The education of experience: Mixed methods evidence demonstrates the benefit of multiparity.

PROBLEM: Existing quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents). AIM: This convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups. METHODS: Thirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition. FINDINGS: Primiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants' qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role. CONCLUSIONS: The practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.

Nutrition-Related Experiences of Women With Perinatal Depression During the COVID-19 Pandemic: A Qualitative Study.

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

Supporting optimal dietary behaviors in women with perinatal depression: A qualitative exploration of experiences, practices, and challenges.

BACKGROUND: Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions. METHODS: Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach. RESULTS: Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding. CONCLUSION: Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

Preliminary Validation of the Psychosocial Assessment Tool in the Neonatal Intensive Care Unit.

OBJECTIVE: Research suggests families whose infants are admitted to the Neonatal Intensive Care Unit (NICU) experience elevated distress and may have pre-existing risk factors for maladjustment. This study sought to validate the newly developed Psychosocial Assessment Tool (PAT-NICU/Cardiac Intensive Care Unit [CICU]), a comprehensive screening measure for family psychosocial risk in the NICU. METHODS: The sample included 171 mothers, who completed the PAT-NICU/CICU and other related measures within 2 weeks of their infant's NICU admission at a level 4 unit within a large pediatric hospital. PAT-NICU/CICU scores were compared to a companion risk survey completed by NICU social workers. Test-retest reliability was assessed through repeated measures at 2-month follow-up. RESULTS: Analyses suggest the PAT-NICU/CICU is effective in classifying psychosocial risk. This is supported by statistically significant correlations between the PAT-NICU/CICU and validated measures, in addition to elevated scores on concurrent measures by risk classification. Internal consistency, test-retest reliability, and acceptability for the PAT-NICU/CICU were satisfactory. CONCLUSIONS: This preliminary study demonstrates the validity, reliability, and acceptability of the PAT-NICU/CICU as a psychosocial screening tool to aid identification of families who may benefit from supportive services during NICU admission. This new measure is a more comprehensive tool that assesses a wide variety of risk factors and stress responses. However, future studies of this measure are needed with more diverse samples. Prompt screening of NICU parents may facilitate earlier linkage with appropriate levels of resources or intervention. This research is crucial in improving risk assessment and psychosocial care for families in the NICU.

A biopsychosocial model of NICU family adjustment and child development.

BACKGROUND: Although infants in Neonatal Intensive Care Units (NICU) are at risk for developmental impairments and parents are at risk for emotional distress, factors that explain outcomes remain unknown. Here, we developed the first biopsychosocial model to explain family adjustment after NICU discharge. METHODS: Participants included 101 families at The Children's Hospital of Philadelphia Neonatal Follow-Up Program who had been discharged 1.5-2.5 years prior. We gathered data using validated assessments, standardized assessments, and electronic medical records. RESULTS: Our structural equation model, informed by the Double ABC-X Model, captured the dynamic relationships among infant, parent, couple, and family factors. Infant medical severity, posttraumatic stress, couple functioning, and family resources (e.g., time, money) were key for family adjustment and child development. CONCLUSIONS: Interventions that target parental posttraumatic stress, couple dynamics, parental perception of time for themselves, and access to financial support could be key for improving NICU family outcomes.

Sociodemographic disparities in preterm birth and low birthweight in the State of Georgia: Results from the 2017-2018 Pregnancy Risk Assessment Monitoring System.

PURPOSE: To update the overall prevalence of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2,500 g) in the State of Georgia, including rural and urban counties. METHODS: A sample was drawn from the 2017-2018 Georgia Pregnancy Risk Assessment Monitoring System (PRAMS). In the complete-case data of singleton births (n=1,258), we estimated the weighted percentage prevalence of PTB, LBW, early/late PTB, and moderately/very LBW subcategories in association with maternal sociodemographic characteristics, and the prevalence stratified by rural/urban county of residence. Univariate and multivariate logistic regression models were fitted to estimate the odds ratios (ORs) of PTB and LBW adjusting for selected covariates. Logistic regression results from multiple imputation by chained equations (MICE) were used for comparison. FINDINGS: The overall rate for PTB was 9.3% and 6.8% for LBW and among them, 2.3% were early PTB, 7.0% were late PTB, 5.4% were moderately LBW (MLBW), and 1.3% were very LBW (VLBW). Non-Hispanic Black women had the highest prevalence of PTB, LBW, early PTB, MLBW, and VLBW, as well as PTB and LBW in urban counties and LBW in rural counties. The odds of PTB (aOR 1.38; 95% CI: 0.81, 2.35) and LBW (aOR 2.68; 95% CI: 1.32, 5.43) were also higher among non-Hispanic Black relative to non-Hispanic White women and among women who received adequate-plus prenatal care compared to inadequate prenatal care. CONCLUSIONS: Socioeconomic and health disparities created by disadvantage should be a focus of state policy to improve neonatal outcomes in the State of Georgia.

