Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial.

BACKGROUND: The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. In turn, distressed parents are at higher risk for providing suboptimal quality of caregiving. As psychoeducational interventions can be effective in reducing psychological distress, the goal of this randomized controlled trial was to examine the effectiveness of low-intensity universal psychoeducational program to prevent postpartum parenting stress, and to enhance parental well-being and caregiving quality. METHOD: Between 26 and 34 weeks of pregnancy, 138 pregnant women and 96 partners were randomized to the intervention or a waitlist control group. The intervention consisted of a booklet, a video, a home visit, and a telephone call. Information was provided on (1) sensitive responsiveness, adapting to the parental role, and attending to own needs; (2) crying patterns; (3) feeding (arrangements); and (4) sleeping (arrangements). The primary outcome was parenting stress postpartum. Secondary outcomes were additional measures of distress (depression and anxiety), parental well-being, and caregiving quality. RESULTS: Both groups showed a rise in distress after birth. No between-group differences were observed on parenting stress, nor on the secondary outcomes. The intervention was rated as useful and of added value by the parents. CONCLUSION: This study offered no evidence that our universal prevention program was effective in decreasing parental distress or in increasing caregiving quality. However, parents found aspects of the intervention useful. More research is needed, including a longer period of follow-up as well as observational measures of parents' responsiveness. TRIAL REGISTRATION: This trial has been registered on 15 September 2016 in the Netherlands National Trial Register, ID: NTR6065, https://www.trialregister.nl/trial/5782 .

Using the Coronavirus Pandemic as an Opportunity to Address the Use of Human Milk and Breastfeeding as Lifesaving Medical Interventions.

Health care providers should use this current pandemic as an opportunity educate the public about the importance of human milk and breastfeeding as lifesaving medical interventions.

Perceived Infant Well-Being and Self-Reported Distress in Neonatal Nurses.

BACKGROUND: Infants who are admitted to a neonatal intensive care unit (NICU) may experience significant symptom burden. Parents are often distressed by these symptoms, which can affect their long-term coping and distress. There is limited research examining nurse perceptions of infant well-being (symptoms, suffering, and quality of life [QOL]) and associations with nurse distress. OBJECTIVE: The objective of this descriptive study was to explore associations between nurse perceptions of infant well-being and self-reported distress. METHODS: Nurses caring for infants with potentially life-threatening/life-limiting conditions were recruited from a Level IV NICU in the Midwestern United States as a part of a study on infant symptom burden. Nurses reported their perceptions of infant well-being and their own distress on a 5-point Likert scale. Surveys were administered at the bedside weekly for up to 12 weeks, depending on length of stay. Infant suffering and QOL were examined in relation to nurse distress. A cross-classified multilevel model was used to account for dependence within nurse and within patient. RESULTS: A total of 593 surveys were collected from nurses. Using a cross-classified multilevel model with variables entered simultaneously, nurse perceptions of greater infant suffering and lower infant QOL were significantly associated with greater nurse distress. DISCUSSION: Preliminary evidence shows that greater perceived infant suffering and lower perceived infant QOL may be associated with greater levels of self-reported distress in NICU nurses. Further work is needed to better understand factors related to symptom management in the NICU and the potential role of caregiver distress and compassion fatigue in NICU nurses.

Maternal experience of their infants' crying in the context of war trauma: Determinants and consequences.

We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.

