Satisfaction with perinatal care providers and the childbirth experience: the moderating role of body mass index.

BACKGROUND: Satisfaction with birth and healthcare provider experiences have long-term effects for maternal health. Research has shown that mothers who report more trust, respect, and self-efficacy in their relationship with their healthcare providers are more likely to report positive birthing experiences. Further, individuals with obesity, including pregnant mothers, are more likely to experience weight-related stigma from healthcare providers which may negatively impact satisfaction with this relationship. Thus, the current study examines maternal pre-pregnancy body mass index (BMI) as a moderator between birth and provider satisfaction. METHODS: A sample of 94 women (ages 16-38) were recruited during pregnancy. Participants completed surveys about their satisfaction with their birth experience, provider satisfaction, height, weight, and demographics including age and education. A moderation analysis was used to examine pre-pregnancy BMI as a moderator between birth and provider satisfaction. RESULTS: Results show that provider satisfaction is positively associated with birth satisfaction among mothers with moderate (overweight) to high (obese) pre-pregnancy BMI scores in our sample. CONCLUSIONS: Findings suggest that strengthening the patient-provider relationship may promote satisfaction with birth experiences.

The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission.

INTRODUCTION: Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective interventions. METHODS: Using a longitudinal clinic-based sample of diverse and low-income pregnant women, we examined whether maternal-fetal bonding measured during the second trimester moderated the association between NICU admission and postpartum bonding measured at six months post birth, controlling for demographic characteristics. RESULTS: Approximately 18% of the sample experienced a NICU admission at birth. NICU admission was associated with lower postpartum bonding (b = -8.74; p < .001, Model 1), whereas maternal-fetal bonding was associated with higher bonding reported at six months postpartum (b = 3.74, p < .001, Model 2). Results of the interaction revealed that women who reported higher maternal-fetal bonding reported higher postnatal bonding regardless of NICU admission status. DISCUSSION: Because maternal-fetal bonding can be enhanced through intervention, it is a promising target for reducing the risks of NICU admission for the early maternal-infant relationship.

Maternal childhood adversity and prenatal depression: the protective role of father support.

Depression during pregnancy is common, and previous research suggests childhood adversity may increase the risk for prenatal depression. Support during pregnancy can buffer these risks, and paternal support is associated with improved maternal well-being during pregnancy. There is evidence to suggest that increased support from fathers may be particularly helpful in combatting depressive symptoms for mothers with adverse childhood experiences. The study aims to explore the role of biological father support as a protective factor against the risks associated with childhood adversity for maternal prenatal depression. Sample included 133 pregnant women recruited from two university-affiliated OB-GYN clinics serving diverse and low-income patients. Participants completed measures on childhood adversity, prenatal depressive symptoms, and father support. Results showed a significant moderating effect of father support on the relation between maternal ACEs and prenatal depressive symptoms, suggesting that higher levels of father support are protective against prenatal depressive symptoms, specifically in mothers with low-to-moderate ACEs. These results highlight the positive impact of paternal support for maternal well-being during pregnancy. Although mothers with low-to-moderate ACEs experience a buffering effect of father support, mothers with high levels of childhood adversity remain at elevated risk for prenatal depressive symptoms even with high father support. As such, screening mothers for ACEs in addition to father support may help identify those at higher risk of prenatal depression.

Pregnancy intendedness and happiness as predictors of maternal-foetal bonding: evidence for mediation.

INTRODUCTION: Prior research has identified associations between pregnancy intendedness and maternal-foetal bonding, but no studies have examined the potential mediation of pregnancy happiness on the development of the maternal-infant relationship. METHODS: In 2017-2018, a clinic-based pregnancy cohort of 177 low-income and racially diverse women in a South-Central U.S. state participated in a study examining their pregnancy intentions, attitudes and behaviours. Pregnancy intentions and happiness and demographic characteristics were measured during the first trimester assessment, and maternal-foetal bonding was measured with the Prenatal Attachment Inventory (PAI) during the second trimester. Structural equation modelling was used to examine the associations between intendedness, happiness and bonding. RESULTS: Findings indicate positive associations between intended pregnancies and pregnancy happiness and pregnancy happiness to bonding. The direct effect from intended pregnancy to maternal-foetal bonding was not significant, providing evidence for full mediation. We did not find any associations between pregnancies that were unintended or ambivalent with pregnancy happiness or maternal-foetal bonding. CONCLUSIONS: Pregnancy happiness provides one potential explanation for the association between intended pregnancies and maternal-foetal bonding. These findings have implications for research and practice, as inquiring about mothers' pregnancy attitudes (e.g. how happy they are about their pregnancy) may be more important for maternal psychological health outcomes, such as the maternal-child relationship, than whether or not their pregnancies were intended.

Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness.

OBJECTIVES: Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness. METHODS: Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions. RESULTS: Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness. CONCLUSION: Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.

Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization.

OBJECTIVE: To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. METHODS: A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks. RESULTS: Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39). CONCLUSIONS: The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.

Is Reproductive Orientation Associated with Sexual Satisfaction Among Partnered U.S. Women?

Little is known about how "reproductive orientation" (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers (N = 2811), we examined the association of reproductive orientation with sexual satisfaction, adjusting for relationship characteristics including union type (cohabitation versus marriage), quality, and length; infertility history; and demographic characteristics including age, parity, and race/ethnicity. Results indicated that women who were ambivalent or trying to get pregnant reported significantly higher levels of sexual satisfaction than women who were sterile in the unadjusted model, but not in the models that included relationship quality. The association of reproductive orientation and sexual satisfaction depended upon relationship quality; among women with lower relationship quality, "trying" was associated with higher, and among those with higher relationship quality, with lower sexual satisfaction.

Is a dyadic stressor experienced as equally distressing by both partners? The case of perceived fertility problems.

Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25-45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a fertility problem; in 4%, only the men; and in nearly a fifth (19%), both perceived a problem. Adjusted for characteristics associated with fertility problems and depressive symptoms, those who perceived a problem exhibited significantly more depressive symptoms than those who did not. Fertility problems are sometimes experienced as individual because in some couples only one partner perceives a problem or has higher distress in response to their own rather than to their partners' perceived problems. For women, fertility problems are experienced as a couple phenomenon because women were more distressed when both partners perceive a problem. The perception of fertility problems is gendered in that women were more likely to perceive a problem than men. Furthermore, men are most distressed when they perceive a problem and their partner does not.

Pregnancy intendedness, maternal-fetal bonding, and postnatal maternal-infant bonding.

This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16-38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal-infant bonding postbirth, and higher maternal-fetal bonding scores are associated with higher postnatal maternal-infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy.

Este estudio modela asociaciones entre la intencionalidad de quedarse embarazada y la vinculación materno-fetal prenatal con la vinculación postnatal entre madre e infante. Los embarazos no intencionales se asocian con una vinculación entre madre e infante desorganizada, lo cual tiene implicaciones adversas a largo plazo para el bienestar materno y del niño. Dada la alta proporción de embarazos no intencionales en los Estados Unidos, es esencial identificar factores de protección. Se reclutaron mujeres embarazadas (edades de 16 a 38 años) de dos clínicas prenatales en una ciudad metropolitana en el centro sur de Estados Unidos, en su primera visita prenatal y con seguimiento a lo largo del embarazo y posterior al nacimiento. Los análisis de regresión múltiple examinaron las asociaciones, la mediación y la moderación. Los resultados indican que mientras menos intencional o deseado es el embarazo según lo reportado por las mujeres, más baja es la vinculación posterior al nacimiento tal como lo reportaron ellas, y más altos puntajes de vinculación materno-fetal se asocian con una más alta vinculación postnatal entre madre e infante. Una interacción reveló que un más alto nivel de vinculación prenatal es un factor de protección para la vinculación postnatal entre aquellas con embarazos no intencionales/deseados. Debido a que la vinculación prenatal puede mejorarse a través de la intervención, reducir los riesgos asociados con el embarazo no intencional es una meta prometedora.

Cette étude modèle les liens entre l'intention de la grossesse et le lien prénatal maternel-fœtal avec le lien maternel-nourrisson postnatal. Les grossesses indésirées sont liées à des perturbations du lien maternel-nourrisson, ce qui a des implications défavorables à long terme pour le bien-être maternel et de l'enfant. Etant donnée la grande proportion de naissances indésirables aux Etats-Unis, l'identification de facteurs protecteurs est critique. Des femmes enceintes (âgées de 16 à 38 ans) ont été recrutées dans deux cliniques prénatales d'une ville urbaine de la région Sud-Centrale des Etats-Unis à leur première prénatale et ont été suivies au travers de leur grossesse et après la naissance. Des analyses de régression multiple ont examiné les liens, la médiation et la modération. Les résultats indiquent que plus les femmes faisaient état de grossesses indésirées/non voulues, le moins elles faisaient état de leur lien maternel-nourrisson après la naissance. Les liens maternel-fœtal élevés étaient liés à un lien maternel-nourrisson postnatal plus élevé. Une interaction a révélé qu'un niveau de lien prénatal plus élevé est protecteur pour le lien postnatal chez celles avec des grossesses indésirées/non voulues. Parce que le lien prénatal peut être amélioré au travers de l'intervention cela en fait une cible prometteuse afin de réduire les risques liés à une grossesse indésirée.

