Well-being of mothers with infant children: a preliminary comparison of employed women and homemakers

Associations between food insecurity and child and parental physical, nutritional, psychosocial and economic well-being globally during the first 1000 days: A scoping review

Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.

Psychobiological influences on maternal sensitivity in the context of adversity

This study evaluated prospective longitudinal relations among an index of poverty-related cumulative risk, maternal salivary cortisol, child negative affect, and maternal sensitivity across the first 2 postpartum years. Participants included 1,180 biological mothers residing in rural and predominantly low-income communities in the United States. Multilevel growth curve analyses indicated that an index of cumulative risk was positively associated with maternal cortisol across the postpartum (study visits occurring at approximately 7, 15, and 24 months postpartum) over and above effects for African American ethnicity, time of day of saliva collection, age, parity status, having given birth to another child, contraceptive use, tobacco smoking, body mass index, and breastfeeding. Consistent with a psychobiological theory of mothering, maternal salivary cortisol was negatively associated with maternal sensitivity observed during parent-child interactions across the first 2 postpartum years over and above effects for poverty-related cumulative risk, child negative affect, as well as a large number of covariates associated with cortisol and maternal sensitivity. Child negative affect expressed during parent-child interactions was negatively associated with observed maternal sensitivity at late (24 months) but not early time points of observation (7 months) and cumulative risk was negatively associated with maternal sensitivity across the postpartum and this effect strengthened over time. Results advance our understanding of the dynamic, transactional, and psychobiological influences on parental caregiving behaviors across the first 2 postpartum years. (PsycINFO Database Record

Maternal empathy, self-confidence, and stress as antecedents of preschool children's behavior problems

PURPOSE

To test psychosocial antecedents (maternal stress, self-confidence, and empathy) of preschoolers' behavior problems.

DESIGN AND METHODS

One hundred and twenty-two postpartum mothers completed a 24-month longitudinal mail survey. A structural equation model that included empathy was tested.

RESULTS

Stress, but not maternal self-confidence or empathy, was directly related to child behavior problems (t=1.98, p=.05). Maternal empathy in combination with self-confidence or stress, however, moderated adverse effects on behavior problems (p=.03). Predictors explained 16% of variance of behavior problems.

PRACTICE IMPLICATIONS

Empathy was protective when stress was high. Empathy training may enhance high-risk parent education.

Correlates of dietary quality and weight retention in postpartum women

The purpose of this study(1) was to identify correlates of dietary quality and postpartum weight retention in women and to examine the association of dietary quality and weight retention. A secondary analysis was conducted of data from 100 women who delivered singleton babies and were over 18 years of age. In sum, 44 women had adequate dietary quality. Most women had adequate intake of meat (79%), milk (66%), and fruit (51%) but not bread (14%) or vegetables (24%). Dietary quality was significantly associated with breast-feeding (rs = .378, p < .000). Dietary quality was not associated with postpartum weight retention. In all, 43% of the variance in postpartum retained weight was explained by weight gained during pregnancy and weight-related distress. A gap exists in the nutrition education and weight management of women after childbirth that allows for a reversal of the healthy eating patterns adopted during pregnancy and throughout the ensuing postpartum life transition.

Food choices of low-income women during pregnancy and postpartum

OBJECTIVES

The purpose of this study was to examine dietary behavior during pregnancy and postpartum in a multiethnic sample of low-income women.

SUBJECTS

Participants were 149 Medicaid-qualified women (30% white, 24% African American, and 46% Hispanic; median age, 22 years).

DESIGN

Subjects were recruited into a longitudinal cohort design 0 to 1 days following delivery. Dietary choices during pregnancy and the first 6 months postpartum were assessed via validated food frequency questionnaires administered at 6 weeks and 6 months postpartum, respectively.

STATISTICAL ANALYSES PERFORMED

Frequencies and means were used for descriptive purposes. Paired and independent sample t tests were used for continuous variables; chi 2 and McNemar tests were used for categorical variables.

