Transition to Motherhood: Adverse Childhood Experiences, and Support from Partner, Family and Friends

BACKGROUND

The complex identity changes women have to go through to become mothers makes it a challenging transitional period. Especially, mothers who have experienced childhood adversity (ACEs) may be vulnerable to poor adjustment to motherhood. However, support from a partner, family and friends can act as a buffer to cope with this challenging transitional period. Therefore, the aim was to study whether ACEs and experienced social support (partners, family, and friends) were related to the adjustment to motherhood or 'motherhood constellation' of women after the birth of their first child.

METHOD

Data were collected via an online questionnaire among first-time mothers from June-September 2020. Motherhood constellation was measured with four items based on the descriptions by (Stern, 1995) about the motherhood constellation, i.e. worries about Life/Growth, Emotional Engagement, Support Systems, Identity Organisation. Multiple regression analyses with pairwise deletion were conducted.

RESULTS

ACEs were related to all four themes of motherhood constellation, indicating that the more frequent these adverse experiences occurred in the past the more concerns, both about the child and herself, the mother had. Moreover, after controlling for ACEs and other forms of support, only support from friends was related to the use of support systems and identity organisation. Finally, statistically significant interactions were found between ACES and support from friends with life/growth and between ACES and support from family with identity organisation. These interactions indicated that contrary to the expectation the positive association between mother's ACEs and worries was stronger for mothers who experienced more support.

CONCLUSION

The consequences of ACEs seemed to show up in the transition to motherhood, indicating that interventions targeting first-time mothers should address the motherhood constellation that may arise from earlier adverse life experiences. Moreover, especially support from friends seemed to be associated with less worries among mothers. Social support has no buffering effect for the negative consequences of ACEs on the themes of motherhood constellation. Further research is clearly needed to get more insight into these themes and to understand the meaning of different types of social support during the transition to motherhood.

Towards an integrated perinatal care pathway for vulnerable women: The development and validation of quality indicators

OBJECTIVE

Development and validation of a set of quality indicators for vulnerable women during the perinatal period.

DESIGN

A three-phase method was used. Phase 1 consisted of a literature review to identify publications for the development of care domains and potential QIs, as well as a quality assessment by the research team. In phase 2 an expert panel assessed the set of concept QIs in a modified three-round Delphi survey. Finally, semi-structured interviews with vulnerable women were conducted as a final quality assessment of a set of indicators (phase 3). Ethical approval was obtained from the ethics committee of the University Hospital Brussels and from the Ethics Committees of all the participating hospitals.

SETTING

The Flemish Region and the Brussels Capital Region in Belgium.

PARTICIPANTS

Healthcare and social care professionals (n = 40) with expertise in the field of perinatal care provision for vulnerable families. Vulnerable women (n = 11) who gave birth in one of the participating hospitals.

FINDINGS

The literature review resulted in a set of 49 potential quality indicators in five care domains: access to healthcare, assessment and screening, informal support, formal support and continuity of care. After assessment by the expert panel and vulnerable women, a final set of 21 quality indicators in five care domains was identified. First of all, organisation of care must involve an integrated multidisciplinary approach taking account of financial, administrative and social barriers (care domain 1: access to healthcare). Second, qualitative care includes the timely initiation of care, a general screening of the various aspects of vulnerability (biological, psychological, social and cognitive) and a risk assessment for all women (care domain 2: assessment and screening). Vulnerable women benefit from intensive formal and informal support taking account of individual needs and strengths (care domain 3: formal support; care domain 4: informal support). Finally, continuity of care needs to be guaranteed in line with vulnerable woman's individual needs (care domain 5: continuity of care).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Implementing quality indicators in existing and new care pathways offers an evidence-based approach facilitating an integrated view promoting a healthy start for woman and child. These quality indicators can assist healthcare providers, organisations and governmental agencies to improve the quality of perinatal care for vulnerable women.

Sexually Transmitted and Blood-Borne Infections in Pregnant Women and Adverse Pregnancy Outcomes

OBJECTIVES

To analyze risk factors for the presence of sexually transmitted and blood-borne infections (STBBIs) in pregnancy and to determine whether pregnant women with STBBIs are more likely to experience adverse pregnancy outcomes.

