Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences.

BACKGROUND: Pregnancy and childbirth are significant events in women's lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants. METHOD: Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions. RESULTS: Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life. CONCLUSIONS: A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women's expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women's needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care. TRIAL REGISTRATION: Protocol registration: PROSPERO CRD42020191081 .

Is it too much for me? General self-efficacy and emotional reactions to infant's cry.

Objectives: In the three experimental conditions we examined the role of the exposure to recorded infant's cry (at high and at lower frequency) or laughter and the level of participants' general self-efficacy on emotional reactions to the infant's cry.Background: Infant's cry can trigger empathic, sensitive responses or elicit frustration and anxiety of the caregiver. General caregiver's self-efficacy serves as a predictor of more sensitive reactions to distress cues of a child.Method: An experimental study with three conditions - exposure to infant cry at high frequency, infant cry at lower frequency or infant laughter, was conducted on the sample of 192 childless undergraduates. Exposure to the selected stimulus was preceded by the General Self-Efficacy Scale and followed by the My Emotions Scale for the assessment of participants' emotional reactions to the presented infant crying or laughter.Results: Participants with high self-efficacy exposed to the child's cry at high frequency presented the highest level of child-oriented emotional reactions and lower level of self-oriented reactions as compared to participants with low self-efficacy.Conclusion: Results suggest that general self-efficacy can serve as a supportive factor in sensitive responding to the high-frequency cry. Improving caregivers' self-efficacy can reduce the risk of insensitive, disturbed parenthood.

Empathy and social closeness toward refugees from Syria: The mediating role of cultural intelligence.

The predictors of social closeness toward refugees are rarely examined. In this study (N = 337), higher cultural intelligence (CQ) and higher empathy were defined as predictors of higher social closeness (lower social distance [the Social Distance Scale] and warmer feelings [the Feeling Thermometer]) toward refugees from Syria. This is the target group of prejudice and intensive coverage in the European mass media. The obtained results indicated that other-oriented empathy (empathic concern and perspective taking) and the motivational CQ predicted higher social closeness and warmer feelings toward refugees from Syria. Empathic personal distress predicted lower social closeness and colder feelings toward this group. Motivational CQ consistently served as the mediator of the relationship between empathy dimensions and social closeness toward Syrian refugees. Our findings reveal the previously unexplored correlations between empathy dimensions and cultural intelligence factors, including the mediational effects in predicting social closeness toward Syrian refugees.

'Do we need doulas ?' - Perspectives of maternity care managers on the role of doulas in Poland.

AIM: The purpose of this study was to analyse perinatal care managers' perspectives on the role of doulas in Poland and to consider how managers' perspectives might affect the opportunities for doulas to practice in individual hospitals. DESIGN: This is a qualitative descriptive study. METHOD: The total of 17 hospitals was selected for the study. Semi-structured interviews were conducted with 11 manager staff members. RESULTS: Three groups of facilities were identified: '0' (n = 6) - refused to give interviews, 'A' (n = 8) - marginal experience in working with doulas, and 'B' (n = 3) - regular experience in working with doulas. The hospitals from Group A showed indifference towards working with doulas. Group B declared a positive attitude towards such cooperation. Attitudes towards doulas vary among executives and are related to the frequency of doula-assisted births. Our results indicate factors that may influence the attitude of medical staff towards doulas and which may contribute to improve future initiatives meant to facilitate collaboration between midwives and doulas. PATIENT OR PUBLIC CONTRIBUTION: This study explored the lived experiences of perinatal care managers.

Cooperation between midwives and doulas in the context of perinatal care - a integrative review of qualitative and quantitative studies.

BACKGROUND: A doula is a person who provides support to women in the perinatal period without providing medical services. During childbirth, the doula becomes a member of the interdisciplinary team. This integrative review aims to analyse the nature of the cooperation between doulas and midwives, its efficiency and challenges and ways of strengthening this cooperation. METHODS: A structured integrative review of empirical and theoretical studies written in English was conducted. The literature search included MEDLINE, Cochrane, Scopus, ProQuest, Science Direct, Web of Science, and Embase Health Source: Nursing/Academic Edition databases. The analysis included papers published in 1995-2020. Dedicated documents were searched for different combinations of terms and standard logical operators. A manual search of the studies was included for additional references. RESULTS: Twenty-three articles from 75 full-text records were analysed. Three main themes emerged. (1) doulas are needed to prop up the system (2) barriers in collaboration between midwives and doulas; and (3) how cooperation between midwives and doulas can be strengthened. None of the articles referred directly to the impact of collaboration between midwives and doulas on the quality of perinatal care. CONCLUSION: This is the first review to analyse the impact of collaboration between midwives and doulas on the quality of perinatal care. Ensuring adequate collaboration between doulas and midwives requires effort from both of these professional groups and the health care system. However, such collaboration is supportive for birthing women and the perinatal care system. Further research in terms of the impact of this collaboration on the quality of perinatal care is needed.

