Becoming a mother--an analysis of women's experience of early motherhood

Unfolding of maternal-infant bonding amidst the COVID-19 pandemic: Social support as a risk and protective factor

BACKGROUND

Social, familial, and physiological stressors may put maternal-infant bonding at risk. Therefore, it is plausible that the stressful conditions brought on by COVID-19 could influence maternal-infant bonding. This study aimed to elucidate the contribution of COVID-19-related experience to variance in maternal-infant bonding, beyond that of established risk factors and as moderated by social support.

METHODS

This longitudinal, multicenter study examined the relationship of demographic and obstetric variables, social support, postpartum depression, as well as COVID-19-related fear, exposure, and subjective difficulty with mother-infant bonding six months following birth. Participants (N = 246) were women who delivered during the pandemics' strict lockdown period and were recruited 10 weeks after a liveborn delivery and followed up six months later.

RESULTS

Relationship between fear of COVID-19 and maternal-infant bonding was moderated by social support: Amongst mothers with high levels of social support, fear of COVID-19 negatively predicted bonding.

DISCUSSION

Results indicate that social support, while overall a protective factor for mother-infant bonding, may lose its buffering effect when fear of COVID-19 is high. This relationship was maintained even when early bonding experiences such as forced separation and the risk incurred by postpartum depression were accounted for. Implications for providers are discussed.

Written on milk: exploring messages written on donated human-milk bags

Every so often, among the bags of breast milk sent for donation to milk banks, clear bags of milk are found that are hand decorated and accompanied by short texts written by donating mothers. In the bank labs, the milk is poured into pasteurisation containers, and the bags are thrown away. The milk comes to the neonatal ward packed in bar-coded bottles. Both donor and the recipient are anonymous to one another. To whom are the donating mothers writing their messages? What can be learnt from their writings and drawings about their lived experiences of transitioning into motherhood? In the current study I integrate theoretical content about the transition to motherhood and theories about epistolary literature, likening the milk bags to postcards and letters. In contrast to a private letter written with ink on folded paper in a closed envelope, writing on 'milk postcards' is exposed and privacy is absent. 'Milk postcards' have a double transparency: the self is reflected in the messages and the contents of the bag-breast milk, a bodily fluid from the body of the donor. From a visual analysis of 81 photos of human-milk bags with text and drawings photographed by milk banks laboratory technicians, it appears that the milk postcards serve as a 'third voice' that echoes the difficulties and the joys in the transition to motherhood, and that donors experience an imagined solidarity with unknown mothers. The milk itself serves sometimes as an image and sometimes as the background for the writing, while its colour, texture and the form in which it is frozen constitute part of the text and serve as self-testimony for the mother of her capability and of her being a nurturing mother, for both her own baby and other unknown babies.

Knowledge, Attitude, and Practice on Antenatal Care Among Pregnant Women and its Association With Sociodemographic Factors: A Hospital-Based Study

Knowledge, attitude, and practices (KAP) for an antenatal check-up during pregnancy is a key indicator of a healthcare facility in a community. Antenatal care (ANC) is a useful practice for lowering infant and maternal mortality. Therefore, the present study was planned to estimate knowledge, attitudes, and practices regarding ANC among pregnant women and determine its association with sociodemographic factors. This hospital-based cross-sectional study was conducted on 400 pregnant women through convenience sampling from March 2020 to February 2021. A semistructured questionnaire included sociodemographic and obstetrical history, and scored questionnaire on KAP was used. The analysis included parametric, nonparametric, and Pearson correlation coefficient tests. The finding of the study revealed that pregnant women had average knowledge (96%), positive attitudes (98.75%), and good practices (58.5%) toward ANC. The level of overall knowledge had a positive correlation with the practices toward ANC (r = 0.18, P < 0.001). The sociodemographic association showed that age, type of family, education, and occupation had a significant association with awareness and practices about ANC. Furthermore, the practice of ANC in our study area was low despite good knowledge and attitude toward ANC. Further, exploratory studies are required and need to be planned to improve practices in prenatal care and ultimately improve their health.

Theorising mother-baby-assemblages: The vital emergence of maternal health

First-time motherhood is a well-studied yet poorly understood determinant of health. Giving birth has significant physical, mental and social health impacts across the life course. Maternal transition research has attempted to understand first-time mothers' psychological and social needs to improve overall health. However, much of this research struggles to capture the fluid and fluctuating nature of affects, senses and bodies across human and non-human spheres, and has reached conceptual saturation. In this paper, I develop mother-baby-assemblages as a way forward in theorising first-time motherhood to better understand how maternal health is produced intra-actively through the relationality between human and non-human actants. I achieve this by plugging into feminist psychoanalytic and new materialist theory, diffractively reading across published qualitative maternal transition literature spanning five decades and enriching affectively through my own mothering encounters. I engage with topics at the forefront of maternal health research, including bodies, babies, vibrant matter, physical and online spaces and paid employment demands. I theorise trans-subjective and more-than-human emergent mother-baby-assemblages that invite relationality and difference over identity and linearity in the becoming-mother to replace human agency with the capacity to affect and be affected through human and non-human forces. I weave together theory, published data and personal encounters to move beyond understanding becoming-mother as a linear process, and instead think of this becoming-through-each-other as mother-baby-assemblages. Maternal health therewith becomes a product of distributed, emerging, fluctuating, and affecting agencies across human and non-human spheres. Such an approach can steer towards health initiatives for first-time mothers that are socio-materially grounded, consider reciprocity of needs, diversify responsibilities for child-rearing, and encourage future scholarship of the human and non-human emergence of maternal health.

An analysis of the very high level of maternal distress experienced by South Korean women with young children

This study was conducted as a part of a larger study to identify the needs of a maternal and early childhood home visit program that the South Korean central government has begun to expand nationwide. This survey measured the distress of mothers with children aged 2 years or younger during the transition into motherhood using the Being a Mother scale (BaM-13) and compared the stress levels for each question with those of existing studies in other countries. The survey results revealed that the mean BaM-13 score of the 350 participants was 17.09 (SD = 6.81), with 87.7% showing very high levels of maternal distress, indicated by a score of 9 or above in BaM-13. The item from the BaM-13 with the highest response rate of 2 or 3 points (sum of the percentage of those who answered 2 and 3 points) was “I have missed the life I had before I became pregnant with this baby/toddler,” to which 80.8% of the respondents agreed. The percentage of South Korean mothers who answered 2 or 3 points was higher for every item on the BaM-13 than that of Australian mothers. A comparison of the total BaM-13 score and 3 factors (child experience, adult’s experience, and emotional closeness) of the BaM-13 according to the participants’ characteristics revealed that discrepancies in women’s sociodemographic factors (including smoking and alcohol consumption behaviors) were not significant, whereas differences in the total BaM-13 score and the 3 factors of the BaM-13 according to the mothers’ scores on the Edinburgh Postnatal Depression Scale were noticeable. The high level of maternal distress observed in this study should be reflected in the nurse-led maternal and early childhood home visit program that the South Korean central government is expanding across the country.