Is infertility resolution associated with a change in women's well-being?

STUDY QUESTION: Is giving birth associated with improved subjective well-being among involuntarily childless women? SUMMARY ANSWER: Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms. WHAT IS KNOWN ALREADY: Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted. STUDY DESIGN, SIZE, DURATION: The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem. PARTICIPANTS/MATERIALS, SETTING, METHODS: Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls. MAIN RESULTS AND THE ROLE OF CHANCE: No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01). LIMITATIONS, REASONS FOR CAUTION: Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies. WIDER IMPLICATIONS OF THE FINDINGS: Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike. STUDY FUNDING/COMPETING INTEREST(S): This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.

Immigration-related arrest, parental documentation status, and depressive symptoms among early adolescent Latinos.

OBJECTIVES: Experiencing an immigration-related arrest of a family member adversely impacts youth well-being, yet the role of parental documentation status for exacerbating adverse mental health outcomes following these arrests has not been investigated. METHOD: Using a general population sample of Latino 7th-grade students in an urban public school district in the south-central United States (N = 611), we examined the relationship between an immigration-related arrest of a family member and depressive symptoms as well as the moderating associations of perceived parental documentation status. RESULTS: Using ordinary least squares regression, findings indicate that experiencing or witnessing an immigration-related arrest of a family member is significantly associated with higher rates of depressive symptoms. Moreover, parental citizenship status has a moderating effect; depressive symptoms are magnified among youth who report that both of their parents have undocumented legal status. CONCLUSIONS: The study findings suggest that there are significant consequences for youth well-being when a family member is arrested for immigration-related violations. Further, among youth whose parents are both undocumented, there appears to be a compounding effect on mental health. Immigration policies, programs, and schools need to consider the emotional needs of youth who have undocumented parents, particularly in the context of elevated immigration enforcement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Latino Parent-Child English Language Fluency: Implications for Maternal School Involvement.

Latino parents have lower levels of school involvement compared to other ethnic groups, which is often attributed-though not tested-to low English language proficiency. Using a population-based sample of 637 7th grade Latino youth attending an urban school district, we find no significant difference in maternal school involvement when mothers and students are either both fluent in English or both non-fluent. When students are more fluent than their mothers, however, maternal school involvement is significantly lower, suggesting that schools may need to take additional steps to encourage parental involvement when there is language dissonance between parents and their children.

Neonatal intensive care unit admission and maternal postpartum depression.

Objective: This study aimed to examine the impact of newborns' Neonatal Intensive Care Unit (NICU) admittance on maternal postpartum depression. Background: Prior research on the parental psychological impacts of a NICU admittance typically includes a hospital sample of parents following birth, so the causality of NICU admittance and maternal depressive symptomatology is unclear. Methods: 127 women across 38 counties in a South Central US state participated in online surveys in their third trimester and approximately six weeks post-birth in 2016. Pre- and post-birth assessments of depression were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). NICU admittance was asked in the post-birth survey. t-Tests and multivariable regression analyses were used to determine predictors of NICU admittance and postnatal depressive symptomatology. Results: Findings indicate that prenatal depression does not differ significantly between mothers by NICU admission status, but NICU admission is a significant predictor of postpartum depressive symptomatology. Conclusions: Having a newborn admitted to the NICU is a risk factor for maternal postpartum depression. These findings have implications for practice; screening mothers in the NICU for depression as a target for intervention has the potential to improve maternal well-being, which in turn should enhance subsequent infant developmental outcomes.

Parental documentation status and academic attitudes and expectations among early adolescent latinos.

