Relationship between maternal antenatal attachment and traumatic childbirth perception among pregnant women

OBJECTIVE

To examine the relationship between the perception of traumatic birth and maternal attachment in pregnant women.

METHODS

This descriptive and correlational study recruited 370 pregnant women who applied for an antenatal visit to outpatient clinics of a state hospital. The data were collected using a Personal Information Form, Maternal Antenatal Attachment Scale (MAAS), and Traumatic Birth Perception Scale (TBPS). Data were collected using the face-to-face method. The study was reported according to the STROBE.

RESULTS

The mean total score of MAAS was 75.71 ± 7.72 and the mean TBPS score was 73.21 ± 28.34. Normal birth pain was perceived as "severe" by 38.3% of pregnant women and as "very severe" by 46.1%. It was determined that 29.2% of pregnant women had a "high" level of traumatic birth perception and 14.5% had a "very high" level. A negative correlation was found between the mean scores of MAAS and TBPS of pregnant women. The trimester of pregnancy, listening to the birth story, planned pregnancy, and traumatic birth perception, was a significant predictor of maternal antenatal attachment.

CONCLUSION

As the maternal antenatal attachment levels of pregnant women increased, their perceptions of traumatic birth decreased.

The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial

Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.

Effects of intermittent kangaroo care on maternal attachment, postpartum depression of mothers with preterm infants

PURPOSE

To reveal the effect of intermittent kangaroo care on maternal attachment, postpartum depression of mothers with preterm infants.

METHODS

The study was conducted as a single centre randomised controlled study with sixty mothers whose newborns were hospitalised in the NICU due to prematurity. The data were collected by the questionnaire form, Edinburgh Postnatal Depression Scale (EPDS) and the Maternal Attachment Inventory (MAI). 'Intermittent kangaroo care' was applied for 30 minutes once a day for 10 days to the experimental group. Women were completed the EPDS and the MAI in postpartum 30-40th days.

RESULTS

The median of the total score of EPDS in the experimental group was 7, and in the control group was 9 (p > 0.05). The median of the total score of MAI in the experimental group was 99, and in the control group was 97 (p <0.05) and it was determined that the effect size of the difference between the groups was medium (1-β: 0.65, Cohen's d: 0.532).

CONCLUSION

It was determined that mothers who received intermittent kangaroo care had higher scores that can be interpreted as higher maternal attachment than others and the postpartum depression scores did not differ between experimental and control group.

Differential effects of maternal- and paternal-adolescent attachments on friendship security and intimacy

The present study examined the differential contributions of adolescent-reported maternal and paternal attachment anxiety and avoidance on friendship security and intimacy. Participants were 776 Canadian adolescents between the ages of 13 and 19 years (M = 15.18, SD = 1.58) who provided ratings of their perceived attachment avoidance and anxiety towards their mothers and fathers and responded to measures of friendship security and intimacy. Findings showed that maternal and paternal attachment avoidance and not anxiety negatively predicted friendship security. Moreover, maternal attachment avoidance was negatively associated with friendship intimacy. Multigroup analyses showed that security was negatively predicted by maternal anxious attachment for junior high school boys and girls. Additionally, paternal avoidant attachment was negatively associated with friendship intimacy for junior high school boys and girls. These findings highlight the unique effects associated with maternal and paternal attachment on specific friendship features and underscore the importance of the role of fathers in adolescence.

[How oxytocin became overtime the attachment-mediating hormone]

Oxytocin is a pleiotropic molecule which, in addition to its facilitating action during parturition and milk ejection, is involved in social and prosocial behaviors such as attachment. This article presents, after a brief historical review, the action of oxytocin during the milk ejection reflex. Oxytocin is indeed essential for this vital function in mammals. It is both a neurohormone released into the bloodstream by the axon terminals of the posterior pituitary and a neuromodulator released in the hypothalamus by the soma and dendrites of oxytocinergic magnocellular neurons. In addition, oxytocin is also released by the axon terminals of parvocellular neurons and axon collaterals of magnocellular neurons in the brain. Both maternal attachment in rats and ewes and attachment between sexual partners in the prairie vole, one of the few monogamous rodent species, are mediated by central oxytocin. However, neither administering oxytocin into the brain nor increasing expression of the oxytocin receptor in the nucleus accumbens using a gene transfer technique converts polygamous voles to monogamous ones. Unfortunately, translation of animal data to human remains problematic due to still unsolved difficulties in modifying the level of oxytocin in the brain.

