Mothers' and fathers' sense of security in the context of pregnancy, childbirth and the postnatal period: an integrative literature review

Emotional inhibition mediates the relationship between maternal postpartum security and pregnancy distress in China: A cross-sectional study

OBJECTIVE

Pregnancy and childbirth bring not only joy but also a concomitant sense of insecurity, which may adversely affect health, role adaptation, and relationships. This study aimed to explore the risk factors for postpartum mothers' sense of security.

METHODS

This cross-sectional study used questionnaires on Parents' Postnatal Sense of Security, Tilburg Pregnancy Distress Scale, and the Emotional Inhibition Scale. Structural equation modeling was used to calculate the mediating effect.

RESULTS

The mean postnatal maternal security value was 44.77 ± 9.02. Multiple regression analyses revealed that several factors, including companionship of the partner during pregnancy, number of prenatal visits accompanied by the partner, complications during pregnancy, pregnancy distress, and emotional inhibition, independently predicted maternal security. Moreover, our structural equation model revealed that emotional inhibition significantly influenced maternal postpartum security directly (β = -0.30, P < 0.001). In addition, pregnancy distress affected maternal security directly (β = -0.45, P < 0.001) and indirectly (β = -0.129, P < 0.001) through emotional inhibition.

CONCLUSION

This study indicated a lower level of postpartum maternal sense of security. Emotional inhibition partially mediates the relationship between postpartum maternal sense of security and pregnancy distress. Therefore, health care professionals providing guidance to pregnant and postpartum women on proper emotional regulation and early identification of pregnancy distress may be more effective in enhancing their postpartum sense of security.

The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled study

BACKGROUND

The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers' QoL and to investigate the association between their QoL, social support, and selected possible predictive factors.

METHODS

A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations.

RESULTS

Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain.

CONCLUSIONS

Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers' QoL and could be provided and facilitated by public health nurses.

TRIAL REGISTRATION

clinicaltrial.gov NCT04162626.

[Fathers' negative experience of childbirth is associated with an increased risk of paternal postpartum depression]

OBJECTIVES

The aim of this study was to investigate the influence of the childbirth experience by primiparous fathers living in France on their level of postnatal depression, parental self-efficacy, and postnatal sense of security.

METHODS

Two hundred and fifty men answered sociodemographic questions and filled up the Edinburg Postnatal Depression Scale (EPDS), the First-Time Father Questionnaire (FTFQ), the Parent Expectations Survey (PES) and the Parents' Postnatal Sense of Security Instrument (PPSSi).

RESULTS

A negative birth experience was associated with a higher rate of postnatal depressive symptoms (P<.001) and a lower level of postnatal security (P<.001). However, no relationship was found between childbirth experience and sense of parental efficacy (P=0.09).

CONCLUSIONS

Similar to mothers, the way fathers experience the birth of their partner can have consequences for the way they go through the postpartum period. In order to prevent possible depressive affects that may impact the relationship with their child, and to strengthen their sense of security when returning home, it is important to provide fathers with appropriate support throughout the perinatal period.

Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study

BACKGROUND

Promoting patients' sense of security is among the goals of nursing care within heart failure management.

OBJECTIVE

The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure.

METHODS

Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status.

RESULTS

The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status.

CONCLUSIONS

Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.

Couple-based interpersonal psychotherapy for first-time parents: A process evaluation

PURPOSE

First-time parents have an increased risk of depression during the transition to parenthood, which has long-term adverse effect on the infant development. Interpersonal psychotherapy (IPT) has been shown to effectively reduce postnatal depression. The objectives of this study were to explore first-time parents' perceptions of a couple-based IPT program and to identify positive and negative influences on the effectiveness of the intervention through a process evaluation.

DESIGN AND METHODS

A process evaluation was conducted as part of a randomized controlled trial of a couple-based IPT program. A program satisfaction questionnaire was used to assess the participants' satisfaction with the structure, process and outcome of the program. Semi-structured telephone interviews were conducted with a purposive sample of 44 first-time parents who had received the couple-based IPT. The interview data were analyzed by thematic analysis.

RESULTS

The qualitative findings showed that the parents perceived couple-based IPT as useful for enhancing their interpersonal relationship, emotional control and competence in child care. The successful implementation of the couple-based IPT program was influenced by its delivery by midwives, the interactive lessons used to engage the participants, the close fit of the teaching contents to the needs of first-time parents and the flexible program schedule and delivery mode.

CONCLUSIONS

The process evaluation indicates that couple-based IPT is an acceptable and feasible intervention for first-time parents to facilitate a healthy transition to parenthood.