Examinamos, primero, cómo la prenatal salud mental materna y el trauma de guerra predecían la manera como las madres experimentan el llanto de sus infantes, según lo indicaban las emociones, la cognición y la conducta, y segundo, cómo esas experiencias influían en la interacción madre-infante y el desarrollo del infante. Las participantes fueron 511 madres palestinas de la franja territorial de Gaza, quienes reportaron sobre su trauma de guerra, los síntomas del trastorno de estrés postraumático (PTSD), la depresión y la percepción de estrés durante el embarazo (T1). Ellas reportaron experiencias de llanto del infante a los cuatro meses (T2), y la interacción madre-infante y el desarrollo sensorial-motor y de lenguaje del infante a los 12 meses de edad del infante (T3). Los resultados revelaron que los problemas de salud mental maternos, aunque no así el trauma de guerra, eran importantes para experimentar el llanto del infante. Un alto nivel de síntomas de PTSD predijo las negativas emociones evocadas por el llanto del infante, y altos síntomas depresivos reducen las activas y positivas respuestas al llanto. Inesperadamente, la alta precepción de estrés prenatal predijo una alta sensibilidad activa y positiva. Con respecto a las consecuencias, la sensible interpretación que las madres tenían del llanto de sus infantes predijo el desarrollo sensorial-motor del infante, y las respuestas activas y positivas de la madre predijeron la alta disponibilidad emocional en la interacción madre-infante. El llanto es la primera herramienta de comunicación para los infantes, y las respuestas sensibles de las madres al llanto contribuyen al bienestar del infante. Por tanto, es importante reforzar las respuestas óptimas de las madres cuando se trata de ayudar a díadas afectadas por la guerra.

Nous avons d'abord examiné comment la santé mentale maternelle prénatale et le traumatisme de guerre ont prédit l'expérience que les mères se faisaient de leur nourrisson pleurant, indiquée par les émotions, les cognitions et le comportement, et ensuite comment ces expériences ont influencé l'interaction mère-bébé et le développement du nourrisson. Les participantes ont consisté en 511 mères palestiniennes de la bande de Gaza, faisant état de leur traumatisme lié à la guerre, de symptômes de stress posttraumatique (TSPT), de dépression et de stress perçu durant la grossesse (T1). Ces participantes ont fait état d'expériences de leur nourrisson pleurant au cours de quatre mois (T2) et de l'interaction mère-nourrisson et du développement sensorimoteur et du développement du langage à douze mois d'âge pour le nourrisson (T3). Les résultats ont révélé que les problèmes de santé mentale de la mère, et non le trauma de la guerre, étaient importants pour l'expérience du bébé pleurant. Un niveau élevé de symptômes TSPT a prédit les émotions négatives évoquées par le bébé pleurant, et des symptômes dépressifs élevés ont prédit des réactions positives et peu actives aux pleurs. Contre toute attente, un stress perçu prénatal élevé a prédit une réaction positive et active élevée. Pour ce qui concerne les conséquences, l'interprétation sensible des mères de leur bébé pleurant a prédit le développement sensorimoteur optimal du bébé et les réactions actives et positives des mères ont prédit une disponibilité émotionnelle élevée dans l'interaction mère-nourrisson. Pleurer est le premier outil de communication pour les bébés et les réactions sensibles des mères aux pleurs contribuent au bien-être du bébé. Il est donc important de renforcer les réactions optimales des mères lorsqu'on aide les dyades affectées par la guerre.

Newborn Care Practices of Mothers in Arab Societies: Implication for Infant Welfare.

INTRODUCTION: There are at least 22 Arab league states and sections in Northern Africa, southwestern Asia, and Europe that incorporate the vast Middle Eastern culture. The purpose of this study was to identify the cultural variations in newborn care practices, self-management of common illnesses, and their potential impact on infant welfare. METHOD: A qualitative design using a focus group approach with 37 Arab mothers in Jordan was used. RESULTS: Findings revealed strong similarities in terms of beliefs, care practices, and the experience of intergenerational conflict in establishing and maintaining traditional practices among mothers. Potentially harmful practices included restrictive swaddling, rubbing a newborn's body with salt, and encouraging the ingestion of herbs in newborns. DISCUSSION: It is important for nurses and midwives to be aware of traditional practices, cultural beliefs, and the implications for infant welfare if they are to effectively engage with families to promote the well-being of the newborn.

