastfeeding, infant care, maternal adaptation and self esteem. Rendering social support also aids in buffering their levels of stress and postnatal depression.Three qualitative articles were included in this review. Meta-synthesis of the qualitative findings yielded 17 findings which were grouped into seven categories and then further categorised into one synthesised finding which was, "Motherhood as a period of learning, adjustment, seeking positive social support whilst buffering against stressors'. This synthesised finding suggested that social support offered by family and friends has both positive and negative effects with which the postpartum mothers have to learn to cope.

CONCLUSIONS

Family members such as the partners and grandmothers should be involved in the provision of care towards the postpartum women. The support from peer volunteers may also contribute to the desired health outcomes. Healthcare professionals ought to be equipped with the knowledge on social support so that they can better assess the needs of the postpartum women and develop a support plan.Further research is necessary to better understand the negative effects of social support and to test interventions to buffer them. The effectiveness of the various types of social support interventions should be subject to further testing in future research. Further research may help to identify which support provider is more effective in enhancing a particular health outcome.

The Impact of Having a Baby on the Level and Content of Women's Well-Being

The primary objective of this study was to more fully understand the impact of having a baby on women's well-being by attending to both the level and the content of well-being. To cover the judgemental and affective aspects of well-being we included global measures of life satisfaction and well-being and affective experience measures derived from the day reconstruction method. In a sample of 19 first-time mothers no differences between pre and postnatal reports of general life satisfaction, depression, anxiety, and experienced positive and negative affect were found, suggesting that the arrival of the newborn baby does not universally impact on women's level of well-being. Changes in the content of well-being were studied by examining changes in the way women experience specific activities and interactions with various social partners. There appeared to be an upward shift in experienced positive affect during active leisure and a slight decrease in negative affect during time spent with relatives. The results are discussed in light of previously documented changes across the transition to motherhood in negative mood states, time use, women's evaluation of various aspects of daily life, and relational satisfaction.

Withdrawal from coparenting interactions during early infancy

This study examines early withdrawal in the coparenting system, and the utility of a brief problem-solving discussion about coparenting responsibilities as a means for evaluating such withdrawal. One hundred and fifteen couples were evaluated both prenatally and at 3 months postpartum. During prenatal assessments, parents rated their personalities and completed marital assessments. After the baby arrived, they completed a negotiation task in which they discussed disputes about parenting roles and responsibilities, and interacted together with the baby in a triadic play assessment. Fathers' but not mothers' withdrawal during coparenting negotiations was associated with greater disengagement and less warmth during triadic play and with fathers' feelings that mothers did not respect their parenting. Fathers' but not mothers' withdrawal during coparenting negotiations was also forecast by low ego resilience and by an increase in depressive symptomatology during the postpartum. As the negotiation task appeared to be an effective provocateur of withdrawal when confronting coparenting disagreement, it may prove useful for eliciting this aspect of coparental process in work with couples.

Antenatal moods regarding self, baby, and spouse among women who conceived by in vitro fertilization

OBJECTIVE

To evaluate the antenatal feelings of women who conceived by IVF, with a focus on their moods regarding self, baby, and spouse.

DESIGN

Controlled, prospective study.

SETTING

Outpatient clinics.

PATIENT(S)

Thirty women who conceived by IVF and 30 demographically matched women who conceived naturally.

INTERVENTION(S)

Validated interview and standardized questionnaires.

MAIN OUTCOME MEASURE(S)

Emotionality; positive affect; negative affect; moods regarding self, spouse, and baby; and global anxiety and depression.

RESULT(S)

Compared with controls, the IVF group scored lower on negative affect and higher on measures of (positive) mood regarding self, baby, and spouse. No differences between groups were found on measures of positive affect, depression, or anxiety. Women who had undergone two to three IVF cycles had lower negative affect scores than women who had conceived after the first treatment cycle, and mood regarding spouse depended on whether or not he had been the sole source of the couple's infertility.

CONCLUSION(S)

Women who conceived by IVF experienced more positive moods during pregnancy than did the controls, and lingering effects of the women's history of infertility were still in evidence.

Women's perceptions of partner support and conflict in the development of postpartum depressive symptoms

AIM

This paper reports a study examining the influence of maternal perceptions of conflict and relationship- and postpartum-specific support from the partner on the development of depressive symptoms in the first 8-weeks postpartum.

BACKGROUND

Although the quality of a woman's relationship with her partner has been associated with risk for postpartum depression, few studies have examined which elements of partner-specific support and conflict are determinants of maternal mental health.

METHODS

Self-administered measures of partner support (Social Provisions Checklist, Postpartum Partner Support Scale), partner conflict (Quality of Relationships Inventory), and depression (Edinburgh Postnatal Depression Scale) were mailed postnatally to a population-based sample of 396 mothers between April 2001 to January 2002. Differences in partner support and conflict at 1 and 4-weeks postpartum were examined between those women who met criteria for probable depression (Edinburgh Postnatal Depression Scale > 9) and those who did not meet criteria for probable depression at 8-weeks postpartum.

FINDINGS

Women with depressive symptoms at 8-weeks postpartum had significantly lower perceptions of relationship-specific and postpartum-specific partner support and significantly higher levels of relationship conflict than women with no depressive symptoms. Multiple regression analyses revealed that three variables, perceived social integration, partner encouragement to obtain help when needed, and partner agreed with infant care, significantly explained the variance in Edinburgh Postnatal Depression Scale scores.

CONCLUSIONS

Maternal perceptions of social integration and partner provision of problem-focused informational support and positive feedback are important in determining maternal mental health. Therefore, in the antenatal period healthcare professionals should teach couples appropriate ways to provide feedback and communicate expectations, especially those relating to infant care strategies. The importance of appraisal and emotional support should be highlighted in order to foster maternal feelings of acceptance and being cared for. Partners should also be encouraged to participate actively in household tasks and infant care activities to protect the mother from becoming overwhelmed.