RESULTS

In all subjects, mean daily servings of grains (7.4 vs 6.2, P <.004), vegetables (2.5 vs 2.0, P <.002), and fruit (3.4 vs 1.7, P <.001) declined following childbirth, while the percentage of energy from fat (37.3% vs 38.4%, P <.023) and added sugar (14.4% vs 16.4%, P <.019) increased. Women who breastfed their infants at 6 months postpartum reported lower intakes of total fat (34.2% vs 37.9%, P <.005) during pregnancy and higher fruit (2.2 vs 1.6, P <.05) and vegetable (2.6 vs 1.8, P <.02) intakes in postpartum than those who bottle-fed. Also, a greater proportion of lactating than nonlactating women (66.7% vs 36.9%, P <.05) met recommendations for fruit intake during pregnancy.

CONCLUSIONS

The findings suggest that the transition from pregnancy to postpartum may be associated with a negative impact on dietary behavior that could compromise nutritional status in low-income women.

Women, work, and well-being 1950–2000:

In this research synthesis, we summarize 161 measures of the effects of women's employment on well being reported between 1950 and 2000. Variations in the conceptualization and measurement of employment and health outcomes and the difficulty in distinguishing social selection from social causation limit the inferences that can be drawn from the evidence. Therefore, we distinguish two types of studies. Longitudinal studies measuring relevant covariates at the first measurement occasion and statistically controlling them in multivariate analyses providing effect-size information are classified as Type II studies. The remaining studies are classified as Type I studies. The main findings were that (1) results from methodologically sound Type II studies confirm the cross-sectional finding that paid employment has no adverse effects on women; (2) the outcome groups psychological distress, subjective health, cardiovascular risks and disease, and mortality do not converge completely.

Balancing personal and family trajectories: an international study of dual-earner couples with pre-school children

In general, the nursing literature neglects healthy families and depictions of families are dominated by systems and developmental theory. The preponderance of dual-earner families has changed the meaning of family, however, nurses have given minimal attention to how women and men attend to work and home. Balancing personal and family trajectories is a substantive theory that accounts for how Canadian and English couples with pre-school children managed work and family life. The theory describes their efforts to maximize personal and family development, by using processes that attempted to support and sustain individual and family health, happiness, and fulfillment.

Elderly Mexican women's perceptions of exercise and conflicting role responsibilities

The purpose of this pilot study was to explore elderly Mexican women's readiness to exercise, and their multiple roles. Fifty older women were sampled from two separate neighborhoods of low socio-economic status. Readiness to exercise was examined using the Stages of Change - Exercise instrument with six categories: precontemplation nonbelievers, precontemplation believers, contemplation, preparation, action, and maintenance. Time devoted to the following functional roles was explored: wife, household, grandmother, personal care, and recreational. Women fell mainly under the first three stages of change both, precontemplation nonbelievers and believers, and the contemplation stage. The stages of change scale and role commitments were not significantly related. Nevertheless, precontemplators devoted less time in all the roles than the women in the other categories of stage of change.

Rediscovering the "M" in "MCH": maternal health promotion after childbirth

Although maternal mortality is not a major health concern in the United States, evidence is accruing that after 6 weeks postpartum mothers continue to face mental and physical health, lifestyle, and parenting concerns. Exemplar areas for enhanced maternal health promotion after childbirth include (a) lifestyle changes in exercise, nutrition, and smoking, and (b) psychosocial well-being, particularly mood and body image. Research on health of women after childbirth supports rethinking the scope and duration of maternal health promotion.