METHODS

This retrospective cohort study involved analyzing the electronic records of 3460 pregnant women followed at Sainte-Justine Hospital in Montréal, Québec, between March 2017 and January 2019. An outcome is defined as a pregnancy where the woman has at least one positive laboratory result for chlamydia, gonorrhea, syphilis, hepatitis B, or hepatitis C (i.e., has one or multiple STBBIs). We performed a logistic regression analysis to determine adjusted odds ratios (aORs) for the risk factors of STBBIs in pregnant women.

RESULTS

We identified 84 positive STBBI cases, an overall prevalence of 2.4% (95% CI 1.9-2.9). A logistic regression analysis showed the following factors to be significantly associated with the presence of STBBIs in pregnancy: age <20 years (OR 4.75; 95% CI 1.89-11.96), age 20-29 years (OR 2.38; 95% CI 1.37-4.14), Afro-Caribbean origin (OR 4.12; 95% CI 1.83-9.27), other non-Caucasian origin (OR 2.38; 95% CI 1.20-4.70), and history of STBBIs (OR 2.33; 95% CI 1.02-5.36). STBBIs were not significantly associated with social and material deprivation indices nor were they associated with low birth weight or preterm birth.

CONCLUSION

This study shows age <20 years, age 20-29 years, Afro-Caribbean or other non-Caucasian origin and history of STBBIs to be risk factors for the presence of STBBIs in pregnancy. These results will allow us to propose interventions to reduce STBBIs in women with common risk factors as part of a comprehensive approach to perinatal care.

Cross-cultural adaptation of the Preterm Parenting & Self-efficacy Checklist

ABSTRACT Objective: To conduct a cross-cultural adaptation of the Preterm Parenting & Self-Efficacy Checklist to the Brazilian Portuguese. Method: A methodological study was carried out with 51 parents of premature infants. Data analysis was based on psychometric and inferential statistical analyses. Results: The instrument content validation by experts obtained excellent agreement (97%) and the semantic analysis by the target population showed good understanding of the terms and ease of use. In test-retest, most participants were female (64.7%); and parents with higher education (47.1%). The instrument showed stability over time, with good internal consistency (α = 0.84). Four factors were generated in the subscales parenting self-efficacy, importance of tasks and self-perceived parental competence (67.0% to 74.2% of the variance). Conclusion: The properties of the Preterm Parenting & Self-Efficacy Checklist – Brazilian Version were maintained, which is a reliable indicator to evaluate the hospital discharge of premature infants.

Sexual risk behavior among HIV-infected women in South Africa at 12-months postpartum

The postnatal period is a time of increased susceptibility to HIV infection and superinfection for postpartum women, sexual partners, and infants. This study examined the effect of a prevention to mother-to-child transmission of HIV intervention compared to standard care, and factors associated with unprotected last sex and inconsistent condom use at 12-months postpartum. Participants were N = 1399 HIV-infected women 6-30 weeks pregnant (M = 18 weeks (SD = 5.75)) assessed during pregnancy and 12-months postpartum. Women were aged an average of 28 (SD = 5.82); 48% reported 10-11 years of education. Older age (adjusted odds ratio [AOR] = 1.00) and being employed (AOR = 1.51) were associated with greater odds of unprotected sex at 12-month postpartum. Disclosure of HIV status (AOR = 0.64) and greater male involvement during pregnancy (AOR = 0.92) were associated with lower odds of unprotected sex at 12-month postpartum. HIV negative or unknown partner status (AOR = 0.45) and greater depressive symptoms (AOR = 0.97) were associated with lower odds of inconsistent condom use at 12-months postpartum. The intervention was not associated with reduced sexual risk behavior. Future studies should address male involvement and consider measurement of culturally tailored male involvement constructs for men South Africa. Perinatal women may require support for sexual communication and gender equity to reduce sexual risk.

Partner relationship satisfaction, partner conflict, and maternal cardio-metabolic health in the year following the birth of a child

Intimate partner relationship quality during the child-bearing years has implications for maternal health. The purpose of this study was to test whether partner satisfaction, partner conflict, and their interaction predicted maternal cardio-metabolic health at 12-months postpartum. Women were recruited in 5 U.S. sites. Partner conflict and satisfaction were measured at 6-months postpartum, and cardio-metabolic indicators (blood pressure, waist-hip ratio, glycosylated hemoglobin, total cholesterol:HDL ratio) were assessed at 6- and 12-months. Cardio-metabolic indices were scored continuously (CM risk) and using clinical risk cutoffs (CM scores). A significant conflict-by-satisfaction interaction emerged for the CM risk, b(SE) = .043 (.016), p = .006, and CM scores, b(SE)= .089 (.028), p = .002, such that when partner satisfaction was low, low partner conflict was associated with poorer postpartum cardio-metabolic health. This is the first study to examine close relationships and cardio-metabolic health during the child-bearing years, an issue warranting further attention.