PRACTICE IMPLICATIONS

The couple-based IPT can be used as an adjunct to standard care to promote perinatal health.

Births in freestanding midwifery-led units in Norway: What women view as important aspects of care

OBJECTIVE

To describe what women view as important aspects of care when giving birth in freestanding midwifery-led units in Norway.

METHODS

Data from four open-ended questions in the Babies Born Better survey, Version 1, 2 and 3 was used. We performed inductive content analysis to explore and describe women's experiences with the care they received.

RESULTS

In all, 190 women who had given birth in midwifery-led units in Norway between 2010 and 2020 responded to the B3 survey. The final sample comprised 182 respondents. The analysis yielded three main categories: 1) The immediate birth surroundings, 2) Personal and safe support, and 3) Organisational conditions.

CONCLUSION

This study adds valuable knowledge regarding what women describe as important aspects of care in free-standing midwifery-led units. Women experience maternity services in these units as peaceful, flexible and family-friendly. However, some women perceive the freestanding midwifery-led unit as a vulnerable service, mainly due to lack of midwives on call and uncertainty around temporary closure of the freestanding midwifery-led units. This finding points to the importance of staffing of birth facilities to ensure that all women giving birth have available midwifery care at all times, which is recommended in the National guidelines for care during labour and birth. Predictability around place of birth for the upcoming birth is crucial for every woman and her family. These goals might be achieved by a stable, continuous maternity service in all geographical areas of the country.

Sense of security during COVID-19 isolation improved with better health literacy - A cross-sectional study

OBJECTIVE

To assess sense of security, health literacy, and the association between sense of security and health literacy during COVID-19 self-isolation.

METHODS

In this cross-sectional survey all adults who caught COVID-19 from the onset of the pandemic until June 2020 in Iceland and received surveillance from a special COVID-19 outpatient clinic, were eligible. Participants retrospectively answered the Sense of Security in Care - Patients' Evaluation and the European Health Literacy Survey Questionnaire. Data were analysed with parametric and non-parametric tests.

RESULTS

Participants' (N = 937, 57% female, median age 49 (IQR=23)) sense of security during isolation was Med 5.5 (IQR=1) and 90% had sufficient health literacy. The proposed regression model (R² =.132) indicated that those with sufficient health literacy had, on average, higher sense of security than those with inadequate health literacy.

CONCLUSION

Sense of security was high among individuals who received surveillance from an outpatient clinic during isolation and was associated with health literacy. The high health literacy rate may be an indication of a high COVID-19 specific health literacy rather than general health literacy.

PRACTICE IMPLICATIONS

Healthcare professionals can improve the sense of security of patients through measures to improve their health literacy, including their navigation health literacy, by practising good communication, and providing effective patient education.

Important aspects of intrapartum care described by first-time mothers giving birth in specialised obstetric units in Norway: A qualitative analysis of two questions from the Babies Born Better study

OBJECTIVE

To explore aspects of intrapartum care that were importanrt for primiparous women who had given birth in large obstetric units in Norway.

METHODS

We used data from the Babies Born Better (B3) survey, version 1, which is an international, web-based qualitative survey. We performed a reflexive, thematic analysis of the responses to two questions about descriptions of aspects of positive care and areas of care requiring improvement during the intrapartum period. The responders could give up to three responses to each question and there were no word limits.

RESULTS

In all, 677 first time mothers who gave birth at the five largest specialised obstetric units in Norway during 2014-2015 were included in the study. The thematic analysis of the 2 205 responses resulted in three final themes: 'Communication and positive interactions with the caregivers', 'Autonomy and active involvement in the labour process', and 'Safety, competence and quality of labour care'.

CONCLUSION

For women who give birth for the first time in specialised obstetric units both relational aspect such as communication and respect, and environmental aspects such as facilities, are of importance. First-time mothers might be particularly vulnerable to absence of positive interactions with caregivers because they lack the resources former birthing experience can give. It is essential to give unexperienced birthing women special attention during childbirth because the first birth may influence decisions in following pregnancies.

Experiences of fathers of children with a life-limiting condition: a systematic review and qualitative synthesis

BACKGROUND

Children with a life-limiting condition often require extensive and complex care, much of which is provided by their parents at home. There is a growing body of research that aims to understand the experiences of these parents, but the majority of this research is from mothers' perspectives, meaning that fathers' experiences are not well understood.

OBJECTIVES

To identify and synthesise findings from existing qualitative studies that have explored the experiences of fathers of children with a life-limiting condition.

METHODS

A systematic review of qualitative research was conducted using thematic synthesis. Searches were conducted in MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index.