Mother-child interactions among children with visual impairment: Addressing maternal attachment style, depression-anxiety symptoms, and child's behavioral problems

OBJECTIVE

The birth of a visually impaired child leads to stress, disappointment, and medical challenges for the family due to the economic and financial costs, unmet expectations of other family members, and social embarrassment-isolation of the family from society. In these families, mothers are exposed to the stressors more often than other family members, because, in most families, they are the primary caregivers. In this study, we examined the relationship between maternal attachment styles, maternal depression and anxiety levels, and behavioral problems of children with visual impairment.

METHODS

This is a case-control study. In the study group, there were 35 children with visual impairment, and in the control group, there were 31 healthy children. All mothers completed adult attachment style dimensions scales, beck depression, and anxiety inventories, and the aberrant behaviour checklist.

RESULTS

Our results demonstrated that children with visual impairment have higher levels of behavior problems including irritability, stereotypic behavior, and inappropriate speech when compared with healthy controls. Contrary to our expectations depression and anxiety, scores of mothers were similar, also, there was not a difference in terms of maternal attachment types. Interestingly, there was a positive relationship between secure attachment and depression among mothers of the visual impairment group. In other words, securely attached mothers were more depressive. On the other hand, there was a positive relationship between anxious/ambivalent attachment and the child's irritability.

CONCLUSION

The relationship between maternal depression and secure attachment could be a consequence of higher maternal sensitivity due to a child's impairment and should be evaluated in future studies.

Responses to Infantile Cuteness Explain the Link between Autistic Traits and Reduced Maternal Attachment

This study examined the link between autistic traits and mother-to-child attachment by introducing two mediators: emotional responsiveness to the infantile cuteness of children and negative parental self-concept. We screened 1,317 mothers and recruited those who have a child with high or low autistic traits based on their Autism Spectrum Quotient score. Fifty mothers in the high autistic and 71 mothers in the low autistic groups participated. Results showed that the autistic traits of children are related to weak maternal attachment. Reduced emotional responses to cuteness and negative self-concept mediated the link. These findings suggest that supporting mothers who have a child with autism spectrum disorder may benefit securing mother-to-child attachment as well as the wellbeing of both mother and child.

Relationship of premenstrual syndrome with postpartum depression and mother-infant bonding

PURPOSE

This study was conducted to investigate the relationship between pre-pregnancy premenstrual syndrome (PMS) history with postpartum depression and mother-infant bonding.

DESIGN AND METHODS

The sample of this descriptive and cross-sectional study included 322 mothers. Data were collected using the Premenstrual Syndrome Scale (PMSS), Edinburgh Postnatal Depression Scale (EPDS), and Brockington Postpartum Bonding Questionnaire (BPBQ).

FINDINGS

There were positive statistically significant correlations between PMSS total and subscale scores and EPDS scores and BPBQ. In addition, there were statistically significant positive correlations between EPDS score scores and BPBQ.

IMPLICATIONS FOR NURSING PRACTICE

Especially by achieving success in PMS management in the pre-pregnancy period, the risk of postpartum depression development can be prevented, and healthy development of mother-infant bonding can be achieved.