Depressão materna e ajustamento conjugal de mães jovens e sua relação com a sintomatologia psicofuncional do bebê / Maternal depression and marital adjustment of young mothers and its relationship with baby's psychofunctional symptoms

Este estudo investigou a depressão materna e a percepção de ajustamento conjugal de mães jovens, para compreender a sua repercussão sobre a sintomatologia psicofuncional do bebê. Trata-se de estudo de casos contrastantes, transversal, no qual foram entrevistadas duas mães (20 a 21 anos) porto-alegrenses, cujos bebês tinham 8 e 11 meses. Foram aplicados também o R-DAS, a EPDS e o Symptom Check List, para avaliar, respectivamente, ajustamento conjugal, depressão materna e sintomas psicofuncionais do bebê. Os dados foram integrados na análise dos casos. Os resultados apontam que a percepção de ajustamento conjugal ruim e a presença de depressão materna podem repercutir sobre a sintomatologia psicofuncional do bebê, por meio de um processo de spillover, isto é, transbordamento dos desajustes conjugais sobre a relação parental. Esses achados são relevantes para a prática clínica, na busca de intervenções psicológicas que promovam a saúde mental de casais e bebês.(AU)

This study investigated maternal depression and perception of marital adjustment of young mothers, to understand its impact on the baby's psychofunctional symptoms. It is a transversal contrasting cases study, in which two mothers (20 and 21years), whose babies were 8 and 11 months old, from Porto Alegre/RS, were interviewed. R-DAS, EPDS and Symptom Check List were also applied to evaluate, respectively, marital adjustment, maternal depression and baby's psychofunctional symptoms. Data were integrated in the case analysis. The results suggest that perception of poor marital adjustment and presence of maternal depression may contribute to baby's psychofunctional symptoms, through a spillover process, i.e., the overflow of marital maladjustment on parental relationship. These findings are relevant to clinical practice, in searching for psychological interventions that promote the mental health of couples and babies.(AU)

CULTURAL MODELS OF INFANT EMOTIONS AND NEEDS AMONG THE GAMO PEOPLE OF SOUTHERN ETHIOPIA.

How mothers perceive their infants' emotions and their subsequent responses are influenced by cultural values and beliefs. Mothers who live in particularly harsh environments may have perceptions about their infants' emotions that reflect not only cultural values but also constraints of the environment. In this qualitative study, 29 Gamo mothers living in rural Ethiopia were interviewed about perceptions of their infants' emotions, how they felt about these emotions, and what they believed their infants needed in response. Through constant comparative analysis and thematic coding, several patterns emerged in mothers' perceptions about their infants' emotions and what constituted appropriate responses. Mothers said that their infants' negative emotions were possibly related to illness and that appropriate responses were focused mostly on breastfeeding, complementary food, and needing to be held. Mothers also discussed their work demands and how they conflicted with their desire to respond to their infants; however, many mothers said that they relied on their older children to help. Mothers' responses were centered on a parenting strategy aimed at promoting infant health and survival, which is consistent with research on parents living in rural environments who subsist by farming and have relatively high risk for infant mortality.

Care Through the Newborn's Eyes.

Separation of mothers and infants after birth is standard practice for many hospitals, yet not evidence-based. Nonseparation clearly has numerous benefits. However, newborns lack a voice to make choices to direct their course of care. The evidence supports nonseparation strategies for mothers and infants that promote attachment, physiologic regulation, nutrition, sleep, communication, and management of stress/pain. Moreover, the evidence is compelling that nonseparation is essential. The time has come to act on the evidence and begin seeing the care we provide through the newborn's eyes.

Validity of a family-centered approach for assessing infants' social-emotional wellbeing and their developmental context: a prospective cohort study.