Experiences of Austrian mothers with mobility or sensory impairments during pregnancy, childbirth and the puerperium: a qualitative study

BACKGROUND

Approximately 8% of all women of childbearing age in Austria live with permanent impairments. In everyday life, women with disabilities face various challenges and discrimination, among which the issue of pregnancy and motherhood, in particular, is often considered taboo, and their parenting abilities are doubted. Knowledge in the medical field about the experiences of women with disabilities during pregnancy, childbirth and the puerperium is limited.

METHODS

To investigate the personal meanings and experiences of women with disabilities in regard to pregnancy, childbirth and the puerperium, in-depth individual, semi-structured interviews were conducted with ten mothers with various mobility or sensory impairments who reside in Austria. The qualitative interview data were analyzed using the qualitative content analysis proposed by Mayring.

RESULTS

Three main themes or categories emerged from the inductive content analysis, namely, (i) the social network, (ii) self-efficacy and self-awareness and (iii) communication, transparency and information. Participants reported limited acceptance of their life decisions and experienced an environment of discriminatory attitudes. They experienced a lack of support and lack of confidence in their parenting abilities, which negatively influenced their self-efficacy and self-awareness. Violations of personal borders and a feeling of being watched and controlled were reported. Communication with health care professionals was often characterized by mutual aspects of fear, uncertainty and awkwardness, as perceived by women with disabilities. Adequate information about pregnancy, childbirth and the puerperium, particularly about measures taken and interventions applied, was frequently missing.

CONCLUSION

Heath care facilities need to be structured to ensure ease of access for women with disabilities. Education should be offered to health care professionals to improve knowledge about care for women with disabilities and to strengthen communication skills. All necessary information needs to be prepared and provided in an adequate manner. The establishment of a health-promoting environment for mothers, their children and their families requires a sensitive, respectful and non-judgmental attitude of society toward women with disabilities during pregnancy, childbirth and the puerperium.

Transition to parenthood during the transition to modernity in Jordan: New parents' views on family and healthcare support systems

AIMS AND OBJECTIVES

This study aims to explore new parents' experiences of family support during their transition to parenthood.

BACKGROUND

Family support is widely considered a crucial factor in contributing toward positive outcomes for parents during transition to parenthood. However, inter-generational and socio-cultural differences among family members in understandings and practices of childcare can be a source of tension between new parents and family members. Few studies have examined the role of family support in the context of rapid social change taking place in Middle Eastern countries. This study aims to address this gap by examining the parenting experiences of young Jordanian couples within the family context they are embedded in.

RESEARCH DESIGN AND METHODS

A qualitative study was conducted in Jordan involving sixty semi-structured, in-depth interviews. Twenty mothers, twenty fathers, and twenty family members identified as support providers were interviewed.

RESULTS

The key theme, "it's too much" emerged from interviews to describe the nature of family support experienced by new parents from marriage to pregnancy and until after the arrival of their first child. The study found varied interpretations of traditional child-care practices among older and younger generation of family members, leading to family conflict. This study also found that the lack of credible information from the health system about child-care compelled them to accept the only available information for them from their parents, often times with much resistance and reluctance. This created a situation of stress and anxiety among young parents and undermined the potential for healthy parenting experience. This study also found that not all social support during early days of parenthood led to beneficial health outcomes to mother and child."Social visiting" by family members to hospital and home, was particularly found to interfere with new parents' pursuit toward privacy and family bonding, immediately following the birth of child.

CONCLUSION

This study has produced a new understanding of the experience of Jordanian new parents' transition to parenthood. This study particularly sheds light on the current dilemma in which these Jordanian new parents find themselves in, which reflect a clash between traditional and modern values. Although the findings aim to contribute to the body of literature that deals with cultural influences on new parents' experiences in Jordon, the learning could be relevant to the other contexts in the Middle Eastern societies.