Climate Change is an Emerging Threat to Perinatal Mental Health.

OBJECTIVE: In this discussion, we build the case for why climate change is an emerging threat to perinatal mental health. METHOD: A search of current literature on perinatal and maternal mental health and extreme weather events was conducted in PubMed/MEDLINE and Web of Science databases. Only articles focusing on maternal mental health were included in this narrative review. RESULTS: The perinatal period represents a potentially challenging timeframe for women for several reasons. Necessary role adjustments (reprioritization), changes in one's ability to access pre-birth levels (and types) of social support, fluctuating hormones, changes in body shape, and possible complications during pregnancy, childbirth, or postpartum are just a few of the factors that can impact perinatal mental health. Trauma is also a risk factor for negative mood symptoms and can be experienced as the result of many different types of events, including exposure to extreme weather/natural disasters. CONCLUSION: While the concepts of "eco-anxiety," "climate despair," and "climate anxiety" have garnered attention in the mainstream media, there is little to no discussion of how the climate crisis impacts maternal mental health. This is an important omission as the mother's mental health impacts the family unit as a whole.

Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms.

Untreated postpartum mood and anxiety disorders (PMADs) place women and their families at risk for negative biopsychosocial sequelae. Innovative and tailored treatments are needed to address potential disruptions in maternal functioning. Third-wave cognitive-behavioral approaches, including acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT), hold promise for optimizing functioning given the focus on values-based living, rather than symptom reduction. PURPOSE: The purpose of this paper is to describe the development of an innovative psychotherapy group for women with symptoms of PMADs. METHODS: This seven-session group, Motherhood and Me (Mom-Me), includes selected skills training from ACT, DBT, and Emotion-Centered Problem-Solving Therapy. RESULTS: Mom-Me group sessions are described, and an outline of key information (session goals, content, and homework assignments) is provided to facilitate practical implementation. CONCLUSION: In line with third-wave approaches, this group was developed to enhance maternal functioning, which, in turn, may help women cope with psychological distress during the transition to motherhood.

Introducing the Postpartum Toolkit: An Examination of the Feasibility, Acceptability and Pilot Efficacy of an Online Clinical Tool to Enhance Postpartum Functioning and Emotional Wellbeing.

During the postpartum period, a birth parent's level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy data suggest that this tool may be effective in improving postpartum emotional wellbeing, though further controlled testing is warranted. A future iteration of the tool that incorporates participant feedback to improve feasibility of use could prove an effective means of delivering support to an at-risk population.

Intensive Perinatal Mental Health Programs in the United States: A Call to Action.

Despite the growth of intensive perinatal mental health programs in the United States, too few programs serve women with perinatal mood and anxiety disorders (PMADs). Furthermore, little is known about program operations, services, the women served, and the methods of collecting outcome data. With this Open Forum, the authors aimed to share their investigation of intensive perinatal mental health programs in the United States and offer recommendations to improve services for women with PMADs. The authors recommend forming a national consortium that can foster collaboration to expand existing services and establish a national database to inform program development, evaluation, policies, and funding.

Parental mental health screening in the NICU: a psychosocial team initiative.

OBJECTIVE: About 40-50% of parents with children admitted to Neonatal Intensive Care Units (NICU) experience clinically significant levels of depression, anxiety, and trauma. Poor parental mental health can negatively influence parent-child interactions and child development. Therefore, early identification of parents at-risk for clinical distress is of paramount importance. METHODS: To address this need, the psychosocial team, including psychology and psychiatry, at a large, level 4 Neonatal Intensive Care Unit (NICU) developed a quality-improvement initiative to assess the feasibility of screening parents and to determine rates of depression and trauma in the unit. RESULTS: About 40% of mothers and 20% of fathers were screened between 2 weeks of their child's hospitalization. About 40-45% of those parents endorsed clinically significant levels of depression and anxiety symptoms. CONCLUSIONS: Recommendations for enhancing the feasibility and effectiveness of this process are discussed and considerations for future clinical and research endeavors are introduced.

The rise of tele-mental health in perinatal settings.

We discuss the use of tele-mental health in settings serving expectant parents in fetal care centers and parents with children receiving treatment in neonatal intensive care units within a pediatric institution. Our emphasis is on the dramatic rise of tele-mental health service delivery for this population in the wake of the onset of the COVID-19 pandemic in the U.S., including relevant practice regulations, challenges and advantages associated with the transition to tele-mental health in these perinatal settings.