RESULTS

Findings from 30 studies were included, representing the experiences of 576 fathers of children with a range of diagnoses including cancer, cystic fibrosis, genetic and neurological conditions. Themes detailed fathers' experiences of uncertainty and shock around the time of their child's diagnosis, their accounts of a 'new normal', difficulties in discussing their emotions, forming relationships with and seeking support from professionals and working fathers' role conflicts. They discussed the life-changing nature of their child's diagnosis, an event that affected all aspects of their lives from everyday activities, to their relationships, spirituality, values and ambitions.

CONCLUSIONS

Fathers experience many difficulties in response to their child's diagnosis and ongoing treatment. Findings highlight the need for healthcare professionals to recognise individual family dynamics and the evolving role of the father. Fathers' responses are not widely understood, and research that directly addresses their own well-being is warranted.

First-time parents' experiences related to parental self-efficacy: A scoping review

Becoming a parent for the first time is a major transition, and parental self-efficacy (PSE) is considered an important predictor of parenting functioning. We aimed to describe and synthesize qualitative studies that explore first-time parents' experiences related to PSE in the transition to parenthood in the first-year postpartum. We conducted a scoping review in accordance with international guidelines. The main search strategy consisted of searches in six electronic databases. We selected studies based on predetermined inclusion and exclusion criteria, extracted data, and conducted a descriptive qualitative thematic analysis. We included 58 studies (presented in 61 reports) with 1341 participants from 17 countries. Most of the participants (89%) were mothers, and a third of the studies were task-specific regarding breastfeeding. The thematic analysis of the findings concerning PSE revealed five main, interconnected themes: culture-factors in society and the healthcare services; parents-processes within the parents; tasks-different parental tasks; support-parents' perceived support from professionals, peers, friends, family, and partner; and child-the child's well-being and feedback. This scoping review describes qualitative studies on first-time parents' experiences related to PSE. The findings inform future studies of PSE and clinical practice by confirming the importance of PSE in the transition to parenthood, the complexity of different factors that may have an impact, and the centrality of breastfeeding in PSE. Based on these findings, we suggest that a full systematic review with quality assessment would be appropriate.

Postnatal mental health during the COVID-19 pandemic: Impact on mothers' postnatal sense of security and on mother-to-infant bonding

BACKGROUND

The unprecedented COVID-19 pandemic context imposed new living conditions which greatly modified women's experience of the postpartum period and brought significant changes to postnatal care.

OBJECTIVE

The main objective of this study was to evaluate the impact of the COVID-19 pandemic context on maternal sense of security and on mother-to-child bonding in the postpartum.

DESIGN

This study had a mixed research design. We compared levels of mother-child bonding disturbances and of maternal emotional security amongst two samples of postnatal women recruited before and during the pandemic. Postnatal depression was also evaluated. A qualitative analysis of the participants' comments on the impact of the COVID-19 pandemic was performed with an open-coding approach.

PARTICIPANTS

Two samples of French-speaking mothers in the first six months after their childbirth, recruited before the pandemic (N=874) and during the pandemic (N=721).

FINDINGS

Mother-child bonding disturbances measured with PBQ and levels of emotional security levels evaluated with PPSSi did not differ significantly between the samples. A high prevalence of women at risk of postnatal depression was found in both samples. However, participants' comments on their postnatal experience during the pandemic contrasted with their quantitative data. Fears of contamination, social isolation, and lack of support were the main factors of insecurity. Lack of closeness with relatives and friends, limited presence of the partner in the maternity ward, and early interactions with the newborn with a mask appear to have altered mother-child bonding during this pandemic period.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings highlight the importance of considering social and environmental factors and needs when evaluating postnatal mental health and providing postnatal care to new mothers during a health crisis. Health services and professionals should pay particular attention to mothers' mental health and well-being and guarantee continuity of care to avoid parents' isolation in the sensitive postpartum period.

Learning from a crisis: a qualitative study of the impact on mothers' emotional wellbeing of changes to maternity care during the COVID-19 pandemic in England, using the National Maternity Survey 2020

BACKGROUND

Pregnancy and the postnatal period can be times of psychosocial stress and insecurity, but high quality maternity care and social support can help mothers cope with stress and feel more secure. The COVID-19 pandemic and associated social and economic disruption increased rates of antenatal and postnatal stress, anxiety and depression, and also had profound impacts on the organisation of maternity services in England.

METHODS

This was a qualitative descriptive study of the impact of pandemic-related changes to maternity care on mothers' emotional wellbeing, using inductive thematic analysis of open text responses to the National Maternity Survey (NMS) 2020 in England. A random sample of 16,050 mothers who gave birth 11-24th May 2020 were invited to take part in the survey, and 4,611 responded, with 4,384 answering at least one open text question.