Continuity and change in women's weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events

The life course perspective offers a framework for understanding continuity and change in health and health practices. Body weight, and the diet and physical activity strategies used to manage weight in pregnancy and the postpartum period, are a focus of much study because of an association between parity and body weight. The motherhood transition offers an opportunity to study weight concerns and weight management strategies during a period of weight fluctuation that is part of a life transition for many women. Our aim was to develop an in-depth understanding of women's experiences of pregnancy and postpartum weight changes, the strategies that women used to deal with weight changes, and patterns in their attitudes and strategies across pregnancy and the postpartum period. A longitudinal design, using multiple, in-depth, qualitative interviews with 36 women from pregnancy through the postpartum period, was chosen for data collection. Prepregnancy orientations towards body weight emerged as the primary influence on women's pregnancy and postpartum attitudes towards weight, on patterns of physical activity and diet, and on postpartum weight outcomes among most study participants. Four different trajectories ("relaxed maintenance", "exercise", "determined", and "unhurried"), characterized by differences in women's orientations towards their body weight and their diet and physical activity patterns across pregnancy and the postpartum period, emerged from the data. Only a few women diverged from prepregnancy trajectories in weight orientation and diet and physical activity patterns postpartum. Delayed resumption of prepregnancy physical activity and dietary patterns contributed to postpartum weight retention for a subset of "exercisers". Stress and age- or role-related changes in perspective interrupted the continuity of weight orientations and behavioral patterns for three other women. These findings highlight the direction and momentum provided by trajectories in health attitudes and strategies as processes shaping responses to a life transition.

The experiential meaning of well-being for employed mothers

Employed mothers must constantly juggle and balance the multiple roles they face on a daily basis, which can be overwhelming and may adversely affect well-being and health. Findings are presented from a naturalistic-inquiry study that explored how employed mothers with preschool-age children experience positive well-being in their lives. Interviews were conducted with 16 mothers who worked full time and had at least one preschool-age child living at home. Findings included seven categories reflective of experiential well-being: mutuality, spirituality, child-centeredness, acceptance, happiness, security, and enrichment of the world. Results of this study are anticipated to contribute to a foundation for theory development and subsequent theory testing for promoting well-being.

Parental sensitivity to infants and toddlers in dual-earner and single-earner families

BACKGROUND

Concerns have been raised about the effects of maternal employment on parent-child relations. Some researchers have concluded that maternal employment status has no effect on children's maternal attachments; others have found that full-time employment initiated in the first year of life is associated with insecure patterns of attachment behavior. The evidence suggests that dual-earner parents who have young children have increased psychological distress, affecting marital quality and spousal and parenting behaviors.

OBJECTIVES

To learn whether parental sensitivity and the determinants of parental sensitivity differ for first-time parents in single-earner and dual-earner families when their first-born children are 3 months of age and when they are 2 1/2 years old; and to learn the extent to which changes in parental sensitivity and the determinants of parental sensitivity differ for single-earner and dual-earner parents during the study interval.

METHOD

This panel study compared marital quality, psychological well-being, and parental sensitivity of single-earner and dual-earner parents when their first-born children were 3 months of age and again when they were 2 1/2 years of age.

RESULTS

Employed mothers were more sensitive to their 3-month olds than were nonemployed mothers. When children were 2 1/2 years of age, dual-earner parents had lower marital quality than single-earner parents. Marital quality was positively associated with parental sensitivity at both study phases. Regardless of maternal employment status, parents' marital quality declined during the study interval.

CONCLUSIONS

Regardless of mothers' employment status, well-educated, middle-class parents tend to provide sensitive parenting. Marital quality and psychological well-being are important supports of sensitive parenting for dual-earner and single-earner families.

Lifestyle factors related to postpartum weight gain and body image in bottle- and breastfeeding women

OBJECTIVE

To explore the relationship of lifestyle variables to postpartum weight gain and body image attitudes of bottle- and breastfeeding women.

DESIGN

Mail survey of new mothers at approximately 4 months postpartum.

SETTING

Southwestern community.

PARTICIPANTS

One hundred one bottle-feeding women (69% white, 20% Hispanic, 11% other) and 106 breastfeeding women (76% white, 19% Hispanic, 5% other) without diabetes. Bottle- and breast-feeding women did not differ on gestational weight gain or weight gain sustained postpartum.