Parents experience a sense of guilt when their newborn is diagnosed small for gestational age, SGA. A grounded theory study in Sweden

BACKGROUND

To become a parent of a child who is born small for gestational age can lead to challenges in addition to the newly acquired parenting role. There is currently a lack of knowledge regarding parents' experiences of having a child born small for gestational age.

PURPOSE

The purpose of this study was to describe the experience of becoming a parent of a child small for gestational age DESIGN AND METHOD: A qualitative inductive approach was chosen with grounded theory as a method, a strategic selection was used and individual interviews with open questions were performed.

RESULTS

The results showed that the parents expressed guilt over the child's size and focused on the ability to nourish their child to keep their unexpectedly small child alive. An experienced concern about the child's food intake could be seen throughout the entire interview material and the need for information was great. A common experience of the parents was that constant feeding of the child dominates their lives.

CONCLUSION

The conclusion is that the unexpectedly small size of the child awakens the parent's instinct to provide life-sustaining care and the parents need increased support and more information around the child's condition. This requires well-trained professionals, because parents to children born SGA often harbour feelings of unpreparedness and guilt.

PRACTICE IMPLICATIONS

Increased understanding and knowledge about the parents' experience of having a child born SGA, healthcare services can optimize the potential for better attachment between parent and child as well as offer appropriate support.

Relative Importance of Determinants of Changes in Eating Behavior during the Transition to Parenthood: Priorities for Future Research and Interventions

Background: Healthy eating behavior throughout pregnancy and postpartum is important. This study aimed to investigate the perceived sex-specific importance of determinants of changes in eating behavior during pregnancy and postpartum. Methods: Fifty-four determinants were rated by first-time parents (n = 179) on their impact. Experts (n = 31) rated the determinants in terms of their modifiability, relationship strength, and population-level effect from which a “priority for research”-score was calculated. Results: During pregnancy, the three highest rated determinants by women were “health concerns”, “physiological changes”, and “fatigue”. Men perceived “health concerns”, “health consciousness”, and “influence of the pregnant partner” as important. Postpartum, the three highest rated determinants by women were “adaptation to rhythm of baby”, “baby becomes priority”, and “practical constraints because of the baby”. Men perceived “adaptation to rhythm of baby”, “fatigue”. and “(lack of) anticipation” as important. According to the experts, “professional influence”, “food knowledge”, and “home food availability” received high priority scores for both sexes and during both periods. Conclusions: Priority for research and interventions should go towards tailored family-based approaches focusing on food education in a broad sense taking into account aspects such as health consciousness, self-efficacy skills, and the social and home food environment while being supported by healthcare professionals.

Support Seeking in the Postpartum Period: Content Analysis of Posts in Web-Based Parenting Discussion Groups

Background

The transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time.

Objective

This study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed.

Methods

A leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines.

Results

In total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes.

Conclusions

Engagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices.

Mothers' experiences of client-centred flexible planning in home-based postpartum care: A promising tool to meet their diverse and dynamic needs

OBJECTIVE

To explore mothers' perspectives and experiences when facilitating greater flexibility in the planning range of home-based postpartum care, as an innovative tool to more client-centred care.

DESIGN

A qualitative study design with semi-structured in-depth interviews.

SETTING

The study was executed in collaboration with a postpartum care organisation in the Netherlands. It was part of a larger research project that studied the health effects of a new way of planning home-based postpartum care. This so-called 'flexible planning' made spreading and pausing of care possible up to the 14^th day postpartum instead of the standard care planning up to the 8^th day postpartum.

PARTICIPANTS

Mothers eligible to be interviewed for this study were participants of the larger research project who were allowed to plan their care according to the flexible planning. Twenty-one mothers were recruited through purposive sampling, of which ten were first-time mothers.

FINDINGS

Mothers valued the flexible planning as the timing of care could be tailored to their personal preferences and contexts. Yet, two main challenges were found: 1. mothers experienced difficulties in communicating and translating their dynamic needs into a care planning and 2. they felt discomfort in assigning tasks to care workers. Besides, our findings showed that care workers' practical as well as their emotional support (i.e. 'doing' vs. 'being') are greatly important in responding to mothers' needs.

KEY CONCLUSIONS

A flexible planning is a promising tool to facilitate more client-centred care in the postpartum care period. Yet, the hectic and overwhelming nature of the first few postpartum days can complicate the forward planning of care. In addition, not knowing what to expect from the postpartum care period and having a main focus on care workers 'doing' can lead to unclear and undesired working relations.

IMPLICATIONS FOR PRACTICE

When planning care in practice, a dialogue should be held between care workers and parents in which both their fields of expertise are respected. Above all, our study elucidated that novel care innovations like ours need to be co-created directly from the start with all involved parties to truly be successful.

Disrupted mothering in Iranian mothers with breast cancer: a hybrid concept analysis

Background

Defining the disrupted mothering would contribute to developing strategies to support mothers with breast cancer. The aim of this study was to analyze the concept of mothering disruption using a hybrid model.

Methods

The Hybrid method for concept analysis was implemented consisting of three phases: theoretical, fieldwork, and final analysis. In the theoretical phase, the literature was searched using electronic databases including PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, CINAHL, Wiley, Ovid, Magiran, and SID from 2000 to 2020. Any quantitative or qualitative studies published in English or Persian, which were focused on mothering disruption in mothers with breast cancer were included in the study. In the phase of fieldwork, 20 mothers were interviewed to explore the aspects of mothering disruption. The interviews were transcribed and analyzed with conventional content analysis. In the final phase, an overall analysis of the two previous phases was performed.

Results

In the theoretical phase, the following attributes were determined: “disturbance in maternal identity and roles”, “maternal insensitivity and unresponsiveness: disconnection physically and psychologically”, “the career disruption process” and “biographical disruption”. The fieldwork phase explored three themes including “the unbalance between multiple roles”, “role failure”, and “reduced maternal sensitivity”. The final synthesis yielded that the main integrated elements of mothering disruption are “disease as threating maternal role and identity”, “inability to interpret and respond to child behaviors and needs”, and “support for transitioning from being patient toward maternal competency”.