BACKGROUND: Family-centered care seems promising in preventive pediatrics, but evidence is lacking as to whether this type of care is also valid as a means to identify risks to infants' social-emotional development. We aimed to examine the validity of such a family-centered approach. METHODS: We conducted a prospective cohort study. During routine well-child visits (2-15 months), Preventive Child Healthcare (PCH) professionals used a family-centered approach, assessing domains as parents' competence, role of the partner, social support, barriers within the care-giving context, and child's wellbeing for 2976 children as protective, indistinct or a risk. If, based on the overall assessment (the families were labeled as "cases", N = 87), an intervention was considered necessary, parents filled in validated questionnaires covering the aforementioned domains. These questionnaires served as gold standards. For each case, two controls, matched by child-age and gender, also filled in questionnaires (N = 172). We compared PCH professionals' assessments with the parent-reported gold standards. Moreover, we evaluated which domain mostly contributed to the overall assessment. RESULTS: Spearman's rank correlation coefficients between PCH professionals' assessments and gold standards were overall reasonable (Spearman's rho 0.17-0.39) except for the domain barriers within the care-giving context. Scores on gold standards were significantly higher when PCH assessments were rated as "at risk" (overall and per domain).We found reasonable to excellent agreement regarding the absence of risk factors (negative agreement rate: 0.40-0.98), but lower agreement regarding the presence of risk factors (positive agreement rate: 0.00-0.67). An "at risk" assessment for the domain Barriers or life events within the care-giving context contributed most to being overall at risk, i.e. a case, odds ratio 100.1, 95%-confidence interval: 22.6 - infinity. CONCLUSION: Findings partially support the convergent validity of a family-centered approach in well-child care to assess infants' social-emotional wellbeing and their developmental context. Agreement was reasonable to excellent regarding protective factors, but lower regarding risk factors. TRIAL REGISTRATION: Netherlands Trialregister, NTR2681. Date of registration: 05-01-2011, URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2681 .

Early Life Predictors of Socio-Emotional Development in a Sample of Egyptian Infants.

INTRODUCTION: Emotional problems are amongst the most critical concerns to be intentionally handled to enhance the wellbeing and development of children. OBJECTIVE: To determine the predictors of socio-emotional development of Egyptian infants related to infant feeding practices, aspects of infant and maternal health and socioeconomic status. SUBJECTS AND METHODS: A cross-sectional comparative study included 322 breast fed, 240 bottle fed and 93 mixed fed infants, from 6-24 months of age, who were enrolled in the Well-Baby Clinic of the National Research Centre and from pediatric outpatient facilities in urban Cairo. Assessment of socio-emotional development was performed using Bayley Scales of Infant and Toddler Development (Bayley III). Detailed maternal and infant history was recorded. Levels of serum zinc, copper, iron, vitamin B12 and complete blood count (CBC) were assessed in a subsample of 193 infants. RESULTS: The risk of having below average socio-emotional composite score was nearly two and half times among formula-fed infants than among breast-fed infants. By binary logistical regression analysis, predictors of below average socio-emotional score were a lower serum zinc value, being formula fed during the first half-year and introduction of complementary food before the age of six months (p< 0.05). CONCLUSION: Exclusive breastfeeding and to a lesser extent mixed feeding during the first half year is correlated with above average socio-emotional development. Maternal education and zinc status were also determinants of better infant mental health. Our endeavors ought to be directed towards integrated interventions addressing multiple risks to children's development.

Challenges of using next generation sequencing in newborn screening.

Whole-genome and whole-exome sequencing for clinical applications is now an integral part of medical genetics practice. The term newborn screening refers to public health programs designed to screen newborns for various treatable metabolic conditions, by measuring levels of circulating blood metabolites. The availability and significant decrease in sequencing costs has raised the question of whether metabolic newborn screening should be replaced by whole-genome or whole-exome sequencing. While newborn genome sequencing can potentially increase the number of disorders identified by newborn screening, the generalization of its practice raises a number of important ethical issues. This short article argues that there are medical, psychological, ethical and economic reasons why widespread dissemination of newborn screening is still premature.

Intervenções precoces na infância: observando a relação mãe-bebê em um serviço de saúde / Early intervention in childhood: watching the mother-baby relationship in a health service / Intervenciones precoces en la infancia: observando la relación madre-bebé en un servicio de salud

Este artigo tem como objetivo apresentar as atividades desenvolvidas em um projeto de extensão. Tal projeto visa a observar a relação entre crianças de 0 a 2 anos e suas mães nos atendimentos realizados pelo Programa da Criança em uma Unidade Básica de Saúde, com o intuito de detectar possíveis riscos ao desenvolvimento infantil de modo precoce. Utiliza-se da técnica de observação, tendo por base os Indicadores Clínicos de Risco ao Desenvolvimento Infantil (IRDI). Caso se identifiquem riscos ao desenvolvimento, são utilizados outros recursos técnicos que podem incluir entrevistas de orientações aos familiares e encaminhamentos à rede de atendimentos especializados. Os resultados alcançados indicam a importância do vínculo entre a equipe e os usuários, a maior atenção às díades e suas relações afetivas e a possibilidade de detecção precoce das problemáticas envolvendo os aspectos emocionais. Por fim, destaca-se a ação interdisciplinar e a atuação da Psicologia na promoção de saúde.