MAIN OUTCOME MEASURES

Postpartum weight gain (relative to prepregnancy weight) and body image attitudes.

RESULTS

Feeding method (breast or bottle) was not associated with postpartum weight gain in the sample as a whole. Bottle-feeding mothers with higher postpartum gains exercised less, had higher fat intake habits, and were more dissatisfied with body image than mothers with lower gains. Breast-feeding mothers with higher and lower gains did not differ on any lifestyle factors. Overall lifestyle and psychologic skill in managing emotions were related negatively to postpartum body image dissatisfaction in both groups of women.

CONCLUSIONS

Breastfeeding women did not differ from bottle-feeding women in sustained postpartum weight gain. In bottle-feeding women, lifestyle factors were associated with levels of weight gain. Lifestyle-focused programs for weight management would potentially benefit these women.

What makes women tired? A community sample

We aimed to determine the major health concerns or problems of women and their personal attributions for the causes of their primary health concerns. We used a survey of women from the Toronto area attending a women's health symposium. Completed questionnaires were returned by 153 (85%) of 180 women attendees. Persistent fatigue was the primary and most commonly cited health concern. Fatigue was ranked first by 42 (27.5%) women and among the top 10 concerns by 123 (80.4%) women. Women attributed their fatigue to a combination of home and outside work (63.4%), poor sleep (38.2%), lack of time for self (34.1%), lack of exercise (32.5%), financial worries (28.5%), relationship problems (22.0%), emotional causes (17.9%), care of ill family members (13.8%), lack of social or individual support (9.8%), poor physical health (8.9%), work in home or child care (3.3%), or gender bias/harassment (2.4%). Our subjects, women from the community, overwhelmingly endorsed social determinants as the cause of their persistent fatigue. Although depression and anxiety form the most robust associations with persistent fatigue in primary care and community studies, women in this sample ranked these factors in seventh place in their attributions. Similarly, although physicians often assume physical causes for fatigue, women rank physical health low in their own attributions. Given the high prevalence of fatigue in women and its impact on quality of life, more attention needs to be given to the social, systemic, and personal factors that women feel contribute to their fatigue to develop more effective interventions.

Employed Mexican women as mothers and partners: valued, empowered and overloaded

This study was designed to explore the daily lived experiences of a group of employed, low-income Mexican women in their maternal and spousal roles. The participants were 41 auxiliary nurses recruited from two large urban hospitals in Mexico. Data were collected through the Women's Roles Interview Protocol (WRIP), which solicited the participants' perceptions of the satisfaction and stresses they experienced in their roles as mothers and spouses, and their descriptions of the coping strategies and the resources they used to deal with stressful life experiences related to these roles. Data analysis consisted of a qualitative thematic analysis of the narrative responses to open-ended questions in the WRIP. Satisfying aspects of the maternal and spousal roles, as identified by the participants, included giving to and receiving from their children and being valued and supported by their partners. Spousal approval of their work was also satisfying. These employed mothers, however, experienced many stressful aspects of functioning in multiple roles, including lack of resources, being absent from their children, self-doubt about their maternal role functioning, role overload and spousal absences. The women coped by juggling priorities and utilizing family resources. From the data analysis, the investigators developed a conceptual framework for understanding these women's experiences with parenting and marriage. The centrality of the family, a sense of value and empowerment as women in maternal and spousal roles, and the reality of role overload are discussed within the Mexican culture context of machismo, its female counterpart hembrismo, and family life. Implications for women's health are framed within a context of family and work.

