Biologically normal sleep in the mother-infant dyad.

OBJECTIVES: We examine infant sleep from evolutionary, historico-cultural, and statistical/epidemiological perspectives and explore the distinct conceptions of "normal" produced by each. We use data from the "Sleeping Like a Baby" study to illustrate how these perspectives influence the ideals and practices of new parents. METHODS: The "Sleeping Like a Baby" study investigated maternal-infant sleep in north-east England. Sleep data for exclusively breastfeeding (EBF) and formula-feeding (EFF) dyads were captured every 2 weeks from 4 to 18 weeks postpartum through actigraphy and maternal report. Mothers also reported their infant sleep ideals and practices. Results explore objective and maternally-reported infant sleep parameters, and concordance of maternal ideals and practices with public health guidance. RESULTS: Comparison of sleep measures showed that mothers overestimate infant sleep duration compared with actigraphy; EFF mothers' reports were significantly more inaccurate than those of EBF mothers. For infants moved to a separate bedroom, maternally-reported sleep increases were not borne out by actigraphy. Across the study period, concordance of maternal ideal sleep location with public health recommendations occurred on average for 54% of mothers, while concordance in practice fell from 75% at 4-8 weeks to 67% at 14-18 weeks. Discordance for EBF dyads occurred due to bedsharing, and for EFF dyads due to infants sleeping in a room alone. CONCLUSIONS: Beliefs about "normal" infant sleep influence parents' perceptions and practices. Clinical and scientific infant sleep discourses reinforce dominant societal norms and perpetuate these beliefs, but biological and evolutionary views on infant sleep norms are beginning to gain traction with parents and health practitioners.

Residential immersive life skills programs for youth with disabilities: a case study of youth developmental trajectories of personal growth and caregiver perspectives.

BACKGROUND: Professional support in pediatric and rehabilitation care environments has been recommended as a means to build youth competence in life skills during their transition to adulthood. Life skills are the essential psychosocial competencies and interpersonal skills needed to manage one's life. Residential immersive life skills (RILS) programs offer youth with physical disabilities enriched learning environments to acquire these skills. This study explored trajectories of personal growth in life skills and positive psychological outcomes among youth participating in a RILS program and related caregiver perspectives. METHOD: Delivered by a multidisciplinary healthcare team, The Independence Program is an intensive summer program housed in a college residence that provides realistic experiences of living away from home for small groups of youth between 17 and 21 years of age who have congenital and/or acquired physical disabilities. Using a longitudinal case study and qualitative descriptive design, four youth and their parents/guardians participated in semi-structured interviews prior to, and then 1 month, and 3 to 4 months after the program. A conventional content analysis yielded chronological narratives for each youth and caregiver dyad of their experiences, perceptions and outcomes over time. These narratives were further summarized using a 'line of development' perspective to describe individual developmental trajectories of personal growth. RESULTS: All four of the youth returned from the program with positive reports about the new life skills acquired and new behaviours they engaged in. These positive reports generally continued post-program, albeit with differing trajectories unique to each youth and varying levels of congruence with their caregivers' readiness to support, accommodate and facilitate these changes. Caregivers differed in their capacity to shift in their parenting role to support consolidation of youth life skill competencies following program participation. CONCLUSIONS: RILS programs can be transformative. Varied youth trajectories identified significant personal growth through enhanced self-determination, self-efficacy and self-advocacy. Congruence in youth and caregiver perceptions of post-program changes was an important transactional factor. Professional support addressing caregiver needs may be beneficial to facilitate developmentally appropriate shifts in parenting roles. This shift is central to a model of shared management whereby adolescents take on greater responsibility for their own care and life choices.

Residential immersive life skills programs for youth with disabilities: Experiences of parents and shifts in parenting approaches.

INTRODUCTION: Residential immersive life skills (RILS) programs are designed for youth with disabilities and facilitate the development of adaptive behaviors for life skills required to navigate adulthood. This study explored parents' experiences of the RILS program journey, shifts in parenting approaches, and the implications of those shifts. METHODS: This study draws on twenty-three qualitative interviews that were conducted with nine parents of youth who attended RILS programs in Ontario, Canada. Three rounds of interviews were conducted at three different time points: Pre-program, 3 months post-program, and 12 months post-program. Data were analyzed using a constructivist grounded theory approach. RESULTS: The interviews captured parents' experiences of the RILS program journey and how their parenting changed as a result. Three overarching themes emerged: (1) Anticipation of RILS programs served as a catalyst for experiencing positive and negative tensions in parenting; (2) Parenting shifted following RILS programs; and (3) Where parenting shifts were limited, challenges for youth arose and reduced youth future growth. CONCLUSION: Parenting approaches can shift as a result of youth attending RILS programs. These shifts can create complex and challenging implications for parents as they seek to further encourage youths' development. This study offers an understanding of the implications of parenting during youths' developmental transition of adolescence to adulthood, and offers recommendations to further support parents in sustaining youth development of life skills during this developmental transition.

