Community-Based Doulas' Roles Within the Birth Support System: Young Black Mothers' Perspectives.

INTRODUCTION: Doulas have been found to be beneficial to pregnant adolescents during childbirth, but little is known about their role within the larger system of people providing birth support, including family and health care providers. The purpose of this study was to examine, from the perspectives of young mothers, the role of the doula within their broader birth support system. METHODS: One hundred pregnant Black adolescents and young women (aged 13 to 21) who were provided perinatal community-based and racially concordant doula services at no cost to them were interviewed after the birth of their newborn, prior to hospital discharge. Interviews generated birth story narratives and responses to focused questions about their experiences of birth support. Thematic analysis was conducted to examine the role of the doula within the context of the broader system of birth support. RESULTS: Doulas functioned in 2 primary ways within the birth support system by (1) providing tandem support alongside family and health care providers and (2) filling gaps in health care not provided by family and providers. Laboring adolescents sometimes described their family members and doulas working in tandem to provide multiple types of support such as comfort measures, coaching, and help with pushing. They also identified gaps in their care or support filled by the doula, in particular gaps due to family members' physical or emotional unavailability or health care providers' many responsibilities. DISCUSSION: The findings highlight the ways in which doulas support pregnant adolescents during childbirth through their deft navigation of the existing support system. Well-being was enhanced by the inclusion of the doula in the birth support system. The findings align with existing research that underscores the valuable role doulas play in supporting individuals during childbirth, particularly for those most affected by processes of marginalization.

Young mother risk-taking moderates doula home visiting impacts on parenting and toddler social-emotional development.

This longitudinal randomized controlled trial examined the impact of a doula home visiting intervention for young, low-income mothers on parenting and toddler social-emotional development and tested whether intervention effects were moderated by maternal emotional and behavioral health characteristics. 156 mothers were offered home visits from a home visitor starting in mid-pregnancy through several years postpartum, with a community doula also working with the mother during pregnancy and after the birth. 156 received case management. Interviews, video recordings of mother-child interactions, and toddler assessments were conducted at 3 weeks, 3 months, 13 months, and 30 months of age. Intent-to-treat analyses conducted with the full sample showed some intervention effects. Moderation analyses, however, showed that most effects were concentrated among mothers engaged in high levels of risk-taking (delinquent behaviors, school suspensions, smoking, alcohol use, sexual risk-taking). Among higher risk-taking mothers, the intervention was related to less intrusiveness during early infancy, less psychological and physical aggression during toddlerhood, more sensitive parenting attitudes, and greater toddler social relatedness. Maternal depressive symptoms were only a moderator for toddler behavior problems. These findings suggest that doula home visiting may be a particularly effective model for enhancing sensitive, non-aggressive parenting among young mothers with a history of risk-taking behavior.

Parenting Among Women in Methadone Treatment: Contributions of Mental Health Problems and Violence Exposure.

The aim of the current study is to explore factors associated with quality of parenting among women in treatment for opioid use disorders. 150 Black American women with 3-5 year old children were recruited through methadone treatment programs. Parenting representations were assessed through the Working Model of the Child Interview and parenting behavior through video recordings of mother-child interaction. Interviews were used to assess mothers' history of violence exposure and to make DSM diagnoses. Mothers' mood disorder was related to distorted representations and to expressions of concerned affect (anxiety, fear, guilt). Mothers' personality disorder was related to expressions of negative affect (anger and frustration) and inversely related to sensitive parenting behavior. Mothers' experience of family violence during childhood and partner violence during adulthood were related to concerned affect in their representations. Women in treatment for substance use disorder have complex and interconnected needs, including parenting supports and trauma-informed mental health services.

Neurocognitive functioning in adult and adolescent offspring of parents with schizophrenia.

INTRODUCTION: Neurocognitive deficits have been proposed as endophenotypes for schizophrenia. Although neurocognitive functioning has been studied extensively in first-degree relatives of schizophrenia patients at single time points, little is known about the change or continuity in deficits across development. METHOD: The longitudinal sample was composed of 86 nonpsychotic participants who had a parent with schizophrenia (n = 28), a parent with a nonschizophrenia mental disorder (n = 31) or parents without mental illness (n = 27). Executive functioning (EF) was assessed during adolescence (M = 18 years) and adulthood (M = 32 years); attention and memory were assessed at adulthood. RESULTS: The schizophrenia group, as adults, showed deficits in attention and memory relative to the no mental illness group. Only on one memory task did the schizophrenia group perform more poorly than the other mental illness group. Executive functioning improved with age for all three groups on Wisconsin Card Sorting Test perseverative errors; the rate of improvement was significantly slower for the schizophrenia and the other mental illness groups, compared to the no mental illness group. Stability in EF functioning over the 16-year period, measured by intraclass correlations, was low. CONCLUSIONS: Adults at familial risk for schizophrenia showed deficits in neurocognitive functioning. The similarity of performance between those whose parents had schizophrenia and those whose parents had other mental illness, in all but the measures of memory, raises the question as to whether the neurocognitive functions examined are endophenotypes of vulnerability to schizophrenia specifically. Modest stability of EF and improved performance with age may reflect cortical maturation during early adulthood.