RESULTS

There were three themes: 'Chaos: impact of uncertainty', 'Abandoned: impact of reduction in care', and 'Alone: impact of loss of social support'. Mothers valued maternity care and many experienced additional stress from chaotic changes and reduction in care during the pandemic; from health professionals' own uncertainty and anxiety; and from restrictions on essential social support during pregnancy, labour and birth. Others felt that health professionals had communicated and cared for them well despite the changes and restrictions, and these mothers felt psychologically safe.

CONCLUSIONS

Planning for future crises should include considering how necessary adaptations to care can be implemented and communicated to minimise distress; ensuring that mothers are not deprived of social support at the time when they are at their most vulnerable; and supporting the psychological welfare of staff at a time of enormous pressure. There are also lessons for maternity care in 'normal' times: that care is highly valued, but trust is easily lost; that some mothers come into the maternity system with vulnerabilities that can be ameliorated or intensified by the attitudes of staff; that every effort should be made to welcome a mother's partner or chosen companion into maternity care; and that high quality postnatal care can make a real difference to mothers' wellbeing.

Expectant parents' emotions evoked by pregnancy: A longitudinal dyadic analysis of couples in the Swedish Pregnancy Panel

RATIONALE

Holistic antenatal care requires knowledge of individuals' emotional response to pregnancy. Little is known about how a pregnant woman and her partner influence each other emotionally during a pregnancy.

OBJECTIVE

This study examines six discrete emotions that expectant couples experience during pregnancy, how these emotions change mid-to late-pregnancy, and whether the partners' emotional responses influence each other.

METHODS

A longitudinal dyadic study where pregnant women and their partners (1432 couples) rated the extent to which the pregnancy evoked joy, strength, security, worry, shame, and anger at pregnancy week 12-19, 22-24, and 36. Latent curve models with structured residuals identify levels of and change in these emotions over time, while accounting for between- and within-couple variance.

RESULTS

Pregnancy evoked mainly joy, strength, security, and worry, and lower levels of anger and shame. Pregnant women and partners felt similar levels of joy, strength, and security, but pregnant women felt more worry, shame, and anger. There was little to no mean-level change in all six measured emotions evoked by pregnancy (between-couple change), and no reciprocal effects between the partners (within-couple change).

CONCLUSIONS

Emotions in mid-pregnancy were also felt in late pregnancy. Furthermore, the pregnant woman and her partner have individual emotional trajectories. The results can assist healthcare professionals and researchers target interventions to expectant mothers and partners, specifically by understanding emotional response to pregnancy as a stable confound and by not approaching the couple as one emotional unit.

Women’s experience of the decision-making process for home-based postnatal midwifery care when discharged early from hospital: A Swedish interview study

INTRODUCTION

Women and their families are often excluded from reproductive decision-making processes in postnatal care, and do not know which choices they have. Shared decision-making is a critical but challenging component of maternity care quality. The aim was to explore women’s experience of the decision-making process about early return from hospital with home-based postnatal midwifery care.

METHODS

This is a descriptive qualitative study. In total, 24 women participated in a semi-structured telephone interview, averaging 58 minutes. Data were analyzed using thematic analysis according to Braun and Clarke.

RESULTS

The main theme explored was ‘The supremacy of giving new mothers autonomy to decide on the postnatal care model they would prefer’. Important aspects of the women’s decision-making process were the time-point for receiving information about the home-based midwifery model of care, to receive sufficient time for consideration about the model, to have a rationale for choosing home-based care, and to comprehend the concept.

CONCLUSIONS

Women must be given sufficient time for consideration and necessary information about postnatal care models, which is essential for making an informed decision. Parents’ readiness for discharge must be identified by midwives who need to facilitate shared decision-making by introducing early postnatal care model choices, describe these options, and support women to explore their preferences. Midwives must ensure parents’ participation in decision-making for the time of discharge from hospital.

Developing a woman-centered, inclusive definition of positive childbirth experiences: A discussion paper

INTRODUCTION

A positive childbirth experience promotes women's health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

AIM

To formulate an inclusive woman-centered definition of a positive childbirth experience.

METHODS

A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women's feedback (n = 42).

RESULTS

The following definition was formulated: "A positive childbirth experience refers to a woman's experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman's psychosocial well-being."

CONCLUSIONS

This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.

"I had so many life-changing decisions I had to make without support": a qualitative analysis of women's pregnant and postpartum experiences during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has posed profound challenges for pregnant patients and their families. Studies conducted early in the pandemic found that pregnant individuals reported increased mental health concerns in response to pandemic-related stress. Many obstetric practices changed their healthcare delivery models, further impacting the experiences of pregnant patients. We conducted a survey study to explore the ways in which COVID-19 impacted the lives of pregnant and newly postpartum people.