Conclusion

With a deeper understanding of the term ‘disrupted mothering’ or ‘mothering disruption’, healthcare providers will have a foundation to improve cancer care, deliver effective communication and help such mothers cross this disruption and achieve restoration of their mothering role. Future research is needed to validate this concept and explore connections with health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01346-w.

First-Time Mothers' Expectations and Experiences of Postnatal Care in England

Postnatal care is the aspect of maternity care with which women in England are least satisfied. Little is known about first-time mothers' expectations of postnatal care, or how these expectations relate to their experiences and appraisal of care. Thirty-two first-time mothers took part in a longitudinal qualitative descriptive study, based on two semi-structured interviews-the first in pregnancy, and the second 2 to 3 months after birth. Trajectory analysis was used to identify the thematic patterns in the relationships between postnatal care expectations, needs, experiences, and confidence. Five trajectories were identified, showing that mothers' satisfaction with postnatal care and confidence were primarily influenced not by the extent to which their expectations were met but the varied extent to which their individual postnatal needs were met. Rapid and responsive assessment of needs both antenatally and postnatally, and appropriate adjustment of care, is key in supporting women effectively at this time.

Providing Psychological and Emotional Support After Perinatal Loss: Protocol for a Virtual Reality-Based Intervention

The loss of an infant during the perinatal period has been recognized as a complex and potentially traumatic life event and can have a significant impact on women’s mental health. However, often times, psychological aftercare is typically not offered, and manualized interventions are rarely used in clinical care practice and have seldom been evaluated. In recent years, a growing number of studies have demonstrated the efficacy of virtual reality (VR) interventions to facilitate the expression and coping with emotions linked to a traumatic event. The objective of the proposed paper is to present the protocol of a randomized control trial aimed to assess a novel VR-based intervention for mothers who experienced a perinatal loss. We hypothesize that the VR-based intervention group will show significantly reduced symptoms related to grief, postnatal depression and general psychopathology after treatment relative to a treatment-as-usual (TAU) group. Participants would be randomly assigned to the TAU + VR or to the VR + TAU condition. The TAU condition as well as the VR-based intervention will last 3 weeks, after which women will complete a post-assessment. The proposed VR-based intervention will consist in three weekly sessions focused, respectively on: (1) collect information about the loss and psychoeducation about perinatal grief, and introduction to the virtual environment; (2) through the use of the virtual environment, women will be assisted in the elaboration and acceptation of loss; (3) recreate, using the specific features of the virtual environment a positive metaphor representing woman’s future life. VR has proved to be a valid intervention tool in clinical psychology, and in the last years VR technologies have become more affordable to be used in clinical practice. With the present study we propose to answer to the unquestionable need for interventions addressed to ameliorate the emotional effects in women who experienced perinatal loss, by exploiting also the therapeutic opportunities offered by a new technology as VR.

Hidden Communities of Practice in Social Media Groups: Mixed Methods Study

BACKGROUND

Although most US mothers initiate breastfeeding, suboptimal breastfeeding rates still exist. Although breastfeeding is a complex process, social support has been linked with increases in positive breastfeeding outcomes. Recent technological advances, including the development of social networking sites, provide mothers with convenient access to a unique array of audiences from which to seek advice about parenting, including breastfeeding. However, little is known about how the use of the sites-specifically groups centered around breastfeeding-influences breastfeeding knowledge, attitudes, or behaviors.

OBJECTIVE

This mixed methods study aimed to explore utilization of an existing probreastfeeding Facebook group and how utilization influences breastfeeding-related knowledge, attitudes, and behaviors.

METHODS

Participants were recruited online through Facebook wall posts from within the existing group. Mothers aged between 18 and 50 years who were pregnant and intended to breastfeed, were currently breastfeeding, or had recently weaned their infant in the past 3 years were eligible to participate. Participants engaged in online focus group discussions (n=21) and individual interviews (n=12). Inductive content analysis of qualitative data led to the conceptualization and contextualization of a breastfeeding community of practice (COP). Using qualitative results, a quantitative survey was then developed to assess the prevalence of qualities of a COP as well as how COP usage influenced breastfeeding-related attitudes and knowledge. A total of 314 mothers completed the online survey.

RESULTS

Qualitative findings showed an overall sense of community, with subthemes of group trust, interaction, and the promotion of breastfeeding. A majority (287/314, 91.5%) of mothers initiated breastfeeding, with 69.0% (216/314) of mothers reporting exclusive breastfeeding their infant at 6 months. Approximately 98.5% (309/314) of mothers reported that the Facebook group captured and stored knowledge; therefore, information could be easily accessed and applied. In addition, 96.2% (302/317) of mothers reported that the Facebook group motivated them to share breastfeeding-related knowledge.

CONCLUSIONS

The results suggest that this existing probreastfeeding Facebook group exhibits characteristics of an online COP, which was organically formed. Utilization of the Facebook group, in the context of an online COP, could be beneficial in impacting breastfeeding-related knowledge, attitudes, and behaviors. However, further examination and exploration of breastfeeding COPs, including using this type of model as a method of lactation support or as a telemedicine framework, is a clear need.

A downturn or a window of opportunity? How Danish and French parents perceive changes in healthy eating in the transition to parenthood

Alarming childhood obesity rates call for research into the factors that influence a child's environment. Although parents have a large influence on children's eating behaviours, surprisingly little research has explored parental healthy eating patterns. We conducted face-to-face interviews with parents of young children (up to 4 years old) living in Denmark (n = 16) and in France (n = 14) to provide insights into how the transition to parenthood affects the perceived healthfulness of eating behaviours. A problem-centred, Life-Course approach was employed, exploring the topics of interest from the perspective of the participants, and then interpreting these on the background of Social Cognitive Theory. From a cross-cultural sample of mostly well-educated parents living in couples, we found that the transition to parenthood represents a turning point for eating behaviour. Marked differences in dietary changes were perceived across four stages: 1) pregnancy, 2) first months with the baby, 3) complementary feeding and 4) child shares family meals. The findings point to an opposite cross-country perception of the impact of parenthood on food behaviours, and to the idea of what we called an "equalizing effect" on individuals' diet, where having a child triggered "unhealthy" eaters to consider dietary improvements while it imposed challenges to "healthy" eaters to maintain their satisfactory food habits. Contrasting differences on perceived behaviour change mainly appeared in terms of food ethics concern, meat consumption, cooking enjoyment, dietary diversity and sugar consumption. The proposition that low food-health-oriented individuals become healthier and (some) more environmentally conscious, reveals an opportunity for effective strategies and public health messages targeting health and food-ethics behaviour. Nevertheless, findings point to a need to consider individualized health support, addressing parental self-care, physiological changes, stress and negative emotions of early parenthood.