Being a mother and a por día domestic worker. Companionship and deprivation

This article presents qualitative findings concerning women's maternal roles, based on interviews conducted in a study on role integration and health, in a Colombian sample of 60 women who are "por día" domestic workers. The results describe the women's worldview as they discuss the stresses and the satisfactions of their mothering roles. The results also include the coping strategies used to deal with the stresses inherent in the maternal role. Women describe how the companionship of their children, watching their children grow, and the nurturing they give their children provides them with pride and deep satisfaction. These satisfying aspects of their role are burdened by the stress related to worry about children's bad behavior, their illness, and a pervasive generalized sense of constant worry. Being single parents adds more stress to these women's lives. Participants coped emotionally through distraction and through talking with friends. Other coping strategies included calming self, problem solving, talking with children, and substance use. The authors conclude with a discussion of the relationship between poverty and work situation as contexts for understanding maternal roles.

Reasons for employment or non-employment during pregnancy

Although women's pattern of employment during pregnancy has markedly changed in the last 30 years, no research has explored the basis of contemporary women's decision making regarding employment during pregnancy. Conceptualizing pregnancy within a life span developmental perspective of adulthood, we used descriptive statistics and content analysis on data from 210 pregnant women to identify factors that influence employment decisions during pregnancy. Intrinsic reasons for working during pregnancy included self-actualization, escape from home, employment identity, and interpersonal contact. Extrinsic reasons for working included money, financial obligations, and employment setting compatibility. Intrinsic reasons for not working during pregnancy included pregnancy-related limitations, home identity, complexity, and family responsibilities. Extrinsic reasons for not working included financial juggle, job availability, and employment setting incompatibility. The results form a basis for anticipatory guidance recommendations for pregnant women.

New fatherhood: myths and realities

Despite evidence for the existence of nurturing fathers, little is known about how and why men increase their involvement with their children. The qualitative study from which these findings were taken explored the experience of 10 Canadian fathers in dual-earner families after the birth of their first infants. The constant comparative method was used to generate a grounded theory explicating the men's process of redefining their roles as spouses, workers, and fathers. Findings from 20 semi-structured interviews conducted with a purposive sample of fathers in their homes revealed that the fathers' experiences consisted of coping with many demands from children, partners, and jobs. These men redefined their roles as fathers after their partners returned to full-time employment. Two stages of monitoring role strain and limiting role strain captured the variation in behavior. This study contributes to community health nurses' understanding of how men respond to the lack of concurrence among societal expectations, others' expectations, and their own realities of fatherhood.

Health and Well-Being of Childbearing Women in Rural and Urban Contexts

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.

Role overload and health: the married mother in the waged labor force

Women are joining the waged labor force in ever increasing numbers, raising the proportion of women who hold multiple roles. Each of these roles frequently place significant time and labor demands on women, causing researchers to speculate on a subsequent negative effect on women's health. Research studies paint colorful images of today's working, married mother but have only begun to identify risks to women's health that might be associated with the increased demands associated with multiple roles.

Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay

Patient delay in seeking help for breast cancer symptoms and provider delay in treating those symptoms combine to decrease a woman's potential for breast cancer survival. This paper reviews the literature on patient and provider delay published since 1975. Meta-analysis of 12 studies using common definitions of patient delay estimates that 34% of women with breast cancer symptoms delay help seeking for 3 or more months. Provider delay appears to be both under researched and underestimated. This review identifies the factors that have been advanced as contributing to patient and provider delay, evaluating the support for each of these reported findings. Theory-based hypotheses emerging from the reviewed studies highlight foci for future investigations.

Shifting the paradigm: toward integrative research on mothers and children

The mother-child relationship has been examined extensively but most research has centered on maternal characteristics associated with poor childhood developmental outcomes or maternal response to stressors. The "maternal deficit" model has misdirected research and intervention. Research on maternal depression based on the maternal deficit model has resulted in research designs that do not adequately address maternal outcomes. Research must be conceptualized to address parent-child relationships and situational factors that influence them.

Paths to concept development in nursing diagnosis

Three pathways to diagnostic concept development are proposed. Principles and methods that operate on each path are presented. Careful concept development contributes to precise diagnostic labels and to the advancement of nursing science.