Many Latino youth are U.S. citizens but live with parents whose immigration status is unauthorized. The association between parental documentation status and early adolescent academic attitudes and expectations is unclear. Using a general population sample of urban 7th grade students who self-identified as Latino in the South Central U.S. (n = 514), we examine the associations between parental documentation status and youth attitudes about the importance of graduating high school and college and expectations of the likelihood of completing high school and attending college. Findings suggest that parent documentation status is not associated with attitudes toward the importance of high school and college among Latino early adolescents, but it is significantly associated with perceptions of the likelihood of achievement. Thus, parent immigration status may be an educational barrier that needs to be addressed early for Latino youth, as efforts in high school may be too late for some students.

The loss of self: The effect of miscarriage, stillbirth, and child death on maternal self-esteem.

A child's death augments how grieving parents view the world, the family, and the self. Using a representative sample of women ages 25-45 who have ever given birth, we assessed whether miscarriage, stillbirth, and child death impact self-esteem and whether this loss is moderated by maternal identity. We found that stillbirth and child death, but not miscarriage, negatively impacted self-esteem. For those who experienced a loss, the impact on self-esteem was moderated by maternal identity. Women who experienced a stillbirth were the only group who had significantly lower self-esteem after controlling for background characteristics and maternal identity variables.

Variation in pregnancy intendedness across U.S. women's pregnancies.

How stable are women's pregnancy intentions across their reproductive lifespans? Are there demographic, social, or attitudinal characteristics that are associated with differing pregnancy intentions patterns? Patterns of intendedness across pregnancies were examined using a sample of 3,110 women ages 25-45 who have been pregnant at least twice from the National Survey of Fertility Barriers. Multinomial logistic regression analyses assessed associations between patterns of intentions and respondents' economic/social status, values and ideologies to determine if intentions are a stable characteristic or pregnancy-specific. The majority of women (60 %) reported varying intendedness across individual pregnancies, indicating that intendedness tends to be pregnancy-specific. Sociodemographic status as well as values and ideologies were significantly associated with pregnancy intendedness patterns. Compared to women who intended each pregnancy, women who were ambivalent, did not intend each pregnancy, or had intermittent intendedness were more likely to be single, younger, Black, report lower importance of motherhood and religiosity and were less likely to be Hispanic. A substantial proportion of women report the intendedness of their pregnancies varied between pregnancies. Research and policy addressing unintended pregnancies should consider that pregnancy intentions are not a static characteristic of most women.

Surgical sterilization, regret, and race: contemporary patterns.

Surgical sterilization is a relatively permanent form of contraception that has been disproportionately used by Black, Hispanic, and Native American women in the United States in the past. We use a nationally representative sample of 4592 women ages 25-45 to determine whether sterilization continues to be more common and consequential by race for reproductive-age women. Results indicate that Native American and Black women are more likely to be sterilized than non-Hispanic White women, and Hispanic and Native American women are more likely than non-Hispanic White women to report that their sterilization surgeries prevent them from conceiving children they want. Reasons for sterilization differ significantly by race. These findings suggest that stratified reproduction has not ended in the United States and that the patterns and consequences of sterilization continue to vary by race.

Maternal postpartum bonding impairment and increased substance use to cope with pandemic-related stress.

Substance use rates, particularly among women, increased substantially during the COVID-19 pandemic. Psychological and economic risks disproportionately experienced by women were associated with increase in substance use patterns during the pandemic. Using substances (i.e., tobacco, alcohol, cannabis) to cope with stress is well-documented; what is less known are protective factors that were associated with less substance use during the pandemic. We examined whether mothers of young children (N = 96) who reported postpartum bonding impairment before the start of the pandemic reported greater substance use during the pandemic as a means to cope. Results from linear regression analyses found that mothers who reported higher levels of pre-pandemic mother-infant bonding impairments reported greater use of alcohol and other substances as a means to cope with pandemic stressors. These findings suggest that social connections might be a strategy to reduce substance use as a maladaptive coping behavior, especially during widespread crises such as the recent pandemic or for mothers of young children. In particular, promoting postpartum bonding through interventions might help to reduce substance use among new mothers.

Maternal periconception food insecurity and postpartum parenting stress and bonding outcomes.

Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchical regression analyses showed that periconception food insecurity was positively associated with parenting stress at 2 months postpartum. A negative association between food insecurity and maternal-infant bonding at 6 months postpartum was mediated after controlling for prenatal depression, social support, and demographic factors. Findings highlight the need for maternal linkage to effective food security programs, such as United States-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for women during their childbearing years due to the critical importance of food security for maternal and infant well-being.