You Can't Take Your Baby Home Yet: A Longitudinal Study of Psychological Symptoms in Mothers of Infants Hospitalized in the NICU

Evidence suggests that mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) experience elevated rates of psychological symptoms. However, previous studies of this population have been mainly cross-sectional and have focused on very preterm infants. Although moderate- to late-preterm infants generally thrive, the possible psychological toll on their mothers has not yet been sufficiently examined. In the current study, we used a longitudinal design to investigate whether mothers of moderate- to late-preterm infants experience elevated rates of psychological symptoms during the infant's hospitalization in the NICU and 6 months later. Results indicated that these mothers did show elevated depression, anxiety, and PTSD symptoms, and that symptom levels were similar in mothers of moderate- versus late-preterm infants. Mothers of moderate- to late-preterm infants hospitalized in the NICU appeared to experience these symptoms steadily over a 6-month period after giving birth. These findings suggest a need for greater support for these mothers while in the NICU.

Transition to parenthood after successful non-donor in vitro fertilisation: The effects of infertility and in vitro fertilisation on previously infertile couples' experiences of early parenthood

Recent social science research in the field of parenting following assisted conception has focused on the experiences of donor-assisted conception and surrogacy. This article draws from a study which explored the experiences of the transition to early parenthood in 16 heterosexual non-donor couples and includes a specific consideration of the experiences of men as they navigate this journey. We argue that these couples' transition to early parenthood can be as complex and provisional as in other newer forms of family making as they struggle with an emerging identity as a parent after successful non-donor in vitro fertilisation following their experiences of infertility. Their family making is contingent upon their ability to work at integrating their experiences of infertility and in vitro fertilisation into their emerging identity as a parent. This struggle is prominent when they contemplate a further pregnancy. Considering a sibling causes them further uncertainty and anxiety because it reminds them of their infertile identify and the possibility of further in vitro fertilisation. We report novel findings about the experiences of this transition to parenthood: how couples' identity as parents is shaped by the losses and grief of infertility and the anxiety of in vitro fertilisation. We argue that their struggle with an emerging parenthood identity challenges the normative, naturalised view of non-donor heterosexual in vitro fertilisation parenthood. Our work contributes to the work on identity in parenthood after in vitro fertilisation in an ongoing effort to understand how assisted technologies shape infertile parents' lives. This article reports a small study with a relatively homogeneous sample recruited from one fertility clinic. Nevertheless as an exploratory study of an under researched topic, we discuss useful insights and ideas for further research with larger and more diverse samples.

What are women stressed about after birth?

BACKGROUND

Having a baby is associated with a variety of stressors, change, and adjustment. This study aimed to identify what women find stressful during the early postpartum period in contemporary Western society.

METHODS

Women (n = 148) 6-12 weeks postpartum wrote anonymously about a situation they found stressful as part of the Health after Birth Trial (HABiT) of expressive writing. Transcripts were analyzed for categories of stressors and cross-cutting themes.

RESULTS

Five categories of stressors were identified. Stressors in pregnancy, labor, and the early postpartum period (49.3%) included physical and emotional difficulties, and insensitive treatment by health professionals. Stressors related to adjusting to life with a baby (35.8%) included difficulties coping with a new baby, parenting, juggling responsibilities, changes to physical health, and loneliness. Stressors related to the baby's health (32.4%) included infant digestive problems, acute health problems, long-term impact, and neonatal intensive care unit experiences. Stressors related to breastfeeding (23.7%) included pressure to breastfeed, feeling like a 'bad mum' for not breastfeeding, or wanting to breastfeed and not being able to. Other stressors related to changing relationships (18.2%): with their partner, children, and other family members. Cross-cutting themes that emerged in different stressor categories were women making negative self-appraisals (eg, a bad mum, failure), feeling guilty, and lack of support from others.

DISCUSSION

Our findings emphasize the importance of exploring stressors and psychological well-being with women to provide support, help women's adjustment postpartum, and ensure interventions are offered when appropriate.

Chronic, but not acute, fatigue predicts self-reported attentional driving errors in mothers attending infant children

Mothers attending infant children usually experience high levels of fatigue, and fatigue has been shown to be related to car crashes through attentional errors, among other causes. The current study investigates the effects of fatigue on the attentional errors while driving of women attending infant children. A sample of 112 women-67 attending infant children and 45 not attending-filled out self-report questionnaires assessing acute fatigue, chronic fatigue, and attention-related driving errors. A mediational analysis showed that women attending infant children had higher levels of fatigue, and that chronic fatigue, but not acute fatigue, was related to attentional errors while driving.

A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding

Background

An emerging body of literature suggests there is a relationship between a pregnant woman’s psychological wellbeing and the development of maternal-fetal attachment (MFA) and early postpartum bonding. The nature of this relationship is not well understood because of the limited theoretical framework surrounding the construct of MFA and variations in study methods and data collection points. In this systematic review, we synthesize the published literature to determine the nature of the relationship from the antenatal to early postnatal period and to provide recommendations for future research and clinical practice.

Method

Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, four electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on at least one domain of maternal wellbeing/mental health and MFA during pregnancy or MFA during pregnancy and the mother-infant relationship during the early postpartum period (up to 12 weeks). No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42018096174).

Results

25 studies examining maternal mental health and MFA/postpartum bonding were selected for inclusion in this review. Key findings identified from the review were: a need to validate existing mental health measures or develop new measures specific for use in antenatal populations; inconsistencies in data collection points throughout pregnancy and postpartum; a lack of consensus about the construct of MFA and the way it is assessed; and a continued focus on postpartum outcomes.

Conclusion

Scientific gaps remain in our understanding of the relationship between maternal mental health and both MFA and postpartum bonding which limit our theoretical understanding of the MFA construct. Recommendations for future research are to employ prospective longitudinal designs that span the full pregnancy and postpartum period, and for consistency in the terminology and methodology used when considering MFA. A re-focus of research attention on the theory behind MFA will allow a richer and more holistic account of the emerging relationship between mother and baby.