METHODS

A mixed-methods survey was distributed to all patients ≥18 years old who were pregnant between January 1st, 2020 - April 28, 2021 in a large Midwest health system. Open-ended survey responses were analyzed for common themes using standard qualitative methodology.

RESULTS

Among the 1182 survey respondents, 647 women provided an open-ended response. Of these, 77% were in the postpartum period. The majority of respondents identified as white, were partnered or married, and owned their own home. Respondents reported feeling greater uncertainty, social isolation, as though they had limited social and practical support, and negative mental health effects as a result of the pandemic. Many cited sudden or arbitrary changes to their medical care as a contributing factor. Though in the minority, some respondents also reported benefits from the changes to daily life, including perceived improvements to medical care, better work-life balance, and opportunities for new perspectives.

CONCLUSIONS

This large qualitative dataset provides insight into how healthcare policy and lifestyle changes impacted pregnant and postpartum people. Respondents expressed similar levels of uncertainty and mental health concerns compared to other cohorts but less overall positivity. Our findings suggest greater attention be given to the impact of pandemic-related stress on pregnant and postpartum women. As the pandemic continues, these data identify areas where investment in additional support may have the greatest impact.

Parent's Health Locus of Control and Its Association with Parents and Infants Characteristics: An Observational Study

The Parent Health Locus of Control (PHLOC) investigates the individual’s beliefs about the factors that govern their state of health and that of their children. The direct association between PHLOC and preventive health behaviours compliance has already been demonstrated in the literature. However, it is still unclear how socio-demographic variables affect the PHLOC. We investigated the Parent Health Locus of Control of parents of full-term and preterm infants and evaluated whether there were any correlations between PHLOC and socio-demographic characteristics of both parents and infants. A single-centre transverse observational study was conducted in the Neonatology Operating Unit IRCCS Ca ‘Granda Foundation Ospedale Maggiore Policlinico of Milan. A self-administered questionnaire of the PHLOC scale was distributed to a sample of 370 parents of 320 full-term and 52 preterm infants attending the follow-up service. Parents under the age of 36 and with a higher level of education (bachelor’s degree or above) believe less in the influence of the media on their child’s health. Parents of preterm and first-child infants recognize the greater influence of health care workers, while parents of newborns that have experience complications in their clinical course, believe more in the influence of fate (Chance Health Locus of Control) and God. Younger parents with a higher level of education may be more prone to healthy preventative behaviours. Preterm birth is positively associated with an increased trust in health care professionals. The experience of disease can increase a “Chance Health Locus of Control” and risky behaviours. Assessment of PHLOC helps identify categories of parents prone to risky health behaviours and offer targeted health education interventions.

Midwives’ experiences of an organizational change in early postpartum care services in Norway: A qualitative study

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

Placing myself in a new normalized life: The process of becoming a first-time father. A grounded theory study

Becoming a first-time father is an important transition period in men's lives that is frequently accompanied by joy and happiness. Engaging fathers has a broader impact on family and community and on fathers' own well-being. This study explores the process of men becoming first-time fathers and the experiences and challenges involved. Seventeen interviews with men in different stages of pregnancy, childbirth, and the postpartum period were conducted. Through a grounded theory design, a novel four-stage theoretical model emerged that represents the journey to first-time fatherhood. These stages are beginning the journey, fatherhood in limbo, facing reality, and settling down. Participants suggested that achieving a new normality was the final stage where they finally felt located with a sense of mastery in their journey to fatherhood. The novel theoretical approach of addressing the process of men's transition allowed more complete access to their perspectives. Men's needs are different at every phase of the transition to fatherhood, and the use of these findings can help care providers in caring for every man according to the stage he is facing.

Family life starts at home: Fathers' experiences of a newly implemented Swedish home-based postnatal care model - an interview study

OBJECTIVE

To explore and describe fathers' experiences of a newly implemented Swedish home-based postnatal care model.

DESIGN

A descriptive cross-sectional qualitative study was conducted as a part of a larger study.

SETTING

Families who qualified to be discharged early were offered to participate in a postnatal home-based model of midwifery care by a hospital in Stockholm, Sweden.

PARTICIPANTS AND MEASUREMENTS

In total, 16 fathers participated in a semi-structured telephone interview, averaging 43 min. Data were analyzed using systematic text condensation.