Woman's Needs and Satisfaction Regarding the Communication with Doctors and Midwives during Labour, Delivery and Early Postpartum.

The study aimed to identify the difference in communication needs of women giving birth and women during early postpartum. An additional goal includes the analysis of the experience and communication needs through the context of a woman's approach to childbirth. The study is a cross-sectional, self-report survey; 521 women between 5 and 10 days after birth participated in the study. Women perceived information provided by the medical staff as the most helpful aspect of verbal communication both during labour and early postpartum. Maintaining eye contact with the medical staff was perceived as the most helpful aspect of non-verbal communication. Women were more satisfied with communication during labour and birth than in the maternity ward and those after non-instrumental childbirth were more satisfied with communication compared to the instrumental birth group. Women perceiving childbirth as the natural, physiological process considered verbal and non-verbal communication during and after childbirth as less helpful than women perceiving birth as more risky and requiring interventions. The results of the study emphasize the importance of verbal and non-verbal communication during birth and early postpartum and at the same time different communication needs during these two time points. It also showed that women who perceive labour as a physiological process seem to be less dependent on the communication with the medical staff than women who accept medical interventions during labour and birth as necessary.

Health Care Providers' Perceptions of Quality of Childbirth and Its Associated Risks in Poland.

OBJECTIVE: To describe Polish maternity care providers' cognitive frames of quality of childbirth and how they relate to providers' perceptions of childbirth using Baranowska's model of quality of care. DESIGN: Mixed-methods, cross-sectional. SETTING: Twenty-four hospitals and outpatient clinics that provide maternity care located in two central districts of Poland. PARTICIPANTS: Obstetricians or resident physicians in obstetrics (n = 50) and midwives (n = 676) who were actively engaged in the provision of maternity care. METHODS: Participants completed a survey that included two tasks. The first was a sentence completion technique that we used as a projective method to investigate participants' preconceived attitudes about quality of childbirth. Depending on the number of perspectives (as in Baranowska's model) included in the statements, participants' perceptions were categorized as strongly narrowed (zero perspectives), narrow (one perspective), intermediate (two perspectives), or holistic (three perspectives). In the second task, we asked participants to choose one statement out of three that best represented their beliefs about childbirth. RESULTS: Participants had mostly intermediate (n = 436, 60%) or narrow (n = 183, 25%) perceptions of quality of childbirth. Those with less work experience tended to have more encompassing perspectives. More than half of the participants perceived childbirth as a physiologic process requiring no medical interventions (n = 385, 53%). Only 9% (n = 65) of the participants reported that childbirth is always associated with great risk. There was a main effect of work experience on the number of perspectives included in the definition of quality of childbirth with F(2, 720) = 5.532, p = .004. Participants with less work experience included more perspectives in their statements. There were no statistically significant differences in the perception of quality of childbirth between obstetricians and midwives, with F(1, 724) = .000, p = 0.991, or between participants from different workplaces, with F(3, 719) = 1.742, p = .157. CONCLUSION: Only a small share of participants had holistic perceptions of quality of childbirth consistent with Baranowska's model. This may not only contribute to the medicalization of maternity care in Poland, but it also contrasts with participants' declarations that childbirth is a physiologic process with no need for medical interventions. Considering the greater rates of medical interventions in maternity care in Poland, the latter finding requires further research.

Is job seniority a protective factor against anxiety among midwives during the SARS-CoV-2 pandemic?

INTRODUCTION: Introduction. The pandemic SARS-Cov-2 outbreak necessitated the implementation of changes in everyday obstetric attendance, which demands continuity of care. Employment of sudden changes in obstetric attendance could have increased anxiety among medical personnel. OBJECTIVE: The aim of the Communication was to analyse the influence of professional experience on the level of anxiety in a group of midwives during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: The analysis included 100 midwives: average professional experience: 11.51 years (max. 36; median 7,5; SD: 10.37; p<0.0001). The largest group of respondents was employed in a tertiary referral hospital (n = 40), the smallest in a medical clinic (n = 7). A preliminary study using an online questionnaire, the Generalized Anxiety Disorder Screener (GAD-7), posted on Internet fora, Facebook fan pages of The Childbirth with Dignity Foundation, and the Foundation for Midwives, using the Snowball sampling method. The Ethics Committee for Research Projects at the Institute of Psychology, University of Gdansk, approved the research project (Approval No. 35/2020). RESULTS: The average score was 9.390 (max. 21, median 8.5; SD; 5.228). The length of professional experience did not correspond to the level of anxiety (r = -0.0097; p = 0.9237). In 20 respondents, no anxiety was traced, while the smallest group indicated severe anxiety (n = 15). Professional experience did not influence the level of anxiety in either group with different level of anxiety (ANOVA test; p = 0.465). . CONCLUSIONS: Professional experience did not influence the level of anxiety. In order to prevent exacerbation of anxiety symptoms, different factors which may playa vital role in enhancing the level of anxiety must be analysed.