Effects of opioids on the parental brain in health and disease

The epidemic of opioid use disorder (OUD) directly affects millions of women of child-bearing age. Unfortunately, parenting behaviors - among the most important processes for human survival - are vulnerable to the effects of OUD. The standard of care for pregnant women with OUD is opioid maintenance therapy (OMT), of which the primary objective is to mitigate addiction-related stress. The aim of this review is to synthesize current information specific to pregnancy and parenting that may be affected by OUD. We first summarize a model of the parental brain supported by animal research and human neuroimaging. We then review animal models of exogenous opioid effects on parental brain and behavior. We also present preliminary data for a unifying hypothesis that may link different effects of exogenous opioids on parenting across species and in the context of OMT. Finally, we discuss future directions that may inform research and clinical decision making for peripartum women with OUD.

"Being the best person that they can be and the best mum": a qualitative study of community volunteer doula support for disadvantaged mothers before and after birth in England

BACKGROUND

Disadvantaged pregnant women and new mothers are at increased risk of psychosocial stress, anxiety and depression. As well as affecting birth outcomes and child development, poor maternal emotional wellbeing can inhibit the development of parenting self-efficacy and successful adjustment to the maternal role. Social support is a protective factor against antenatal and postnatal depression, anxiety and stress, and improves mothers' confidence in infant care. Community doula programmes have been developed to meet the social support and information needs of disadvantaged women. In these programmes trained volunteer doulas support mothers during pregnancy, at birth and for a short period postnatally.

METHODS

This was a descriptive qualitative study, informed by phenomenological social psychology, exploring mothers' and doulas' experiences of antenatal and postnatal community doula support. Semi-structured qualitative interviews were undertaken with 13 disadvantaged mothers and 19 doulas at three community volunteer doula projects in England. Interviews were audio-recorded and transcripts were analysed using inductive thematic analysis.

RESULTS

The overarching theme emerging from the analysis was "Supporting the mother to succeed and flourish". There were five subthemes: "Overcoming stress, anxiety and unhappiness", "Becoming knowledgeable and skilful", "Developing self-esteem and self-efficacy", "Using services effectively", and "Becoming locally connected". Doulas believed that their community role was at least as important as their role at births. Their support was highly valued by vulnerable mothers and helped to improve their parenting confidence and skills.

CONCLUSIONS

Volunteer doula support before and after birth can have a positive impact on maternal emotional wellbeing, by reducing anxiety, unhappiness and stress, and increasing self-esteem and self-efficacy. Doulas help mothers feel more knowledgeable and skilful, support them to make effective use of maternity services, and enable them to build social ties in their community. To facilitate the best service for vulnerable mothers at the end of doula support, doula projects should consider formalising their relationship with other community organisations that can offer ongoing one-to-one or group support. They might also alleviate some of the potential distress caused by the ending of the doula relationship by increasing the flexibility of the ending, or by organising or permitting informal low level contact.

"It's Hard Being a Mama": Validation of the Maternal Distress Concept in Becoming a Mother

New mothers actively adapt to new demands and challenges in the mothering role but some may find this adjustment difficult and distressing, depending on their perceptions and resources. Previous research on maternal distress is primarily concentrated on needs of mothers with depression but nonpathological approaches of viewing difficulties in early parenting should be explored. A secondary analysis of a descriptive, qualitative study was completed on new, low-income mothers in early parenthood to determine how maternal distress influences mothers' transition to becoming a mother and to validate the use of the Maternal Distress Concept in the clinical setting. Findings reveal new mothers experience maternal distress on various levels: stress, adaptation, functioning, and connecting. Implications for practice and education are discussed.

Association Between Health Literacy and Parental Self-Efficacy among Parents of Newborn Children

OBJECTIVE

To determine whether health literacy was associated with parental self-efficacy in a diverse sample of parents of newborns. We hypothesized that parents with lower health literacy would have lower parental self-efficacy.

STUDY DESIGN

We conducted a cross-sectional analysis of baseline surveys from 253 English and Spanish speaking parents >18 years old with newborns <28 days old enrolled in a trial testing a multisite primary care-based parenting intervention. Surveys assessed parental, child, and environmental characteristics, and used validated instruments to measure health literacy and parental self-efficacy (total and 4 subtypes). Bivariate analyses identified parental, child, and environmental characteristics associated with parental self-efficacy. Multivariable linear regression models examined the associations between health literacy and parental self-efficacy, adjusting for covariates.

RESULTS

Parents (median age, 29 years) were 92.1% female, 54.5% black/African American, and 29.6% Hispanic/Latino. More than one-half (58.9%) had completed some college education or more, 49.0% spoke mostly English, and 16.2% had low health literacy. In bivariate analyses, parental self-efficacy was significantly lower in parents with fewer household residents. In multivariable analyses, parents with low compared with high health literacy had significantly lower parental self-efficacy scores (total and 4 subtypes including caretaking procedures, evoking behaviors, reading behaviors and signaling, and situational beliefs).

CONCLUSIONS

Lower health literacy was associated with lower parental self-efficacy in parents of newborns. To maximize impact on positive parenting behaviors and child outcomes, interventions assisting parents with low parental self-efficacy should consider strategies to address low health literacy.

Sleep quality buffers the effects of negative social interactions on maternal mood in the 3-6 month postpartum period: a daily diary study

Sleep and social relationships are two key determinants of psychosocial health that undergo considerable change across the transition to motherhood. The current study investigated the bidirectional relationship between daytime Positive and Negative Social Interactions (PSIs & NSIs) and nighttime sleep quality on maternal mood across 1 week in the 3-6 month postpartum period. Sixty healthy, non-depressed first-time mothers completed 7-consecutive days of daily social interaction and sleep diaries. Results indicated that higher than average sleep quality buffered the effect of higher than average NSIs on maternal mood (i.e., buffered mood reactivity) and appeared to promote mood recovery following a particularly "bad day" (i.e., higher than average NSIs). In addition, although PSIs were more common than NSIs overall, the most frequent and positively rated PSIs were with baby as were the most frequent and negatively rated NSIs. To our knowledge, our results are the first to characterize the impact of PSIs on postpartum maternal mood, assess maternal-infant social interactions in daily diary study of postpartum social relationships, and demonstrate the role that maternal sleep quality plays in social discord-related mood reactivity and mood recovery processes in the 3-6 month postpartum period.

"I did a lot of Googling": A qualitative study of exclusive breastfeeding support through social media

BACKGROUND

Little qualitative research has been done to explore the quality of breastfeeding support through social media in New Zealand.