FINDINGS

Three major themes emerged: To decide on home- or hospital-based postnatal care - a matter of safety, To be offered professional midwifery postnatal support at home, and To be at home helped fathers to navigate parenthood. Fathers appreciated the home-based postnatal care and felt safe because of the received professional support from midwives.

KEY CONCLUSIONS

Home-based postnatal care was valued by fathers whose partner had a non-complicated vaginal birth because they felt safe in their home environment and supported by midwives. The home environment aided fathers in supporting their partners and developing a father-infant bond.

IMPLICATIONS FOR PRACTICE

Home-based postnatal care was valued by fathers and should be considered an option for new families. To offer home-based postnatal care may result in less overcrowded postnatal wards. Midwives need to enable fathers' participation and support their parental role regardless of where the care takes place.

Father-child bonding and mental health in gay fathers using cross-border surrogacy during the COVID-19 pandemic

RESEARCH QUESTION

What are the psychological implications of the COVID-19 pandemic for father-child bonding and mental health among Italian gay fathers pursuing surrogacy in the USA or Canada?

DESIGN

Between 20 March and 29 July 2020, this cross-sectional case-control study collected data on father-child bonding quality, depression, anxiety and somatization in 30 Italian gay fathers (n=15 families) who were having or successfully had a child through cross-border surrogacy during the COVID-19 pandemic. These fathers were compared with a sociodemographically similar group of 50 Italian gay fathers (n=25 families) who had children through cross-border surrogacy prior to the pandemic.

RESULTS

Although father-child bonding quality and the mental health symptoms of fathers scored below the clinical cut-off points in both groups, fathers who had or were having a child during the COVID-19 pandemic reported poorer father-child bonding (estimate 3.04, SE 1.47, P=0.044) and more depressive (estimate -1.47, SE 0.49, P=0.005), anxious (estimate -1.96, SE 0.55, P<0.001) and somatic symptoms (estimate -2.48, SE 0.52, P<0.001).

CONCLUSIONS

The findings call for the development of international guidelines for cross-border surrogacy and underline the need for tailored and ongoing psychological and legal support for intended gay fathers to ease their strain and anxiety related to having a child through cross-border surrogacy during the COVID-19 pandemic.

What women emphasise as important aspects of care in childbirth - an online survey

OBJECTIVE

To explore and describe what women who have given birth in Norway emphasise as important aspects of care during childbirth.

DESIGN

The study is based on data from the Babies Born Better online survey, version 2.

SETTING

The maternity care system in Norway.

STUDY POPULATION

Women who gave birth in Norway between 2013 and 2018.

METHOD

Descriptive statistics were used to describe sample characteristics and to compare data from the B3 survey with national data from the Medical Birth Registry of Norway. The open-ended questions were analysed with an inductive thematic analysis.

MAIN OUTCOME MEASURES

Themes developed from two open-ended questions.

RESULTS

The final sample included 8401 women. There were no obvious differences between the sample population and the national population with respect to maternal age, marital status, parity, mode of birth and place of birth, except for the proportion of planned home births. Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Sense of Continuity and Consistency, and Sense of Security. Overarching theme: Coherence in Childbearing.

CONCLUSIONS

Norwegian women across all birth settings emphasise maternity care that authentically focuses on both socio-cultural and psychological aspects of care, and physical and clinical factors. If the positive aspects of care identified in this study are adopted at all levels of the maternity care system and from all care providers, there is a high chance that most women will have a safe outcome, and a strong sense of coherence related to a positive birth and motherhood experience.

TWEETABLE ABSTRACT

Having a baby is a pivotal life changing experience and not just a clinical event, according to a survey of 8400 women in Norway. Positive birth and motherhood experiences depend on maternity staff who are both skilled and kind.

What are the factors affecting parents' postnatal sense of security?

INTRODUCTION

The postpartum period is part of an important process for mothers and fathers. A sense of security is central as it might influence a parent's journey towards becoming a successful parent. The aim was to determine factors affecting parents' postnatal sense of security (PPSS) before postpartum discharge from a hospital in Konya, Turkey.

METHODS

A descriptive study was conducted. From January 2019 to March 2019, a questionnaire was given to a convenience sample of 188 couples discharged from a regional hospital in Turkey. The sense of security was assessed using the PPSS instrument, with low scores defined as those less than the mean.

RESULTS

Low and high sense of security was based on the mean in the population, for mothers 49.36 and for fathers 34.90. It was found that 43.6% of mothers and 69.7 % of fathers had a low score, which was linked to some specific factors in the postpartum period. These were the type of birth, being ready to take responsibility for baby care, being ready to be discharged, being healthy, having any concern about the baby's health, social support presence, having professional support, and presence of a sense of security.