(Re-)activity in the caregiving situation: Genetic diversity within Oxytocin-Vasopressin Pathway is associated with salivary oxytocin and vasopressin concentrations in response to contact with a crying infant-simulator.

Oxytocin (OT) and vasopressin (AVP) hormones as well as their receptors (OXTR and AVPR1a) have been deemed crucial for caregiving and sensitive responsiveness to infant cues. However, previous research on genetic polymorphisms and OT and AVP levels in the context of caregiving were sparse and have brought contradictory findings. The aim of this reported observational study was to examine the impact of genetic variations within genes related to OT and AVP signaling pathway on hormones levels' changes in response to the caregiving situation. A total of 221 adult intimate couples (110 childless, non-pregnant and 111 expectant couples) participated in three 10 min sessions, during which they were taking care of a crying life-like simulator. 30 min prior to the first session salivary samples to analyze basal OT and AVP, and polymorphisms in OXTR, AVPR1a and CD38 genes were collected. Subsequent OT and AVP levels were measured 15 min after each session. The two most frequently studied OXTR SNPs (rs53576 and rs2254298) had no or a minor impact on higher OT levels, which were linked to rs1042778, rs13316193, rs2228485, rs2268490, rs4686302 genotypes. AVP levels were affected by rs1042778, rs13316193, rs4686302 and rs237887. OT levels varied depending on the OT (rs2770378, rs4813625), CD38 (rs379686), and 5-HTR2A (rs6314) genotype. OT and AVP levels were also associated with rs6314 (5-HTR2A). AVP levels were linked to ESR1 (rs1884051) and SIM1 (rs3734354) variations. Shorter variants of RS3 and RS1 were associated with lower levels of AVP. In conclusion, analyzed polymorphisms were associated with both the level and changes in OT and AVP hormone levels in the standardized situation of caregiving reactions to infant crying.

Empathy and Hormonal Changes as Predictors of Sensitive Responsiveness towards Infant Crying: A Study Protocol.

Sensitive responsiveness refers to parents' ability to recognize and respond to infants' cues and has been linked to parental empathy. Additionally, oxytocin (OT) and vasopressin (AVP) are hormones important for sensitivity and empathy. The aim of this study is to test the links between dispositional empathy along with changing OT and AVP levels and responsiveness to a life-like doll in couples and to verify whether these factors are predictors of responsiveness to a child's cues. Exploratory analyses include predictors of sensitive responsiveness: polymorphisms of OXTR, AVPR1a and CD38 genes, personal characteristics and relational factors. The project employs standardized experimental settings that can be used with non-parents and the assessment of parental sensitive responsiveness towards their child. The participants are couples expecting their first child (111) and childless couples (110). The procedure involves caretaking of a life-like doll. Salivary samples and questionnaire data are collected in a planned manner. In the second part, the expectant couples are invited for the assessment of their sensitivity to their own child (Free Play episodes). Parental sensitivity is assessed using the Ainsworth Sensitivity Scale. This paper presents an interdisciplinary research project that reaches beyond the questionnaire measurement, considering many factors influencing the dynamics of adult-infant interaction.

What are the Critical Elements of Satisfaction and Experience in Labor and Childbirth-A Cross-Sectional Study.

The labor experience and satisfaction with childbirth are affected by the care provided (external factors) and individual variables (internal factors). In this paper, we present a descriptive analysis that aims to indicate the strongest correlates of birth experience among a wide range of indicators. The study is a prospective, cross-sectional, self-report survey. It includes the experiences of women giving birth in public and private hospitals in Poland. The two main variables were birth experience and satisfaction with care. The analysis consists of three parts: data pre-processing and initial analysis, explorative investigation, and regression analysis. Among the 15 variables with the highest predictive value regarding birth experience were being informed by the medical personnel, communication, and birth environment. The most significant variables among 15 variables, with the highest predictive value regarding care, were those concerning support, information, and respectful care. The strongest predictor for both, birth experience and satisfaction with care, is the sense of information, with logit coefficients of 0.745 and 1.143, respectively, for birth experience and satisfaction (0.367 and 0.346 for standardized OLS coefficient). The findings demonstrate that by using explanatory variables, one can predict a woman's description of her satisfaction with perinatal care received in the hospital. On the other hand, they do not have such a significant and robust influence on the birth experience examined by the variables. For both the birth experience and satisfaction with care, the sense of being informed is the highest predictor.