AIM

This article aims to explore the influence of social media on exclusive breastfeeding practice.

METHODS

A qualitative study involving face-to-face postpartum interviews with 30 mothers who were recruited from the lower North Island of New Zealand. Each participant was followed via short monthly audio-recorded telephone interviews until giving up exclusive breastfeeding or until six months after the birth. The theories "strength of weak ties" and "landscapes of care" are applied to the thematic analysis of the interview material to illuminate the influence of social media on breastfeeding practices.

RESULTS

Qualitative analysis of the interview material identified four themes: 1) Mothers need reliable online infant feeding information; 2) Smartphone apps can be a good option for promoting breastfeeding; 3) Information is accessed through weak ties among breastfeeding mothers on Facebook, and 4) the utility of geographically distant infant feeding support via Skype.

DISCUSSION

Most participants sourced post-partum information and advice to support breastfeeding through the Internet, while those with geographically distant family members accessed emotional and practical breastfeeding support via Skype.

IMPLICATIONS FOR PRACTICE

Breastfeeding advocates should use social media to promote and support exclusive breast-feeding practice.

CONCLUSION

The influence of social media on breastfeeding points to the relational nature of breastfeeding which is embedded in 'real' world and virtual social networks as well as the cultural, geographic and social contexts of a mother's life.

Maternal mental health during the neonatal period: Relationships to the occupation of parenting

PURPOSE

To (1) examine the extent of a range of early mental health challenges in mothers with a very preterm infant hospitalized in the NICU and mothers of full-term infants, (2) identify family social background and infant medical factors associated with higher levels of maternal psychological distress, and (3) assess the relationship between maternal psychological distress and maternal perceptions of the parenting role, parenting confidence and NICU engagement.

METHODS

At hospital discharge 37 mothers of very preterm infants (≤32 weeks gestation) and 47 mothers of full-term infants (≥37 weeks gestation) completed structured assessments of their psychological wellbeing and transition to parenting. Mothers of very preterm infants were also questioned about their NICU visitation and involvement in infant care.

RESULTS

Sixty-four percent (n = 54) of mothers experienced psychological distress (n = 26, 70% of preterm; n = 28, 60% of full-term). Lower infant birthweight was associated with maternal psychological distress (p = .03). Mothers of very preterm infants had significantly more psychological distress related to having a Cesarean section delivery (p = .02). Higher levels of psychological distress were associated with lower levels of parenting confidence in mothers of both very preterm and full-term infants (p < .02).

CONCLUSION

Although parents of very preterm infants have higher rates of maternal mental health challenges, mothers of full-term infants at high social risk are also impacted.

The Parenting Journey: Daily Parental Management in Families with Young Children

Transitioning to parenthood and establishing a family are significant life events, and although an expected and normal part of adult life, it is a time of stress, change, and learning. The family has been well-studied with regard to developmental norms and the diagnosis and treatment of physical, cognitive, and emotional problems. However, little is known about how parents of young children establish, manage, and maintain their families on a daily basis. Social constructivist grounded theory was used to examine day to day parental management in families with young children. A theory, adjusting and redefining priorities, was developed to explain how parents make decisions related to the health and well-being of family members. A group of 24 New Zealand parents was interviewed about their daily management in families where the eldest child was aged no older than 3 years. Findings of this study revealed that parents used 4 overarching and constantly interacting viewpoints to consider situations: the personal, the parent, the parent unit, and the family unit. Their learning went through cycles of intensity and relaxation as parents considered their short term and long term priorities. Sometimes major changes to family structures and processes were required to maintain family stability, and sometimes the adjustments needed were relatively minor. These dimensions contributed to parents' continuous efforts to meet the needs of all family members and to create a unique family environment that encompassed the guiding principles upon which parents made their decisions. This study highlights the need for health professionals to recognize the unique, complex and dynamic decision-making process parents are already engaged in when managing their families.

Process of becoming a mother for Iranian surrogacy-commissioning mothers: A grounded theory study

AIM

Little knowledge is available about the experiences of the commissioning mothers during the process of surrogacy; thus, the present study was conducted in order to explore and analyze this process.

METHODS

This study was conducted in a referral institute in Tehran with a qualitative approach and using grounded theory methodology. The data were collected through 39 unstructured, in-depth interviews that were conducted with 15 gestational commissioning mothers, two of their husbands, four surrogates, and five of the personnel at centers for assisted reproduction (some participants were interviewed more than once). Sampling started purposively and then continued theoretically.

RESULTS

The analysis revealed the main concern of these mothers to be the feeling of "insecurity about becoming a mother" and their predominant strategy for dealing with it to be "seeking security about becoming a mother," which emerged as a core concept. The consequences of the mothers' adopted strategies and the effects of the intervening factors included "reaching a state of relative peace," "a continuing threat to one's identity," and "mental and physical exhaustion."

CONCLUSION

Identifying the demands of this group of mothers can help medical personnel, particularly nurses, adopt better plans for the future and to optimize the care they provide to these patients.

Emotional state of “young” fathers

<b>Background</b><br /> The birth of the first child begins a new stage in family life, and the woman and the man must adopt new roles in society. However, adapting to the new conditions of life and the requirements of the new role can be difficult.<br /> <b>Participants and procedure</b><br /> The main tools used in the study were the SUPIN scale, the STAI inventory and a questionnaire constructed by the authors. The participants were 90 men who became first time fathers in the period of 6 months prior to the study.<br /> <b>Results</b><br /> The results indicate that the first time fathers show a medium level of state anxiety related to the current situation and a low level of trait anxiety understood as an enduring disposition. The level of anxiety is related to the age of the child, but only in the men who fathered a son: the older the son was, the greater was the intensity of state anxiety in the father.<br /> <b>Conclusions</b><br /> The deep conviction that the father should be a role model for the son can be a source of anxiety about the ability to manage and the ability to meet the related responsibility. According to the tradition of our culture, the father has to prepare the son to be a man, to assume a man’s roles in society and teach him how to live. The lower intensity of positive emotions related to the birth of a daughter can be explained from the point of view of the true man stereotype – a daughter does not fulfil it.