Effect of Postpartum Yoga on Breastfeeding Self-Efficacy and Maternal Attachment in Primiparous Mothers

Objective: This study was conducted to determine the effect of yoga practice on the breastfeeding self-efficacy and maternal attachment of primiparous mothers in the postpartum period. Methods: This study was performed in a quasi-experimental model with pretest and posttest control groups. The domain of the study was formed with women with 20-40-day-old babies enrolled in two Family Health Centers. One hundred and twenty-four women participated in the study. The Individual Identification Form, Breastfeeding Self-Efficacy Scale, and Maternal Attachment Scale were completed by the experimental and control groups. The experimental group engaged in 60 minutes of postpartum yoga practice 2 days a week for 8 weeks in the company of the researcher. Results: After yoga practice, there was a statistically significant increase in the breastfeeding self-efficacy and improvement in the maternal attachment of the experimental group (p < 0.05). The corresponding increase and improvement of the mothers in the control group were less than those of the mothers in the experimental group (p < 0.05). Conclusion: This study finds that it is beneficial for both the mother's and the baby's physical and psychological health for health professionals to teach mothers to practice yoga, which positively affects breastfeeding and maternal attachment in the postpartum period.

Maternal Attachment Representations during Pregnancy, Perinatal Maternal Depression, and Parenting Stress: Relations to Child's Attachment

BACKGROUND

This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child's attachment at 15 months after childbirth.

METHODS

Mothers (n = 71), and their infants participated in a longitudinal study of maternal attachment, pre and postnatal depression, parenting stress and child attachment. Adult Attachment Interview (AAI) was conducted between 24 and 26 weeks of pregnancy (Time 1), depression was assessed using the Edinburgh Perinatal Depression Scale (EPDS) (at Time 1 and 6 months after childbirth, i.e., Time 2), parenting stress was assessed using the Parenting Stress Index-Short Form (PS-SF) (at Time 2) and the Strange Situation Procedure (SSP) at child's 15 months of age (Time 3).

RESULTS

Free-autonomous maternal classification of attachment increases the likelihood of secure child classification in her offspring, while decreases that of avoidance and ambivalence. Insecure maternal representation of attachment evaluated during pregnancy and higher levels of parenting stress at six months after childbirth was associated with higher rates of infant insecure attachment at 15 months.

CONCLUSIONS

Our study validates the importance of considering maternal representations of attachment crucial in determining the quality of the caregiving environment, thereby the healthy development of children, despite the presence of other contextual risk.

[Enhancing Maternal-Infant Attachment in a Neonatal Intensive Care Unit During the Pandemic Prevention Period]

BACKGROUND & PROBLEMS

Parent-infant attachment is affected by parent-infant interaction. The limitations on related visitations during the COVID-19 pandemic suspended the opportunity to engage in kangaroo care (skin-to-skin contact) activities. These changes impacted parent-infant attachment in the neonatal intensive care unit. After investigation, the score of premature infant-parent attachment was found to be only 64.6 points during the period in which visitation limitations were in effect.

PURPOSE

To enhance maternal-premature infant attachment during the pandemic period by 10% (from an average score of 64.6 to 71.1).

RESOLUTION

This project involved nurses playing audio files provided by mothers to their premature infants, and recording a video and taking pictures of the infants during this process. This project used a cloud platform as bidirectional pipelines. Furthermore, emotional support and caring information were provided to the mothers via expressive arts therapy and phone interviews.

RESULTS

After the intervention, the premature infant-parent attachment score rose to 74.4 from the pre-intervention score of 64.6.

CONCLUSIONS

During pandemic control periods, traditional modes of care aimed at building infant-parent attachment are not applicable. The intervention project used was found to be an effective alternative approach to increasing maternal-premature infant attachment. Breaking the restrictions of time and place, this project applies family-centered care, and may provide a reference for developing software, hardware, and communication equipment for other care units related to newborns.

The relationship between maternal function and maternal attachment of women during the postpartum period

OBJECTIVE

The objective of this study was to investigate the relationship between maternal functions including self-care and adjustment and maternal attachment during the postpartum period.

BACKGROUND

Mothers adapt to their new role during the postpartum period by recognising both their baby and their physical, emotional, and social recovery. During this period, a mother's interaction with her baby supports attachment.