A Stepped Care Model of Patient Navigation to Enhance Engagement with Perinatal Mental Health Care.

During the perinatal period, women are at increased risk for developing perinatal mood and anxiety disorders (PMADs). As perinatal mental health screening efforts increase, significantly more women will be identified who require mental health services. Evidence-based treatments exist, yet many women do not receive adequate care. Patient navigation (PN) offers a promising patient-centered approach to improve treatment attendance and engagement. The purpose of this study is to describe the development of a stepped care PN service at an intensive outpatient program for women with PMADs. Our experience incorporating this model of PN revealed significant features that may guide other treatment care facilities to adopt this service to increase identification and connection to care.

In Their Own Words: A Qualitative Investigation of the Factors Influencing Maternal Postpartum Functioning in the United States.

During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother's level of postpartum functioning not only impacts her experience as a mother but also the infant and family unit. However, efforts to bolster functioning are lacking, and previous literature has identified a gap between what experts recommend and what mothers desire during the postpartum period. To address this, we conducted structured interviews with a diverse sample of 30 postpartum mothers to identify factors that mothers report are most influential to their postpartum functioning. In total, we identified 23 clinically actionable factors, all of which are backed by existing literature. In addition to an in-depth presentation of the qualitative findings, we also present a heat map to visualize the relevance of these factors to each of seven established domains of maternal functioning. Lastly, based on our findings, we offer a taxonomy of interventional strategies that could bolster maternal functioning during this critical period.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization.

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.

Hasta un 15% de progenitores tiene un infante que pasará un tiempo en una Unidad de Cuidado Intensivo Neonatal (NICU). Después de la salida, los progenitores deben cuidar de un infante médicamente débil y preocuparse por su desarrollo. El presente estudio examinó cómo la severidad de la enfermedad del infante se asocia con la adaptabilidad familiar. Los participantes eran progenitores con infantes que habían salido de la Unidad de Cuidado Intensivo Neonatal entre 6 meses y 3 años antes de participar en el estudio (N = 199). Por medio de una encuesta electrónica tipo Qualtrics, los progenitores reportaron el historial médico de su infante, el estrés de la crianza, la carga familiar, el funcionamiento como pareja y el acceso a recursos. Los análisis de regresión de variables múltiples revelaron que asuntos médicos más severos del infante durante la hospitalización (v.g. período más largo de hospitalización, más aparatos médicos) se asociaban con mayor carga familiar, aunque no así con estrés o el funcionamiento como pareja. Los asuntos de salud infantil posteriores a la hospitalización (v.g. diagnóstico médico, más médicos especialistas) se asociaron con mayor estrés, un más pobre funcionamiento como pareja y mayor carga familiar. Menos tiempo para los progenitores se asoció con un aumento en el estrés y un más pobre funcionamiento como pareja. De modo sorprendente, los progenitores de infantes que habían sido hospitalizados otra vez reportaron menos estrés y mejor funcionamiento como pareja, pero mayor carga familiar. Las intervenciones con enfoque familiar que incorporan educación sicológica acerca de la comunicación entre proveedor y paciente, apoyo a la propia pareja y el cuidado propio pudieran ser eficaces para prevenir la secuela sicosocial entre familias.

Jusqu'à 15% des parents ont un bébé qui passera du temps en Unité Néonatale de Soins Intensifs. A la sortie de l'hôpital les parents peuvent se retrouver à prendre soin d'un bébé fragile du point de vue médical et s'inquiéter de son développement. Cette étude a examiné comment la sévérité de la maladie du bébé est liée à l'ajustement de la famille. Les participants ont inclu des parents avec des bébés étant sortis de l'Unité Néonatale de Soins Intensifs 6 mois à trois ans avant la participation à l'étude (N = 199). Au travers d'un questionnaire Qualtrics en ligne, les parents ont fait état de l'histoire médicale des bébés, du stress de parentage, du poids sur la famille, du fonctionnement du couple et de l'accès aux ressources. Des analyses de régression multivariables ont révélé que les problèmes médicaux du bébé durant l'hospitalisation les plus graves (i.e. durée plus longue du séjour, plus de dispositifs médicaux) étaient liés à un poids sur la famille plus fort, mais pas au stress ni n'affectait le fonctionnement du couple. Les problèmes de santé du bébé après l'hospitalisation (soit un diagnostic médical, plus de spécialistes médicaux) étaient liés à un stress plus élevé, à un fonctionnement du couple moins bon, et à un poids sur la famille plus fort. Moins de temps pour les parents était lié à un stress supplémentaire et à un fonctionnement du couple moins bon. Avec surprise, les parents de bébés qui étaient réhospitalisés ont fait état de moins de stress et d'un meilleur fonctionnement de couple, mais d'un poids plus fort sur la famille. Les interventions centrées sur la famille qui incorporent une psychoéducation sur la communication médecin-parent, le soutien du partenaire et le soin de soi peut s'avérer efficace afin d'éviter des séquelles psychosociales négatives chez les familles.