Exploring Maternal Perceptions of Infant Sleep and Feeding Method Among Mothers in the United Kingdom: A Qualitative Focus Group Study.

BACKGROUND: In a context with strong rhetorical support for breastfeeding in the health system, yet extremely low rates of breastfeeding after hospital discharge, U.K. women's decisions about infant feeding reflect the reality of competing priorities in their lives, including obtaining adequate sleep. Popular wisdom in the U.K. tightly links breastfeeding and inadequate night-time sleep. Mothers are advised by peers and family to introduce formula or solid foods to infants to promote longer sleep. OBJECTIVES: The first objective of this study was to investigate women's understandings of the nature of infant sleep and their perceptions of links between infant feeding method and sleep. The second was to explore how these perceptions influence infant feeding and sleep practices. Underpinning our work is the understanding that infant care choices result from trade-offs by which mothers strive to balance infant- and self-care. METHODS: We conducted seven focus groups with mothers of infants in two regions of the U.K. Verbatim transcripts were thematically coded and emergent themes were identified. RESULTS: We found clearly diverging narratives between breastfeeding and formula-feeding mothers. Breastfeeding mothers viewed the fragmentary nature of infant sleep as natural, while mothers who were formula feeding felt this was a problem to be fixed. CONCLUSIONS AND PRACTICE: The strategies used to promote infant and maternal sleep in each group were aligned with their underlying perception of how infant sleep works. Maternal perceptions of the nature of infant sleep and its relation to infant feeding method impact infant care practices in the first year of life.

Oxytocin and Epstein-Barr virus: Stress biomarkers in the postpartum period among first-time mothers from São Paulo, Brazil.

OBJECTIVES: The purpose of the study was to examine the relationship between self-reported stress levels among new mothers in São Paulo, Brazil and two biomarkers of stressful experience, oxytocin (OT) and Epstein-Barr Virus antibody level (EBV-ab), with planned pregnancy hypothesized as a moderator of biological response to stressful conditions. METHODS: Sixty-three first-time mothers between the ages of 15 and 45 were recruited from neighborhoods in São Paulo, Brazil. Quantitative and qualitative data were collected longitudinally, bi-weekly between two and 12 weeks postpartum. OT level was assessed from breast milk samples and EBV-ab from blood spot samples. An Interpersonal Satisfaction scale was developed, validated, and administered, along with the Cohen perceived stress scale (PSS). RESULTS: In-depth interview data revealed unplanned pregnancy to be a significant stressor in the lives of first-time mothers. In linear regression, OT level was negatively associated with interpersonal satisfaction score (P = 0.022) and positively associated with PSS score (P = 0.007). When splitting the sample by planned status of the pregnancy, women with an unplanned pregnancy showed a strengthened positive association between OT level and PSS (P = 0.001; Adj R(2) = 0.44) and negative association with interpersonal satisfaction (P = 0.017; Adj R(2) = 0.15), while no associations existed for women with a planned pregnancy. EBV-ab level was not correlated or associated with stress/satisfaction measures. CONCLUSION: OT is an effective biomarker in the measurement of stress in the body, and additionally reflects differential experiences with difficult interpersonal circumstances, such as unplanned pregnancy. By contrast, EBV-ab failed to reflect differences in self-reported stress levels between mothers.

Relationships between postpartum depression, sleep, and infant feeding in the early postpartum: An exploratory analysis.

Introduction: The study objectives were to determine the relationships between postpartum depression and maternal and infant sleep parameters and to examine the impact of infant feeding method on infant and maternal sleep and postpartum depression symptomatology. Methods: Participants were 61 new mothers aged 18 to 45 years old, and their full-term, normal birth-weight, singleton infants. Participants were recruited from a large teaching hospital in northeast England. Data collection took place in participants' homes. The study used a prospective longitudinal design, with data collected at six, 12 and 18 weeks postpartum. We collected data on total sleep time, longest sleep period, wake after sleep onset, and night waking for mothers and infants objectively from actigraphic records and subjectively from maternal sleep logs. Participants reported on sleep disturbances using the General Sleep Disturbances Scale, on maternal sleepiness, and on depression symptomatology using the Edinburgh Postnatal Depression Scale. Results: Scores on the Edinburgh Postnatal Depression Scale and General Sleep Disturbances Scale were consistently correlated with each other (6 weeks r = 0.452, p < 0.01; 12 weeks r = 0.317, p < 0.05; 18 weeks r = 0.493, p < 0.01), and did not correlate with objective measures or subjective reports of maternal or infant sleep. Edinburgh Postnatal Depression Scale scores at six, 12 and 18 weeks were predicted by General Sleep Disturbances Scale, prior Edinburgh Postnatal Depression Scale score, or both, but not by sleep parameters. With regard to infant feeding method, EPDS score was not higher among exclusively breastfeeding than among exclusively formula-feeding participants at any time point (6 weeks t = 0.306, p = 0.762; 12 weeks t = 0.343, p = 0.733; 18 weeks t = 0.426; p = 0.673). Different pathways emerged to predict Edinburgh Postnatal Depression Scale score for exclusively breastfeeding and exclusively formula-feeding women. Discussion: Postpartum depression may be associated with disturbed sleep due to negative perception of sleep among depressed women, rather than disrupted sleep causing postpartum depression. With regard to infant feeding method, exclusively breastfeeding women are not more likely to suffer from postpartum depression, and different pathways may predict development of postpartum depression symptoms in exclusively breastfeeding and exclusively formula feeding women.