METHOD

The study design was planned as a descriptive-relational type. The study was performed in two Family Healthcare Centres located in Antalya city, Turkey country. The population of the study consisted of 250 mothers aged 18-45 years who had a postpartum period between 8 and 11 weeks. A simple sampling method was used. Data were collected using the mothers' identification forms, the Barkin Index of Maternal Function, and the Maternal Attachment Inventory. The forms were administered to mothers via the face-to-face interview method. Numerical, percental, and relational statistical methods as well as arithmetic means were used in the data analysis.

RESULTS

The mean score of the Barkin Index of the Maternal Function was 76.97 ± 10.19 and the mean score of the Maternal Attachment Inventory was 100.92 ± 3.17. There was a positive, low, and significant relationship between maternal function and maternal attachment (r = 0.22, p = 0.00). There was a positive, low, and significant relationship between maternal attachment and self-care, maternal psychology, infant care, social support, and maternal adjustment scores.

CONCLUSION

The maternal attachment level was found to be high in women with high maternal function. To develop the relationship between functional status and maternal attachment, mothers may provided with social support and, if necessary, psychological support.

Infant temperament as a predictor of maternal attachment: A Jordanian study

AIM

To investigate the relationship between maternal bonding and infant temperament during the first year of infant's life. Moreover, it also wanted to explore which perinatal factors could influence the quality of maternal attachment.

METHOD

A cross-sectional study design was used to collect data from a sample of 277 mothers during the period of May-October 2018. The participants were asked to complete a three-part survey that was developed to collect data on maternal attachment and infant temperament. Data was collected between March 2019-June 2019.

RESULTS

The analysis of the data revealed that there was a significant relationship between infant temperament and maternal attachment [F(2, 95) = 6.783, p-value = .001]. It also revealed that the factors that most influenced maternal attachment were infant temperament and planned pregnancy, which together explained 54% of the variance in maternal attachment (R2   =  7.5).

CONCLUSION

Maternal attachment in Jordanian mothers can be explained by two significant factors: infant temperament and planning for pregnancy.

Predictors of maternal attachment among breastfeeding mothers in Jordan

Aim

This study aims to investigate the difference in maternal attachment in different scenarios, that is among mothers who breastfed their infants and mothers who combined breastfeeding with other types of feeding and determine the predictors of maternal attachment in breastfeeding mothers.

Design

A survey was used to collect data from 222 mothers from Jordan University of Science and Technology in Jordan.

Method

Who used breastfeeding or mixed methods and had healthy infants aged from 3 to 12 months and who did not have postpartum complications. The survey was conducted in three healthcare centres in Irbid city, Jordan.

Results

Mothers only breastfeed their infants did not differ in their attachment compared with those who used mixed feeding methods (using breastfeeding with formula feeding). Many factors showed significant impact on maternal attachment, which includes the mother's education, if they have assistance in caring for their infant, marital relationship quality, the infant's gender and the planning for pregnancy.

Single-unit vs multiple-unit transfusion in hemodynamically stable postpartum anemia: a pragmatic randomized controlled trial

BACKGROUND

The American Academy of Blood Banks recommends single-unit red cell transfusion protocols across medicine to reduce transfusion complications and the use of a scarce resource. There are minimal data regarding single-unit protocols in obstetrics.

OBJECTIVE

We aimed to compare single-unit vs multiple-unit transfusion protocols for treatment of hemodynamically stable postpartum anemia.

STUDY DESIGN

We performed a randomized trial comparing initial transfusion with 1 unit of packed red blood cells (single-unit protocol) to 2 units of packed red blood cells (multiple-unit protocol) from March 2018 to July 2019. Women who required transfusion >6 hours postpartum were approached for consent. Unstable vital signs, hemoglobin level <5 g/dL, hemoglobinopathy, and cardiomyopathy were exclusion criteria for enrollment. Hemoglobin assessment and standardized clinical evaluation were performed 4 to 6 hours posttransfusion; additional packed red blood cells were given if indicated. The primary outcome was total units transfused. Secondary outcomes included length of stay, endometritis, wound separation or infection, venous thromboembolism, and intensive care unit admission within 30 days postpartum. Breastfeeding, depression, maternal attachment, and fatigue scores were assessed at 4 to 9 weeks postpartum. A total of 66 women were required to detect a 20% reduction in units transfused with a single-unit protocol (power=80%; α=0.05).