How Well Do Couples Care When They Are Expecting Their First Child? Family and Dyadic Predictors of Parental Sensitivity in Expectant Couples.

Belsky's Process Model points to family-of-origin (especially experiences of mistreatment in childhood) as well as personality and marital relations as determinants of parenting quality, including parental sensitive responsiveness. Parental sensitivity might be intuitively developed during pregnancy and affects perinatal mental health. However, there is a lack of studies investigating effects of family-of-origin and relationship perceptions on expectant couples' parental sensitive responsiveness. The aim of the presented study was to test mediation and moderation effects of perceived partner's empathic concern and retrospectively assessed abuse experienced in childhood on sensitive parental responsiveness operationalized as caretaking behaviors and emotional reactions to a crying life-like doll. One hundred eleven expectant couples (N = 222; age: M women = 28.4 years, SD = 3.03; age: M men = 29.2 years, SD = 3.31; relationship duration: M years = 6.8, SD = 3.43; gestational week: M = 31.3, SD = 4.58) assessed the extent to which they experienced physical and emotional abuse from their parents in childhood and rated their current partner's empathic concern. In the experimental procedure, couples reacted to a crying life-like doll and were assessed by trained psychologists using the modified Ainsworth Sensitivity Scale to measure couples' sensitive responsiveness. The results confirmed a significant mediational effect of perceived women's (and not men's) empathic concern for the relationship between the reported experience of abuse in family-of-origin by expectant fathers (and not mothers) and couples' sensitivity. Support and interventions regarding couples' empathy and parenting competence can be offered to both mothers and fathers to identify those who are at risk of low parental sensitivity.

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: A web-based cross-sectional survey.

INTRODUCTION: The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants. METHODS AND ANALYSIS: It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.

Do Physical Activity and Personality Matter for Hair Cortisol Concentration and Self-Reported Stress in Pregnancy? A Pilot Cross-Sectional Study.

BACKGROUND: Physical activity reduces psychosocial stress in pregnant women. Stress levels might be self-reported (psychosocial) or measured with biomarkers, one of which is hair cortisol concentration (HCC). Additionally, personality has been associated with stress and physical activity. METHODS: The first aim of our study was to explore the differences in self-reported stress assessed by the Perceived Stress Scale (PSS) and in HCC with regard to physical activity level in pregnant (N = 29) and non-pregnant (N = 21) women. The second aim was to analyze the correlations among perceived stress, HCC, frequency of exercise and personality in the two groups separately. RESULTS: There was a significant difference in frequency of exercise and self-reported stress between the two groups, with a lower level in pregnant women, but no differences in HCC and in personality were found. In the group of pregnant women, there was a significant negative correlation between HCC and frequency of exercise sessions, with the latter correlating positively with openness to experience. In the group of non-pregnant women, perceived stress negatively correlated with extraversion, agreeableness and emotional stability. HCC correlated negatively with conscientiousness. CONCLUSIONS: Our findings indicate the importance of physical activity programs dedicated to pregnant women for their life quality.

Gender and Body-Fat Status as Predictors of Parental Feeding Styles and Children's Nutritional Knowledge, Eating Habits and Behaviours.

The home food environment is critically important for the development of children’s health-related practices. By managing dietary restrictions, providing nutritional knowledge and demonstrating eating behaviours, parents contribute to children’s food preferences and eating patterns. The present study examined nutritional knowledge, eating habits and appetite traits among 387 Polish five-year-old healthy and overfat boys and girls in the context of parental feeding styles and body-fat status. We observed that girls presented healthier eating habits than boys; however, overfat boys had better nutritional knowledge. Children’s body-fat percentage (%BF) was found to be linked with eating behaviours such as low satiety responsiveness and increased food responsiveness in girls as well as low emotional undereating and increased emotional overeating in boys. Our results revealed that overfat mothers, who were more prone to use the encouragement feeding style, rarely had daughters with increased %BF. Parents of overfat girls, however, were less likely to apply encouragement and instrumental feeding styles. Contrary to popular belief and previous studies, overfat women do not necessarily transmit unhealthy eating patterns to their children. Parents’ greater emphasis on managing the weight and eating habits of daughters (rather than sons) probably results from their awareness of standards of female physical attractiveness.