When Women with Cystic Fibrosis Become Mothers: Psychosocial Impact and Adjustments

Advances in the treatment and life expectancy of cystic fibrosis (CF) patients mean that motherhood is now a realistic option for many women with CF. This qualitative study explored the psychosocial impact and adjustments made when women with CF become mothers. Women with CF (n = 11) were recruited via an online forum and participated in semistructured telephone interviews about their experiences of becoming a mother. Transcriptions were analysed using Grounded Theory. Analysis revealed three core categories: (i) “Living with CF”: how becoming a mother impacted on health and treatment adherence, requiring a change in support from the CF team, (ii) “Becoming a Mother”: balancing issues common to new mothers with their CF, and (iii) “Pooling Personal Resources”: coping strategies in managing the dual demands of child and CF care. Participants experienced a variety of complex psychosocial processes. Most participants acknowledged an initial negative impact on CF care; however over time they reported successful adaptation to managing dual commitments and that adherence and motivation to stay well had improved. This study highlights the need for preconceptual psychosocial counselling and postpartum adjustment to CF care.

Transition to motherhood in women with eating disorders: A qualitative study

OBJECTIVES

The aim of this study was to examine in depth the individual experience of transition from pregnancy to motherhood, among women with current eating disorders (EDs), focusing on differences between the first and subsequent pregnancies.

DESIGN AND METHODS

We analysed the narratives of 12 women with severe ED during pregnancy using interpretative phenomenological analysis. We employed a sequential structure, and the emerging themes were ordered according to consecutive pregnancy stages.

RESULTS

Our results indicate that experiences of pregnancy vary across pregnancy stages and in the first pregnancy compared to subsequent pregnancies. In particular, during their first pregnancy women with an ED seem to experience an inner conflict and questioned the continuity of their ED identity leading them to be more open to change.

CONCLUSIONS

The first pregnancy, during its early stages, should be considered a potentially unique window for intervention for women with current ED.

PRACTITIONER POINTS

Eating disorders (EDs) are known to seriously affect fertility, pregnancy, and pregnancy outcomes. Our research sheds a light on experiences of pregnancy in women with ED and ultimately helps to define a window for intervention. Our findings have important implications in understanding mechanisms of relapse in the post-partum period and consequently could help in tailoring an adequate intervention for women with ED and in preventing ED relapse.

Prevalence and Risk Factors of Relationship Dissatisfaction in Women During the First Year After Childbirth: Implications for Family and Relationship Counseling

The aim of this study was to investigate the rate of relationship dissatisfaction among Australian women during the first year after childbirth and to uncover factors affecting their relationships. Postnatal women who had given birth during the previous 12 months were invited to participate in a cross-sectional online study. A comprehensive, multisection questionnaire, as well as the Relationship Assessment Scale (RAS), Female Sexual Function Index (FSFI), and Patient Health Questionnaire - 8 (PHQ-8), were used to collect data. Responses were analyzed using SPSS for Windows. Results showed that 37.2% of the participants experienced relationship dissatisfaction. Results of the multiple logistic regression revealed that the following were significant risk factors for relationship dissatisfaction during the first postpartum year: annual income of less than AU$50,000, sexual dysfunction, and a clinical diagnosis of depression and having symptoms of depression according to the PHQ-8 scores (p < 0.05). Compared to women in a heterosexual relationship, women who were in a same-sex relationship were less likely to have relationship dissatisfaction. In addition, in the period six to 12 months postpartum, women were less likely to have relationship dissatisfaction compared to the period 5 months or less postpartum (p < 0.05).

The Effects of Pregnancy-Adaptation Training on Maternal-Fetal Attachment and Adaptation in Pregnant Women With a History of Baby Loss

BACKGROUND

Studies have shown that educating mothers can improve their adaptation to pregnancy and motherhood roles. There are also studies that have investigated the effects of certain interventions on maternal-fetal attachment. However, studies on the effects of maternal adaptation training on maternal-fetal attachment in mothers with a history of fetal or baby loss are rare.

OBJECTIVES

The aim of this study was to determine the effects of a pregnancy adaptation training package on maternal-fetal attachment in pregnant women with a history of baby loss.

PATIENTS AND METHODS

This quasi-experimental study was conducted on 60 pregnant women with previous fetal or neonatal death in 2014. The women were randomly divided into an experimental group (n = 30) and a control group (n = 30). The pregnant women in the experimental group received routine prenatal education in addition to four sessions of a pregnancy adaption training package. The control group received only routine prenatal education. The data were collected using a demographic questionnaire, Cranley's maternal-fetal attachment scale, and a prenatal self-evaluation questionnaire at the beginning and at the end of the study. The data analysis was conducted using the Mann-Whitney U, Wilcoxon, chi-square, Fisher's exact, and spearman correlation coefficient tests.

RESULTS

Before the intervention, there were no statistically significant differences between the study and control groups in terms of maternal-fetal attachment (P = 0.280) and adaptation to pregnancy (P = 0.883). However, following the intervention, the mean score of the maternal-fetal attachment was significantly higher in the experimental group, when compared with the control (77.57 ± 7.23 vs. 61.53 ± 2.62; P = 0.001). In addition, the mean post-intervention adaptation to pregnancy score was significantly lower in the experimental group than in the control group (118.89 ± 8.12 vs. 126.38 ± 4.17; P = 0.001).

CONCLUSIONS

The pregnancy adaptation training package increased the adaptation and maternal-fetal attachment scores in pregnant women with a history of baby loss.

Socioeconomic disadvantages and neural sensitivity to infant cry: role of maternal distress

Socioeconomic disadvantage such as poverty can increase distress levels, which may further make low-income mothers more vulnerable to difficulties in the transition to parenthood. However, little is known about the neurobiological processes by which poverty and maternal distress are associated with risks for adaptations to motherhood. Thus, the current study examined the associations between income and neural responses to infant cry sounds among first-time new mothers (N = 28) during the early postpartum period. Lower income was associated with reduced responses to infant cry in the medial prefrontal gyrus (involved in evaluating emotional values of stimuli), middle prefrontal gyrus (involved in affective regulation) and superior temporal gyrus (involved in sensory information processing). When examining the role of maternal distress, we found a mediating role of perceived stress, but not depressive symptoms, in the links between income and prefrontal responses to infant cry. Reduced neural responses to infant cry in the right middle frontal gyrus and superior temporal gyrus were further associated with less positive perceptions of parenting. The results demonstrate that perceived stress associated with socioeconomic disadvantages may contribute to reduced neural responses to infant cry, which is further associated with less positive perceptions of motherhood.

Experiences of First-Time Mothers With Persistent Pelvic Girdle Pain After Childbirth: Descriptive Qualitative Study

BACKGROUND

Pelvic girdle pain (PGP) is common during pregnancy and negatively affects women's lives. When PGP persists after the birth, the way it affects women's lives may change, particularly for first-time mothers as they adjust to motherhood, yet the experiences of women with persistent PGP remain largely unexplored.