RESULTS

A total of 66 women were randomized (33 per arm). There were no differences between groups in demographic or clinical characteristics, including delivery mode, blood loss, and randomization hemoglobin levels. The mean number of units transfused was lower in the single-unit protocol than in the multiple-unit protocol (1.2 U vs 2.1 U; P<.001). Only 18.2% of women in the single-unit arm required additional packed red blood cells. At posttransfusion assessment, women in the single-unit arm had lower hemoglobin levels (7.8 g/dL vs 8.7 g/dL; P<.001), but there were no differences in vital signs or symptoms between groups. There were also no differences in length of stay, 30-day complications, or 4 to 9 week postpartum outcomes.

CONCLUSION

In women with hemodynamically stable postpartum anemia, a single-unit protocol avoided a second unit of packed red blood cells in >80% of women without significant impact on morbidity. Our work supports the use of single-unit initial transfusion in this population.

Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.

The effect of kangaroo care on maternal attachment in preterm infants

Aim

The study was conducted to determine the effect of kangaroo care on maternal attachment in preterm infants in Turkish mothers.

Subjects and Methods

The study was conducted a quasi-experimental research design between October 2015 and February 2016 in the neonatal intensive care units (NICU) of two state hospitals located in the east and west of Turkey. The study population consisted of preterm infants hospitalized in the NICU at the time of the research and met the study-group selection criteria. The study population was divided into two groups as an experimental and control group. Kangaroo care (n = 30) was provided to the infants in the experimental group by their mothers. No intervention was applied to the infants in the control group (n = 30) other than the routine practice. Data were collected by the researcher using the 'Introductory Information Form' and the 'Maternal Attachment Inventory'. Data analysis was performed with SPSS (Statistical Package for Social Sciences) 18 software package. The data were analyzed using percentile distributions, mean, standard deviation, t-test, and Chi-square test. Official permissions and ethical approval were obtained to conduct the study.

Results

It was determined that the experimental and control group included in the study were similar in terms of the characteristics of the baby and the mother (P> 0.05). In the study, the mean maternal attachment scale score (MAS) of the group in which the kangaroo care was provided was higher than the control group with a statistically significant difference between the groups (P < 0.05).

Conclusion

As a result of the study, it was concluded that kangaroo care positively affects maternal attachment and it is suggested that further studies should be conducted to evaluate the effect of kangaroo care on mother-infant attachment in Turkey.

Does maternal attachment to her infant mediate the link between perceptions of infant crying at 6 months and parenting stress at 24 months? A structural equation modelling approach

BACKGROUND

Parenting stress is influenced by many factors including maternal attachment and excessive infant crying, yet the nature of these relationships is not well understood. For example, excessive infant crying despite maternal soothing may impact maternal attachment to the child, leading to higher stress. This paper explored whether maternal perception of excessive infant crying at 6 months was associated with higher maternal parenting stress at 24 months, and whether maternal attachment mediated this relationship.

METHODS

All families, present at 24 months in a randomized controlled trial of a 5-year early intervention programme targeting school readiness skills in disadvantaged area of Ireland, were included. At 6 months, infant crying was assessed using a maternal reported measure of duration of infant crying, and maternal attachment to the infant was assessed using the Condon Maternal Attachment Scale. Parenting stress was assessed at 24 months using the childrearing stress subscale from the Parenting Stress Index. Structural equation modelling was used to explore the direct and indirect effects of maternal perceptions of excessive infant crying on parenting stress, controlling for infant, maternal, and environmental characteristics, and focusing on the mediating role of maternal attachment.

RESULTS

Reporting excessive infant crying at 6 months was associated with lower maternal attachment at 6 months, which led to higher parenting stress at 24 months. In addition, vulnerable adult attachment style, previous maternal mental health difficulties, low paternal education, paternal involvement with the child, and not being married were associated with higher parenting stress.