Determinants of tubal ligation in Puebla, Mexico.

Tubal ligation provides an effective and reliable method by which women can choose to limit the number of children they will bear. However, because of the irreversibility of the procedure and other potential disadvantages, it is important to understand factors associated with women's choice of this method of birth control. Between May 1999 and August 2000, data were collected from 755 women aged 40 to 60 years from a cross-section of neighborhoods of varying socio-economic make-up in Puebla, Mexico, finding a tubal ligation rate of 42.2%. Multiple logistic regression models were utilized to examine demographic, socio-economic, and reproductive history characteristics in relation to women's choice of tubal ligation. Regression analyses were repeated with participants grouped by age to determine how the timing of availability of tubal ligation related to the decision to undergo the procedure. The results of this study suggest that younger age, more education, use of some forms of birth control, and increased parity were associated with women's decisions to undergo tubal ligation. The statistically significant difference of greater tubal ligation and lower hysterectomy rates across age groups reflect increased access to tubal ligation in Mexico from the early 1970s, supporting the idea that women's choice of tubal ligation was related to access.

Discrepancies in maternal reports of infant sleep vs. actigraphy by mode of feeding.

OBJECTIVES: Many studies of infant sleep rely solely on parentally-reported data, assuming that parents accurately report their infant's sleep parameters. The objective of this paper is to examine whether night-time sleep parameters of exclusively breastfed or exclusively formula-fed infants differ, and whether correspondence between parental reports and objective measures varies by feeding type. METHODS: Mother-infant dyads intending to breastfeed or formula-feed exclusively for 18 weeks were recruited. Mothers were multiparas and primiparas, aged between 18 and 45 years. Infants were full-term, normal birthweight singletons. Maternal report and actigraphic data on infant sleep were collected fortnightly, from four to 18 weeks postpartum. Data were analysed cross-sectionally using t-tests and GLM analysis to control for interaction between feed-type and sleep location. RESULTS: Actigraphy-assessed infant sleep parameters did not vary by feed-type but parentally reported sleep parameters did. Maternal report and actigraphy data diverged at 10 weeks postpartum and discrepancies were associated with infant feeding type. Compared to actigraphy, maternal reports by formula-feeding mothers (controlling for infant sleep location) over-estimated infant's Total Sleep Time (TST) at 10 weeks and Longest Sleep Period (LSP) at 10, 12 and 18 weeks. CONCLUSIONS: These results raise questions about the outcomes of previous infant sleep studies where accuracy of parentally-reported infant sleep data is assumed. That parental reports of infant sleep vary by feeding type is particularly important for reconsidering previous studies of infant sleep development and intervention studies designed to influence sleep outcomes, especially where feed-type was heterogeneous, but was not considered as an independent variable.

Examining health equity through satisfaction and confidence of patients in primary healthcare in the Republic of Trinidad and Tobago.

Surveys of patient satisfaction are widely used for identifying priorities and problems in healthcare reforms. The present study examined satisfaction and confidence of patients in public healthcare in Trinidad and Tobago. Data were gathered by interviewing a random sample (n = 280) of primary healthcare (PHC) patients. Level of patient satisfaction was high but not constant. Results of interviews showed that patients with a higher monthly income (p = 0.032) and patients who most recently used private medical care (p = 0.037) had lower levels of satisfaction with health services. Employment had an effect on satisfaction (p = 0.065), significant among patients who had recently accessed private medical care (p = 0.039). Patients using PHC clinics preferred private care to public care. Confidence in public care decreased with increasing complexity of the medical condition. These preliminary results support continued efforts in health-sector reforms and call for the enhancement of data on satisfaction through more comprehensive qualitative data-collection methods.