CONCLUSIONS

Many parents, particularly fathers, have a low postnatal sense of security. In the postpartum period, it is very important for midwives, who are always with the family, to identify the risks for a low sense of security during this period and provide effective care. More studies in different settings with larger samples are recommended.

Motherhood: Female Perspectives and Experiences of Being a Parent with ASC

Little is known about the emotional pressures and practical management of daily challenges and, intra and interpersonal demands of raising a child as a parent with a diagnosis of Autistic Spectrum Conditions. The present study utilised a qualitative approach to understand perceptions of females diagnosed on the autistic spectrum of ‘being a parent’. Eight semi-structured interviews were analysed using Interpretative Phenomenological Analysis. Benefits and challenges of being a parent were highlighted alongside population-specific skill and characteristics associated with strength and resilience, love, nurture, routine and sensory considerations. Findings identify the need for population-specific specialist parenting support, provide direction for professionals in clinical settings and expand the paucity of research in this area.

Childbirth experiences of immigrant women in Chile: Trading human rights and autonomy for dignity and good care

BACKGROUND

Childbirth is a transcendent life experience but may also be a moment of great vulnerability, especially when it occurs outside the mother's country of origin.

OBJECTIVE

To explore the perceptions and experiences of Spanish-speaking immigrant women regarding the healthcare they received during labour and childbirth in Santiago, Chile.

METHODS

This qualitative, transcendental phenomenological research was performed at two maternity hospitals using purposive criterion sampling. Eighteen individual and two group interviews were conducted. The resulting information was transcribed and then coded and categorised using phenomenological analysis.

RESULTS

Six categories were extracted from the narratives which reflect a pragmatic relationship with the healthcare team that included a perception of 'justified' lack of care. The mothers' exercise of autonomy was subjugated by power-knowledge relations between the women and caregiver that compelled them to refrain from expressing their needs and preferences out of fear of abuse. The women valued emotional support, pain relief and satisfaction of needs in association with medical procedures and companionship. The women rated their experiences as positive if they avoided mistreatment and, as 'the essence of the experience', perceived the care as a favour rather than a right.

CONCLUSION

Most immigrant women felt that they had received treatment similar to that of native-born mothers. However, low expectations of autonomy shaped their evaluations of the experiences. Also, a high value on companionship and pain relief, characterised the women's experiences of childbirth. These findings of the interviews reflect a need for a stronger focus on empowerment with an emphasis on gender and rights.

The link between parental psychological control, depressive symptoms and epigenetic changes in the glucocorticoid receptor gene (NR3C1)

AIMS

This paper examines the relationship between parental Psychological Control (PC) and depressive symptoms in adolescents and assesses whether this relationship was mediated by DNA methylation, focusing on the glucocorticoid receptor gene (NR3C1), which plays a crucial role in HPA-axis functioning and is linked to environmental stress and depression. This is among the very few studies that looked at the relation between DNA methylation, environmental stress and depression in family trios.

METHODS

The study cohort consisted of 250 families: father, mother and a biologically related adolescent (adolescents (48.9% boys), mean age: 15.14, SD= 1.9; mean age mothers: 45.83, SD= 4.2; mean age fathers: 47.77, SD= 4.7). Depressive symptoms and PC were measured in adolescents and in both parents. DNA methylation levels in NR3C1 were examined in all participants.

RESULTS

Depressive symptoms in adolescents were predicted by PC of both mothers and fathers. Moreover, maternal depressive symptoms were associated with maternal PC, and fathers' depressive symptoms and PC. In fathers, only the level of their self-reported PC was associated with their depressive symptoms. There was no relation between adolescents' DNA methylation and depressive symptoms or the level of parental PC. Yet, there was a significant association between maternal depressive symptoms and maternal epigenetic patterns in NR3C1.

CONCLUSIONS

These findings highlight the need for more research in order to better understand the biological and contextual mechanisms through which parenting and parental emotional well-being is related to the development of psychopathology.

First-Time Fathers' Attitudes Towards, and Experiences With, Parenting Courses in Denmark

Several studies report that men, just like women, go through a complex emotional upheaval when they are about to become parents and that men need support to be able to tackle parenthood in the best way possible. This qualitative study addresses the extent to which parenting courses attended by both the mother and the father constitute an appealing institutional service for first-time fathers and whether they find them useful in tackling the challenges they face during the pregnancy and after the birth. The article explores difficulties with recruiting fathers to such courses and ensuring their continued attendance since men's masculinity dilemmas can affect the extent to which they are willing to seek help and to complete such courses. The findings indicated that fathers' sense of responsibility and awareness of their role as a father in their child's life was strengthened, and overall, they were satisfied both with the topics addressed during the course and with the teaching. Strong networks were formed among some of the parents at the parenting course. Caution is called for when drawing general conclusions about the benefits of such courses for first-time parents, as they are seldom attended by parents with minority ethnic backgrounds or by vulnerable and underprivileged parents.