This article aims to present the activities developed in an extension Project. Such a project aims to observe the relationship between children, from zero to two years old, and their mothers, in the assistance carried out in the Child Program in a Basic Health Unit, targeting to detect possible early risks to child development. Observation techniques are used, based on the Clinical Risk Indicators in Child Development (CRICD). If risks to development are identified, other technical resources are used, that may include orientation interviews of family members and redirections to specialized services network. Results indicate the importance of the bond between the health care team and the users, the need of greater care regarding dyads and their relationships and the possibility of early detection of problems involving emotional aspects. Finally, the interdisciplinary actions and the role of Psychology concerning health promotion are highlighted.

Este artículo tiene como objetivo presentar las actividades desarrolladas en un proyecto de extensión. Este proyecto pretende observar la relación entre niños de cero a dos años y sus madres en la atención realizada por el Programa Infantil de una Unidad Básica de Salud, con el fin de detectar precozmente los posibles riesgos para el desarrollo del niño. Se utiliza la técnica de observación basada en los Indicadores Clínicos de Riesgo al Desarrollo Infantil (IRDI). Cuando se identifican riesgos para el desarrollo, otros recursos técnicos son utilizados, que pueden incluir entrevistas de orientación a los familiares y derivaciones a la red de atención especializada. Los resultados obtenidos indican la importancia del vínculo entre el equipo y los usuarios, una mayor atención a las duplas y sus relaciones afectivas y la posibilidad de detección precoz de los problemas que afectan a los aspectos emocionales. Por último, se destaca la acción interdisciplinaria y la actuación de la Psicología en la promoción de la salud.

Effect of infant health problem, mother's depression and marital relationship on infant abuse in Korea: mediating pathway of marital relationship.

PURPOSE: The purpose of this study is to test a model linking infant health problem, mother's depression and marital relationship to infant abuse. METHODS: This study employed a cross-sectional survey design. Data were collected from 2009 Data of Index Studies for Korean Children and Adolescents Development. Survey data from 1,060 infants and their mothers (including infant health status and infant physical illness scale, depression scale, marital relationship scale, and child abuse scale) were used to test the model. The model was tested using path analysis techniques within structural equation modeling. RESULTS: The model fit indices suggested that the original hypothesized model adequately fit the data (χ(2) = .33, df = 5, p = .84, Tucker-Lewis Index = 1.04, Comparative Fit Index = 1.00, Root Mean Square Error of Approximation = .00). Infant health problem and mother's depression had a negative direct effect on marital relationship, which in turn had a direct negative effect on infant abuse. Infant health problems directly affected infant abuse and also influenced infant abuse indirectly through the marital relationship. Mother's depression had significant direct effects on infant abuse and also influenced infant abuse indirectly through the marital relationship. CONCLUSION: The findings from this study demonstrate the fundamental importance of infant health as linked to the mother's mental health, and marital relationship and increasing the quality of marital relationship may be the key to infant abuse prevention.

Effects of an intervention to promote socioemotional development in terms of attachment security: a study in early institutionalization in Chile.

The Chilean government commissioned a quasi-experimental study with a pre-/postintervention design that had two general aims: (a) to assess infants' psychoaffective developmental levels (pre-intervention phase) and (b) to evaluate whether an intervention based on the promotion of socioemotional development modifies the infant's psychoaffective development. Sixty-two institutionalized infants and their alternative caregivers were evaluated at a pre-intervention stage. An intervention then took place, with the caregivers trained according to an "attachment sensitivity manual." Results showed normal ranges of psychomotor development (64% normal, 9% delayed) and a very high frequency of attachment insecurity, as compared to the normative population (53%).The intervention significantly improved social orientation and object orientation as well as activity and reactivity levels. We conclude that although institutionalized infants in Chile do not exhibit high levels of atypical attachment, socioemotional deterioration may lead to vulnerability in present and future development. Finally, the scope of this study affected public policies regarding children, initiating a change to a foster family system and a variety of modifications in the strategies for adopting institutionalized infants.