CONCLUSION

Findings suggest that the association between maternal perceptions of excessive crying at 6 months and later parenting stress may be mediated through maternal attachment to the infant. Interventions based on improving maternal attachment could be investigated to determine the effectiveness of supporting mothers with low attachment.

Systematic Review of Skin-to-Skin Care for Full-Term, Healthy Newborns

OBJECTIVE

To determine the effect of skin-to-skin mother-infant holding, touch, and/or massage on full-term, healthy newborns and their primary caregivers.

DATA SOURCES

A seven-member scientific advisory panel searched the databases PubMed, CINAHL, and Scopus using the search terms massage, skin-to-skin contact, kangaroo care, touch, therapeutic touch, and full-term newborns for research with human participants published in English with no date parameters.

STUDY SELECTION

The initial search yielded 416 articles. After reviewing titles and retaining only articles that met the review criteria, 280 articles remained. The panel co-chairs reviewed and discussed the abstracts of these articles and retained 90 for review.

DATA EXTRACTION

Each article was assigned to one panel member and one co-chair for review. Members of the panel met via teleconference to present articles and to determine whether they had scientific merit and addressed the research question. Articles that did not meet these standards were eliminated. Forty articles included relevant evidence: 33 articles on skin-to-skin holding and 7 on infant massage.

DATA SYNTHESIS

We created a table that included the purpose, design, and findings of each study. This information was synthesized into a feasibility report by the co-chairs.

CONCLUSION

Evidence supports recommendations for skin-to-skin care for all full-term, healthy newborns. Although there is inadequate evidence to recommend massage as standard care for all newborns, massage has been shown to help consolidate sleep patterns and reduce jaundice.

Reflective functioning, maternal attachment, mind-mindedness, and emotional availability in adolescent and adult mothers at infant 3 months

The study evaluated reflective functioning (RF), maternal attachment, mind-mindedness, and emotional availability among 44 adolescent mother-infant dyads and 41 adult mother-infant dyads. At infant age 3 months, mother-infant interaction was coded with the mind-mindedness coding system and Emotional Availability Scales; mother attachment and RF were evaluated with the Adult Attachment Interview (AAI). Adolescent mothers (vs. adult mothers) were more insecure and had lower RF; they were also less sensitive, more intrusive and hostile, and less structuring of their infant's activity; they used fewer attuned mind-related comments and fewer mind-related comments appropriate to infant development. In adult mothers, the Mother Idealizing and Lack of Memory AAI scales were correlated to non-attuned mind-related comments and the Father Anger scale to negative mind-related comments. In adult mothers, RF was associated with sensitivity. This was not the case with adolescent mothers. In both groups of mothers, there were no associations between sensitivity and mind-mindedness.

Stress and Posttraumatic Stress in Mothers of Children With Type 1 Diabetes

The onset of acute and chronic illness in children frequently triggers episodes of stress and posttraumatic stress symptoms (PTSS) in mothers. Mothers of children with type 1 diabetes (T1D) consistently report high levels of stress and PTSS. The purpose of this integrative review was to review and synthesize the published empirical research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this integrative literature review. A total of 19 studies were identified from a sample of 128. Stress and PTSS were prevalent in mothers of youth with T1D. While PTSS was most severe at disease onset, symptoms often persisted 1 to 5 years after diagnosis. The diagnosis of T1D in a child was traumatic for mothers. Stress and PTSS in mothers adversely affected children's health. Management of stress symptoms in mothers may lead to improved behavioral and metabolic outcomes in children.

Does the visibility of a congenital anomaly affect maternal-infant attachment levels?

PURPOSE

To determine whether congenital anomaly visibility affects maternal-infant attachment levels.

DESIGN AND METHODS

The study population consisted of mothers who had infants with cleft lip/palate or congenital heart anomalies who were receiving treatment in a university hospital. The data were collected using the Structured Questionnaire Form and the Maternal Attachment Inventory.