OBJECTIVES

The objective of this study was to explore primiparous women's experiences of persistent PGP and its impact on their lives postpartum, including caring for their infant and their parental role.

DESIGN

This was a descriptive qualitative study.

METHODS

Following institution ethical approval, 23 consenting primiparous women with PGP that had started during pregnancy and persisted for at least 3 months postpartum participated in individual interviews. These interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Four themes emerged: (1) "Putting up with the pain: coping with everyday life," in which women put up with the pain but had to balance activities and were grateful for support from family and friends to face everyday challenges; (2) "I don't feel back to normal," in which women's feelings of physical limitations, frustration, and a negative impact on their mood were described; (3) "Unexpected," in which persistent symptoms were unexpected for women due to a lack of information given about PGP; and (4) "What next?," in which the future of women's symptoms was met with great uncertainty, and they expressed worry about having another baby.

CONCLUSION

For first-time mothers, having persistent PGP postpartum affects their daily lives in many ways. These findings provide important information for health care providers, which will improve their understanding of these women's experiences, will enhance rapport, and can be used to provide information and address concerns to optimize maternity care during pregnancy and beyond.

Playgroup Participation and Social Support Outcomes for Mothers of Young Children: A Longitudinal Cohort Study

Objective

This study aimed to examine friendship networks and social support outcomes for mothers according to patterns of playgroup participation.

Methods

Data from the Longitudinal Study of Australian Children were used to examine the extent to which patterns of playgroup participation across the ages of 3–19 months (Wave 1) and 2–3 years (Wave 2) were associated with social support outcomes for mothers at Wave 3 (4–5 years) and four years later at Wave 5 (8–9 years). Analyses were adjusted for initial friendship attachments at Wave 1 and other socio-demographic characteristics.

Results

Log-binomial regression models estimating relative risks showed that mothers who never participated in a playgroup, or who participated at either Wave 1 or Wave 2 only, were 1.7 and 1.8 times as likely to report having no support from friends when the child was 4–5 years, and 2.0 times as likely to have no support at age 8–9 years, compared with mothers who persistently participated in playgroup at both Wave 1 and Wave 2.

Conclusion

These results provide evidence that persistent playgroup participation may acts as a protective factor against poor social support outcomes. Socially isolated parents may find playgroups a useful resource to build their social support networks.

Parental experiences of early postnatal discharge: A meta-synthesis

OBJECTIVE

the aim of this study was to investigate new parents׳ experiences of early postnatal discharge.

DESIGN

a meta-synthesis including 10 qualitative studies was conducted using Noblit and Hare׳s method of meta-synthesis development.

SETTING

qualitative studies performed in western countries from 2003-2013 were included.

PARTICIPANTS

the 10 included studies involved 237 mothers and fathers, first time parents as well as multiparous.

FINDINGS

we identified four overlapping and mutually dependent themes reflecting the new parents׳ experiences of early postnatal discharge: Feeling and taking responsibility; A time of insecurity; Being together as a family; and Striving to be confident. The mothers׳ and fathers׳ experiences of responsibility, security and confidence in their parental role, were positively influenced by having the opportunity to be together as a family, receiving postnatal care that included both parents, having influence on time of discharge, and getting individualised and available support focused on developing and recognising their own experiences of taking care of the baby.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

the new parents׳ experiences of early discharge and becoming a parent were closely related. Feeling secure and confident in the parental role was positively or negatively influenced by the organisation of early discharge. This underscores the importance of the way health professionals support new mothers and fathers at early postnatal discharge.

The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes

OBJECTIVE

this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors.

DESIGN

a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records.

SETTING

data were recruited from antenatal health-care clinics in Halland, Sweden.

PARTICIPANTS

a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42.

MEASUREMENTS

five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States.

FINDINGS

results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy.

KEY CONCLUSIONS

this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth.

'I thought it would keep them all quiet'. Women's experiences of breastfeeding as illusions of compliance: an interpretive phenomenological study

AIMS

To explore the experiences of breastfeeding women.

BACKGROUND

There is a plethora of data demonstrating that human breast milk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the United Kingdom has shown a steady increase in the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. This study was designed to extend current knowledge around breastfeeding experiences, decisions and behaviours.

DESIGN

Qualitative, interpretive phenomenological approach.

METHODS

Data were collected between July 2009-January 2010 through in-depth interviews with 22 women from a city in the East Midlands where the prevalence of breastfeeding has showed a decreasing trend. Data were collected between 3-6 months after the birth of their youngest baby.

FINDINGS

Analysis of data uncovered a key theme: illusions of compliance. The findings revealed that women's breastfeeding behaviours were socially mediated. They adopted a good mother image by conforming to the moral obligation to breastfeed immediately after their babies were born. Those women who struggled to establish breastfeeding tried to hide their difficulties rather than admit that they were not coping.

CONCLUSION

This study provides insights into women's infant feeding decisions and behaviours, building on understandings of 'good mothering' in the wider literature. Importantly we highlight some of the previously unknown strategies that women employed to portray themselves as calm, coping and in control when in reality they were struggling and not enjoying breastfeeding.

Mothers' strategies in handling the prematurely born infant: a qualitative study

INTRODUCTION

Family, especially mother, is faced with numerous challenges by experiencing a premature birth. Since knowing about mother's efforts regarding prematurely born infant helps us in our comprehensive understanding of the impact of this incident on the family system and its performance. The present study was carried out to explore the mothers' strategies regarding prematurely born infant.

METHODS

In a conventional qualitative content analysis, data was collected through purposive sampling by semi-structured deep interviews with 18 mothers who had prematurely born infant during 2012-2013 in the teaching hospitals of the north and northwest of Iran. All the interviews were recorded, typed, and finally analyzed.

RESULTS

Data analysis resulted in the extraction of categories of "asking for help, elevating capacity and reducing personal responsibilities and commitments". These categories were revealed in mothers respectively by the different sub-categories of "religious appeal and relying on beliefs, seeking information from the treatment and caring team, participating in infant's care, companionship and support of family and friends","focusing on positive thinking and imagination, patience and strength " and "ignoring some routine affairs and reducing role-related activities and duties".

CONCLUSION

Considering the uniqueness of the mother's role in responding to the needs of infants, healthcare system should consider mothers as real target in the intervention strategies in order to promote health and quality of life, so maybe this way, the burden of care and management of critical situations caused by a premature birth on the mother can be reduced.