The Spanish version of the Mothers' Postnatal Sense of Security Scale: Psychometric properties and predictive utility

Postnatal sense of security is a relevant construct related to several variables of motherhood. However, it has not yet been studied in the Spanish context. The aims were: (a) To analyze the psychometric properties of a Spanish version of the Mothers' Postnatal Sense of Security Scale (PPSS-S); (b) analyze the factors related to mothers' sense of security during the first 2 weeks following childbirth (sociodemographic variables and factors related to maternity); and (c) examine the predictive utility that mothers' sense of security has on symptoms of postpartum depression 6-11 months after childbirth. This was a prospective longitudinal study performed in the first 6-11 months post-partum in four regions of Spain. A total of 928 mothers whose mean age was 33.67 years (standard deviation = 4.54) participated. The confirmatory factor analysis showed adequate adjustment to the original structure (χ²  = 17,272.79, df = 153, p < .001; Tucker-Lewis index = 0.98; comparative fit index = 0.98; root mean square error of approximation = 0.058 [0.053-0.063])and the overall internal consistency was 0.89. Direct relationships were shown between women' sense of security and already having had a child, the absence of postpartum health complications (either in the mother or the newborn) and receiving consistent information from healthcare professionals. Our results showed adequate evidence for the reliability and validity of the Spanish version of the PPSS-S. Understanding mothers' sense of security during the early months of motherhood, as well as related factors in the postpartum period, will allow health professionals to implement preventive measures to promote mental health and could help reduce symptoms of postpartum depression.

Factors Related to the Intra-Partner Postnatal Sense of Security in a Spanish Sample

BACKGROUND

The fathers' sense of security and their related factors during the process of parenthood remains largely unexplored. The objectives were to analyse: the psychometric properties of the Spanish version of the Parent's Postnatal Sense of Security scale used for fathers, and the factors related to fathers' sense of security during the postpartum period.

METHODS

A total of 583 fathers participated. The fathers' version of the questionnaire was adapted for Spanish speakers. The psychometric properties of the instrument and its relationship with the mother's sense of security were considered.

FINDINGS

The results showed that the data fit well with the original model (TLI = 0.98, CFI = 0.98, and RMSEA = 0.05). The fathers' sense of security was associated with previously having become a father (t = -2.39, p = .02), the level of state anxiety (r = -0.34; p < .01) and trait anxiety (r = -0.24; p < .01), as well as the sense of security of their partners (r = 0.55, p < .001). In the regression analysis, the mothers' sense of security construct provided the greatest explanation of the model.

DISCUSSION

The results of this study highlight the importance of considering the family unit in pre-, intra-, and postnatal education in order to increase the sense of security of both parents and reduce their anxiety levels.

APPLICATION TO PRACTICE

This study provides Spanish healthcare professionals with access to a scale for assessing fathers' sense of security in the immediate postpartum period and allows them to identify needs in the process of becoming parents, emphasising the inclusion of both parents in any intervention.

Teaching Father-Infant Massage during Postpartum Hospitalization: A Randomized Crossover Trial

PURPOSE

The purpose of this study was to evaluate acceptability and impact of infant massage video instruction on fathers' behaviors in early postpartum.

METHODS

A randomized crossover design was used. Participants were fathers of healthy term infants born at a Magnet hospital in Southern California. Measures included a demographic survey, Father-to-Infant Bonding Scale, Father-Infant Observation Scale, and postdischarge phone interview. Study nurses observed father-infant interactions for 5 minutes. Fathers were randomized to one of two groups: fathers in group 1 saw the massage video before they were observed with their infants and fathers in group 2 saw the video after. Fathers completed the Bonding Scale at baseline in person and again within a week of discharge by phone. Statistics were descriptive and comparative. Responses to interview questions were categorized and described.

RESULTS

Ninety-eight fathers aged 18 to 44 years participated. Over half of fathers identified as Hispanic and the majority spoke English at home. Most fathers had positive responses to infants on individual Bonding Scale items. Fathers differed significantly in observed interactions with infants depending upon timing of massage instruction; fathers observed immediately after the video had more total interactions, specifically fingertip touching. Poststudy evaluations were predominantly positive.

CLINICAL IMPLICATIONS

We found a brief infant massage instruction offered by video was well accepted by fathers and increased observed father-infant interactions.