Maternal attitudes and knowledge about newborn screening.

PURPOSE: To determine whether mothers of newborns understand basic facts about newborn screening (NBS), and how they feel about state retention of dried bloodspots (DBS) for research use. DESIGN: This study was a cross-sectional survey administered to 548 mothers of newborns in postpartum units in five different hospitals in north Texas after Institutional Review Board approval. Each participating site delivered and collected surveys using systems that were convenient for them. The survey instrument used in this study is the Maternal Attitudes and Knowledge about Newborn Screening Survey. The survey was developed by the investigators. Summary statistics were provided for each participating site and surveys were combined for final data analysis. Multiple regression analysis was used to quantify associations between responses and demographic variables. RESULTS: Overall, knowledge about details of NBS and DBS retention was inadequate. The most frequent source of information about NBS was the postpartum nurse. Mothers tended to believe that using newborn bloodspots for research was a good thing, but Medicaid recipients and minorities were more reluctant than others to share dried bloodspots for research. CLINICAL IMPLICATIONS: Mothers are not fully informed about NBS or the use of infant bloodspots for research. Bloodspot storage in Texas could shrink under new opt-in policies, constraining a resource needed for genetic and other research. Further research to design and test educational interventions that are sensitive to the concerns of parents about DBS storage and that can be efficiently implemented antenatally is needed.

Reasons for earlier than desired cessation of breastfeeding.

OBJECTIVE: To describe the prevalence and factors associated with not meeting desired breastfeeding duration. METHODS: Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate the importance of 32 reasons for stopping on a 4-point Likert scale. Multiple logistic regressions were used to examine the association between the importance of each reason and the likelihood of mothers not meeting their desired breastfeeding duration. RESULTS: Approximately 60% of mothers who stopped breastfeeding did so earlier than desired. Early termination was positively associated with mothers' concerns regarding: (1) difficulties with lactation; (2) infant nutrition and weight; (3) illness or need to take medicine; and (4) the effort associated with pumping milk. CONCLUSIONS: Our findings indicate that the major reasons why mothers stop breastfeeding before they desire include concerns about maternal or child health (infant nutrition, maternal illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and milk-pumping problems). Continued professional support may be necessary to address these challenges and help mothers meet their desired breastfeeding duration.

Predictors of infant foster care in cases of maternal psychiatric disorders.

PURPOSE: Our aim was to investigate the factors associated with mother-child separation at discharge, after joint hospitalization in psychiatric mother-baby units (MBUs) in France and Belgium. Because parents with postpartum psychiatric disorders are at risk of disturbed parent-infant interactions, their infants have an increased risk of an unstable early foundation. They may be particularly vulnerable to environmental stress and have a higher risk of developing some psychiatric disorders in adulthood. METHODS: This prospective longitudinal study of 1,018 women with postpartum psychiatric disorders, jointly admitted with their infant to 16 French and Belgian psychiatric mother-baby units (MBUs), used multifactorial logistic regression models to assess the risk factors for mother-child separation at discharge from MBUs. Those factors include some infant characteristics associated with personal vulnerability, parents' pathology and psychosocial context. RESULTS: Most children were discharged with their mothers, but 151 (15 %) were separated from their mothers at discharge. Risk factors independently associated with separation were: (1) neonatal or infant medical problems or complications; (2) maternal psychiatric disorder; (3) paternal psychiatric disorder; (4) maternal lack of good relationship with others; (5) mother receipt of disability benefits; (6) low social class. CONCLUSIONS: This study highlights the existence of factors other than maternal pathology that lead to decisions to separate mother and child for the child's protection in a population of mentally ill mothers jointly hospitalized with the baby in the postpartum period.