We studied how attachment representations contribute to central components of transition to motherhood, prenatal emotion processing (EP) and emotional availability (EA) of mother-infant interaction, and whether there are group specific differences. Participants were 51 treatment-enrolled substance-abusing (SA) mothers and their infants and 50 non-using comparison dyads with obstetric risk. Mother's attachment representations (AAI) and EP were assessed prenatally and EA when infants were four months. Results showed that autonomous attachment only had a buffering effect on prenatal EP among comparisons. All SA mothers showed more dysfunctional EP than comparisons and, contrary to comparisons, autonomous SA mothers reported more negative cognitive appraisals and less meta-evaluation of emotions than dismissing SA mothers. Preoccupied SA mothers showed high negative cognitive appraisals, suggesting under-regulation of emotions. Attachment representations were not associated with EA in either group; rather, SA status contributed to global risk in the relationship. Surprisingly, autonomous SA mothers showed a tendency towards intrusiveness. We propose that obstetric risk among comparisons and adverse relational experiences among almost all SA mothers might override the protective role of mother's autonomous representations for dyadic interaction. We conclude that prenatal emotional turbulence and high interaction risk of all SA mothers calls for holistic treatment for the dyad.
AIM: To compare mothers' and fathers' individual views and experiences of the attachment process in a neonatal intensive care unit within the first week after a premature birth. BACKGROUND: The attachment between parents and children is a precursor to the consolidation of parenting skills, the growth and development of the infant and the establishment of a bond between parent and child. Premature birth and the resultant hospitalization disrupt the normal attachment process between parent and child. Most of the literature on attachment theory focuses on the mother-child connection and is being criticised for regarding the father's role as supportive and peripheral. METHODS: The design of this study was descriptive with a hermeneutic approach. Twelve parents (six mothers and six fathers) in a 13-bed neonatal intensive care unit in a Norwegian regional hospital participated in a field study addressing the encounter between parents and nurses. This paper is based on the semi-structured interviews with the parents at discharge. RESULTS: The interview analysis revealed two main categories. (a) Taken by surprise: For mothers, the premature birth created a feeling of powerlessness and they experienced the immediate postnatal period as surreal and strange. The fathers experienced the birth as a shock, but were ready to be involved immediately. (b) Building a relationship: Mothers experienced a need to regain the temporarily lost relationship with their child, whereas the fathers experienced the beginning of a new relationship. CONCLUSION: Comparing parents' experiences of the attachment process within the first days after a premature birth reveals a striking contrast between the mother's experience of surrealism and the father's ability to be involved immediately after birth. Relevance to clinical practice. Parents' of premature children's different starting points should be acknowledged as professionals encourage parents to have early skin-to-skin contact with their premature infant.
The object of this study was to examine the role of emotional reactivity in infants with congenital heart defects (CHD) in relation to their mothers' symptoms of postnatal depression. The study population was drawn from the Norwegian country-wide CHD registry from the Department of Pediatric Cardiology at Oslo University Hospital and the Norwegian Mother and Child Cohort Study. Mother-infant dyads with mild/moderate or severe CHD (n=242) were assessed with a 6-item short version (EPDS-6) of the Edinburgh Postnatal Depression Scale and the Infant Characteristic Questionnaire's fussy/difficult subscale (ICQ-D/F-7) at 6 months postpartum. When adjusting for infant emotional reactivity, mothers of infants with severe CHD showed significantly elevated symptoms of postnatal depression 6 months postpartum (odds ratio=2.22) compared to the mothers of infants with mild/moderate CHD. The results identify severe CHD in infants as a predictor of heightened symptoms of postnatal depression in mothers, independent of the infant's emotional reactivity. Although a causal direction underlying the association could not be determined, the possible, negative reciprocal relationships between severe CHD in infants, high levels of emotional reactivity in infants, and symptoms of maternal postnatal depression are considered.
This qualitative and longitudinal study aims at defining a model of early parent-infant relationships in the perinatal period. Eighteen parental couples were interviewed. The resulting model is based on five themes in the parent-infant relationship, i.e. discovery of the infant, physical proximity, emotional closeness, initiation of complementary interactions and personal commitment to the parental role. The article clearly shows the differences between mothers' and fathers' experiences in developing these relationships with their infant. The nurse's assessment of early parent-infant relationships and her interventions are discussed in a second article, p. 32.