RESULTS

Statistically significant differences in maternal-infant attachment levels were observed between infants with cleft lips/palates and healthy infants and between infants with congenital heart anomalies and healthy infants.

PRACTICE IMPLICATIONS

It is important to apply appropriate nursing interventions for these mothers during the postpartum period.

Effectiveness of an Attachment-Based Intervention Program in Promoting Emotion Regulation and Attachment in Adolescent Mothers and their Infants: A Pilot Study

This pilot study examined the effectiveness of an attachment-based intervention program, PRERAYMI, based on video technique, psychological counseling and developmental guidance in improving the style of interaction and emotion regulation of adolescent mothers and their infants after 3 and 6 months of intervention. Analyses revealed that adolescent mothers who participated in the intervention (vs. control group adolescent mothers) increased their Sensitivity and reduced their Controlling style after both 3 and 6 months of treatment. Infants who participated in the intervention (vs. control group infants) increased their Cooperative style and reduced their Passive style from 3 to 9 months. Moreover, the intervention group dyads (vs. control group dyads) increased the amount of time spent in affective positive coordination states (matches), decreased the amount of time spent in affective mismatches, and had a greater ability to repair mismatches from 3 to 9 months. Furthermore, the intervention group dyads (vs. control group dyads) increased the amount of time spent in reciprocal involvement in play with objects from 3 to 9 months. The quality of maternal attachment did not affect the intervention effect.

Maternal attachment and mind-mindedness: the role of emotional specificity

We explored the relation between maternal mind-mindedness (i.e., a mother's tendency to verbally refer to her infant's mental world through use of infant-directed mental state terms) and maternal attachment. Mothers (N = 76), classified prenatally as Autonomous, Dismissing, Preoccupied, and Unresolved using the Adult Attachment Interview (AAI), simulated speaking to their 6-month-old infants in positive and negative emotion contexts. Mothers' utterances were coded for frequency of use of emotion and cognition-related mind-minded terms. Results indicated a significant negative relation between coherence of mind scores on the AAI and emotion mind-mindedness in the positive emotion context. When differences between insecure attachment categories and mind-mindedness were explored, results indicated that mothers with Preoccupied attachments were significantly more likely to use emotion-related terms than mothers with Dismissing attachments and that these differences were most pronounced in the negative emotion context. A similar pattern was found for mothers with Unresolved attachments compared to those with organized (Autonomous, Dismissing, Preoccupied) attachment classifications, however use of emotion mind-minded terms did not differ by emotional context. Future research directions highlighting the importance of exploring the unique contribution of Preoccupied, Dismissing and Unresolved attachment and emotional context in the exploration of mind-mindedness are discussed.

Pregnant mothers' perceptions of how intimate partner violence affects their unborn children

OBJECTIVE

To explore the perceptions of pregnant women on the experience of intimate partner violence (IPV) as it affects maternal and fetal health.

DESIGN

Secondary qualitative content analysis.

SETTING

Individual interviews conducted within three urban obstetric and gynecologic clinics.

PARTICIPANTS

Our sample included a subset of eight pregnant women experiencing IPV during the current pregnancy. Participants were selected from a larger parent study that included qualitative data from 13 women.

METHODS

We analyzed in-depth individual interview transcripts in which participants discussed how they perceived IPV to affect their health as well as the health of their unborn children. Constant comparative techniques and conventional content analysis methodology were used in analysis.

RESULTS

Three themes emerged to illustrate mothers' perceptions of how IPV influenced maternal and fetal outcomes: protection, fetal awareness, and fetal well-being.

CONCLUSIONS

This analysis provides important insights into concerns that pregnant women experiencing IPV shared about maternal attachment and fetal well-being. Health care providers can use these findings to better assess the physical and psychological concerns of pregnant women experiencing IPV. Further research is needed to better understand how IPV contributes to adverse neonatal outcomes, particularly from a biological perspective.