Utilization of NICU Infant Medical Indices to Classify Parental Risk for Stress and Family Burden.

INTRODUCTION: This study was conducted to examine whether the parental report of objective infant medical indices (e.g., birth weight, length of stay) can be used to identify parents at risk for psychosocial sequelae. METHODS: Parents (N = 199) cohabitating with their partner and child who was discharged from a neonatal intensive care unit (NICU) 6 months to 3 years prior to the administration of the study completed an online survey, which included parent-reported infant health, parenting stress, family burden, and family resources. RESULTS: A hierarchical cluster analysis identified the following three clusters of parents at risk for stress and family burden as determined by infant medical severity and access to resources: lowest risk (n = 77), moderate risk (n = 68), and highest risk (n = 8). DISCUSSION: This work highlights how a measure using parent-reported infant health severity, which was developed for this study, can be used to better understand family outcomes following NICU hospitalization.

Maternal depression, anxiety, stress, and maternal-infant attachment in the neonatal intensive care unit.

OBJECTIVE: The objectives of this study were to identify maternal psychological responses to infants' neonatal intensive care unit (NICU) admission, understand the relationship between psychological symptoms and maternal-infant attachment, and evaluate change in psychological symptoms over time. BACKGROUND: Accumulating evidence suggests that infants' admission to a NICU may adversely impact maternal psychiatric functioning. NICU mothers typically experience high levels of depressive, anxiety, and stress symptoms. METHODS: Mothers (N = 127) recruited from their infants' NICU bedside at three hospitals in the Philadelphia area completed self-report measures of depression, anxiety, stress, and maternal-infant attachment during the NICU admission and then 2-4 months later. A series of bivariate correlations, paired samples t-tests, and linear regression analyses were used to evaluate the primary study aims. RESULTS: NICU mothers reported elevated rates of depressive, anxiety, and stress symptoms. Maternal-infant attachment was negatively associated with anxiety and stress symptoms. Both depressive and anxiety symptoms were higher during NICU admission compared to 2-4 months later, and depressive symptoms during NICU admission predicted depressive symptoms 2-4 months later. CONCLUSIONS: This study demonstrates that NICU admission may heighten maternal risk for psychiatric symptoms, and maternal-infant attachment in the NICU may be an important correlate of maternal anxiety and stress symptoms.

Introducing mother-baby interaction therapy for mothers with postpartum depression and their infants.

Postpartum depression (PPD) and other perinatal mental health disorders have profound adverse effects on maternal-infant interaction and child health. However, standard psychiatric treatment does not necessarily improve the quality of mother-infant interaction. The purpose of this article is to describe the evidence-based CARE intervention and its translation to practice as Mother-Baby Interaction (MBI) Therapy to promote infant outcomes by supporting mothers' sensitive, responsive, and contingent interactions with their infants. Two vignettes illustrate MBI. We advocate that MBI needs to be a requisite adjunct treatment for PPD, and other perinatal mental health disorders, to promote maternal functioning, and positive long-term infant health outcomes.

The role of parental self-efficacy in parent and child well-being: A systematic review of associated outcomes.

BACKGROUND: For decades, parental self-efficacy (PSE), or parents' belief in their ability to influence their child in a healthy and success-promoting manner, has been understood as a key factor in promoting healthy functioning for parents and their children. In that time, an extensive collection of research examining the specific impact of PSE on parents and their children has developed. However, to the authors' knowledge, no comprehensive and systematic review of the outcomes linked to this factor exists, and the two most closely related non-systematic reviews were published over 10 years ago. METHODS: Therefore, by utilizing an iteratively optimized set of search terms applied across four databases, the current review sought to systematically collect, synthesize, and present the extant literature concerning the role of PSE in parent and child well-being. RESULTS: This search strategy yielded a total of 115 studies, the results of which were organized into three broad thematic categories relating to: the parent and child relationship, parental mental health, or child development. CONCLUSIONS: These results recapitulate the clinical relevance of PSE, and provide an updated and comprehensive understanding of both the role PSE plays in the welfare of parents and children, as well as the gaps in the literature as it currently stands.