OBJECTIVE: To describe how mothers of premature or sick mature babies, experienced the care and their own state of health after birth in postnatal care in a neonatal co-care ward. DESIGN: A Husserlian phenomenology method inspired by Giorgi was used. Six mothers were interviewed using a semi-structured, open-ended interview guide. SETTING: A neonatal ward using a concept of co-care for premature or sick mature babies and their mothers. FINDINGS: In essence, mothers felt that, whatever the circumstances, they wanted to be close to their babies. It was the mother's experience that the organisation, staff or other circumstances prolonged the separation from her baby. The mother experienced the separation from the baby intensely during the first days after birth (even for a short period of time); after returning home, they had still not come to terms with it. The mothers regarded the entire stay in hospital as one event; they did not differentiate between wards or ward staff in the delivery, maternity or neonatal wards. All mothers in the study had, therefore, also experienced part-care for shorter or longer periods when separated from their baby, being then later reunited in co-care. CONCLUSION: This study can be used as a basis for discussion on more individualised care through co-operation and organisation between delivery, maternity and neonatal wards, in order to reduce the amount of time mother and baby are separated.
Maternal intellectual disability (ID) is regarded a risk factor in child development, but there is no scientific evidence on maternal ID in relation to children's attachment. Using a matched comparison design, a small group (n = 23) of mothers diagnosed with ID was studied to help fill this gap. Besides maternal ID, we examined the role of abuse/trauma/maltreatment (ATM) in the mothers' biographies, along with potential confounds. Comparison group mothers (n = 25) had normal variations in intelligence and matched mothers with ID on residential area, income, child age, and sex. History of maternal ATM was assessed using a semi-structured interview and was found to be significantly more likely in the ID group mothers' experience than the comparison group mothers. Children's (M age = 77 months) attachment representations were assessed with the Separation Anxiety Test. Among children of mothers with ID, a substantial minority (35%) had a secure and the vast majority (>80%) an organized attachment representation. Mothers with ID who had suffered elevated ATM were significantly more likely to have children who were scored high on disorganization and insecurity. We discuss possible implications of our findings for societal considerations regarding parenting and child attachment in the context of parental ID status.
To compare the risk of postpartum depression among nulliparous women enrolled in a structured antenatal programme, with nulliparous women allocated to standard care as well as to identify obstetric characteristics in women at risk of developing postpartum depression.
A randomised controlled trial involving 1193 Danish nulliparous women. A total of 603 women attended the "Ready for Child program" and 590 received standard care. Data were collected from the ongoing local birth cohort at Aarhus University Hospital and from questionnaires mailed to the women attending the study.
No difference in postpartum depression was found between those who attended the intervention group and the reference group. Overall, being at risk of postpartum depression was associated with preterm birth, unscheduled caesarean section, low Apgar score, lack of pain relief during labour, experienced low attendance of the midwife in the delivery room, unprepared for hospital discharge, none or minor breastfeeding in the early postpartum period, insufficient knowledge about breastfeeding, poor or fair self-rated mental health, and uncertain or weak attachment to the newborn child.
The findings suggest that a short general antenatal programme in pregnancy may not be sufficient to prevent postpartum depression six weeks after birth. However, there are several risk factors during the birth process and the early postpartum period that can help identify women at risk for developing depression.
(i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire - Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women.
Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.
A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item-subscale correlations, Cronbach's a, and a if item deleted) was evaluated for the seven available subscales. Confirmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test-retest correlations were assessed in a subgroup (n = 48).
All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach's a's for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Confidence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale a's. The CFA demonstrated better model fit for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test-retest correlations ranged from 0.65 to 0.84.
The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts.
OBJECTIVE: to gain a deeper understanding of both parents' experiences during the mother's stay in hospital for threat of an early delivery and eventual preterm birth. DESIGN: explanatory design with separate interviews for mothers and fathers using the grounded theory method. SETTING: University Hospital in southern Sweden. PARTICIPANTS: 17 mothers and six fathers, who had experienced a threat of early delivery and eventual preterm birth, while the mother was in hospital. FINDINGS: the core category 'inter-adapting' and the following three categories and six subcategories emerged: interacting (communicating with the professional caregivers; keeping the family together through a stressful situation; seeking empowerment during labour and birth); reorganising (arranging for a new family situation); and caring (accepting the restrictions for the health of the fetus; reaching out to the baby and taking part in the care). KEY CONCLUSIONS: during the mothers' stay in hospital, the most stressful issues experienced were the parents' concern for the baby and the separation from the family. Parents are able to manage the situation by mutually adapting to each other, family members, significant others and caregivers. A new concept 'inter-adapting' therefore emerged. IMPLICATIONS FOR PRACTICE: for perinatal care, feelings of separation can be reduced and family bonds strengthened through integrating the different wards involved.
The Ojibwe have transitioned over the past 100 years from a woodland people moving with the seasons, to forced confinement on rural reservations, to inner-city poverty. Traditionally, Ojibwe women's knowledge has been passed through the generations orally. Using ethnographic methods, data were gathered on traditional infant feeding practices from Ojibwe women (N = 44). Few of these traditions have been documented previously. Some traditions are similar to other indigenous cultures while others are culturally specific. Understanding traditional breastfeeding practices can provide valuable information for those working with indigenous people in a variety of settings, so that they create services that are consistent with traditional values.