Validity and reliability of the Turkish version of the Maternal Antenatal Attachment Scale

AIM

The objective of this study was to translate the Maternal Antenatal Attachment Scale (MAAS) into Turkish, to adapt it to Turkish cultural conditions, and to determine its validity and reliability.

METHODS

This study was conducted in a state hospital in the Central Anatolia Region, Sivas, Turkey. A total of 190 pregnant women were included in the study. Data was collected by MAAS. The validity of language, content, and construct were examined to evaluate the validity of the MAAS. Cronbach's alpha was used to assess internal consistency reliability.

RESULTS

The consistency of specialist opinion on the scale, translated into Turkish and back-translated, was determined (Kendall W = 0.11; P > 0.05). The factor loadings resulting from the factor analysis directed at the construct validity of the scale were in the 0.33-0.71 range, and the items were grouped under two factors. Cronbach's alpha reliability coefficient overall for the entire scale was 0.79; it was calculated as being 0.76 for the first sub-dimension (11 items) and 0.65 for the second sub-dimension (eight items).

CONCLUSION

The Turkish version of the MAAS is a valid and reliable tool for the evaluation of the maternal-fetal attachment level in the antenatal period.

Adolescent opiate exposure in the female rat induces subtle alterations in maternal care and transgenerational effects on play behavior

The non-medical use of prescription opiates, such as Vicodin(®) and MSContin(®), has increased dramatically over the past decade. Of particular concern is the rising popularity of these drugs in adolescent female populations. Use during this critical developmental period could have significant long-term consequences for both the female user as well as potential effects on her future offspring. To address this issue, we have begun modeling adolescent opiate exposure in female rats and have observed significant transgenerational effects despite the fact that all drugs are withdrawn several weeks prior to pregnancy. The purpose of the current set of studies was to determine whether adolescent morphine exposure modifies postpartum care. In addition, we also examined juvenile play behavior in both male and female offspring. The choice of the social play paradigm was based on previous findings demonstrating effects of both postpartum care and opioid activity on play behavior. The findings revealed subtle modifications in the maternal behavior of adolescent morphine-exposed females, primarily related to the amount of time females' spend nursing and in non-nursing contact with their young. In addition, male offspring of adolescent morphine-exposed mothers (MOR-F1) demonstrate decreased rough and tumble play behaviors, with no significant differences in general social behaviors (i.e., social grooming and social exploration). Moreover, there was a tendency toward increased rough and tumble play in MOR-F1 females, demonstrating the sex-specific nature of these effects. Given the importance of the postpartum environment on neurodevelopment, it is possible that modifications in maternal-offspring interactions, related to a history of adolescent opiate exposure, plays a role in the observed transgenerational effects. Overall, these studies indicate that the long-term consequences of adolescent opiate exposure can impact both the female and her future offspring.

The journey of becoming a mother

Nature intends that the physical and hormonal changes of pregnancy insure the growth and development not just of the baby but of the mother. The physical and emotional changes of pregnancy and, then, labor, birth, and breastfeeding play vital roles in guiding women on the journey of becoming a mother. Standard prenatal care and medicalized labor and birth interfere in powerful ways with nature's plan and, consequently, women's ability to negotiate this journey. In this column, these issues are explored, and implications for childbirth education are discussed.

A Comparison of Maternal Attachment between American Adolescent and Adult Mothers of Preschoolers

American adolescent mothers have been viewed as less effective parents than adult mothers. The socioeconomic disadvantages of adolescent mothers should be taken into account. The objectives of this study were to compare maternal attachment between adolescent and adult mothers of preschoolers and to examine changes of adolescents' maternal attachment over time. A secondary analysis of data from a larger study of maternal employment and low birth weight infant outcomes were used. Data were collected through home visits using structured questionnaires at two different time points. Forty-three pairs of adolescent and adult mothers who could be matched on family structure, maternal race, and child's gestational status were compared on maternal attachment. The 7-item Attachment subscale of the Parenting Stress Index was used to measure maternal attachment. Results revealed that the adolescent mothers were not less attached to their preschoolers than the adults. This held true when important confounding factors were taken into account using multiple regression.