African American Adolescent Mothers' Childbirth Support From Fathers, Grandmothers, Nurses, Doctors, and Doulas.

The morning after giving birth in a large urban hospital, 121 African American adolescents participating in a community doula program identified the people who had been with them during labor and birth and narrated their birth stories. Besides medical providers, the people most likely to be present for the birth were the infants' fathers (n = 73, 60%), the mothers' mothers (n = 70, 58%), and their doulas (n = 100, 83%). Birth stories were coded to identify types of support provided by different people. Mothers' mothers, infants' fathers, and doulas were more likely to be mentioned in the stories as providers of emotional and instrumental support than were medical providers. Doulas were more likely to be mentioned as providers of information than were family members or medical providers.

A longitudinal investigation of young mothers' prenatal attachment, depressive symptoms, and early parenting behaviour.

OBJECTIVES: This study explores whether young, low-income mothers' prenatal attachment to their infants is related to attachment and parenting behaviour postnatally. BACKGROUND: A small literature has documented continuity in maternal attachment from pregnancy to postpartum and shown that early maternal attachment is associated with positive parenting behaviour. Less is known about whether prenatal attachment has a unique impact on parenting behaviour, or if it is primarily a step in the development of postnatal attachment, which in turn influences parenting. Additionally, it is unclear whether associations between attachment and early parenting might be attributable to other factors such as depressive symptoms. METHOD: This longitudinal study followed young primiparous mothers from pregnancy through 3-weeks postnatal. 240 ethnically/racially diverse low-income American women reported their attachment-related thoughts and feelings and their depressive symptoms during pregnancy and postnatally. At 3 weeks postpartum, mothers were observed interacting with their infant. RESULTS: There was stability in attachment and depressive symptoms from pregnancy to postpartum. In multivariate path models, prenatal attachment was directly associated with two types of parenting behaviour: positive engagement and encouragement of learning, even when accounting for depressive symptoms and postnatal attachment. There was an indirect effect of prenatal attachment on sensitivity through postnatal attachment. CONCLUSION: The foundation of a mother's emotional connection to her infant begins before birth. Parenting support programmes for young mothers should begin during pregnancy. Supporting the establishment of positive prenatal attachment may also have a positive influence on later parenting behaviour among mothers, including mothers experiencing depressive symptoms.

Associations between parenting representations and behavior among young mothers and mothers with opioid use disorder.

Mothers' representations reflect how they experience their child and their relationship, and can guide parenting behavior. While studies of representations typically focus on infancy, this study examines associations between mothers' representations and behavior with their preschoolers using two samples: young mothers (n = 201; 42% African American, 42% Latina, 8% European-American, 8% multi-ethnic; Mage  = 32 months) and mothers in treatment for opioid use disorder (OUD; n = 150; 100% African American; Mage  = 49 months). This study aims to identify the distribution of representations within these populations, differences in parenting between mothers classified with balanced and non-balanced representations, and distinct parenting behaviors associated with distorted and disengaged representations. The Working Model of the Child Interview was conducted to assess representations, and mother-child interactions were video-recorded. The distribution of balanced, distorted, and disengaged representations was 59%, 25%, and 15% among young mothers, and 21%, 39%, and 40% among mothers with OUD. Balanced representations (coherent, rich, engaged, respectful) were associated with positive parenting, including sensitivity, autonomy support, cognitive support and less negative regard among young mothers, and sensitivity and encouragement in the OUD sample. Mothers with disengaged representations (emotionally distant, lacking detail, indifferent) demonstrated less support for learning compared to mothers with distorted representations (involved but inconsistent, negative, or bizarre descriptions of child).

Las representaciones de las madres reflejan cómo ellas perciben a sus niños y sus relaciones y pueden guiar la conducta de la crianza. Mientras que los estudios sobre representaciones típicamente se enfocan en la infancia, este estudio examina las asociaciones entre las representaciones de las madres y el comportamiento con sus niños prescolares usando dos grupos muestra: madres jóvenes (n=201; 42% afroamericanas, 42% latinas, 8% europeo-americanas, 8% multiétnicas; edad promedio=32 meses) y madres bajo tratamiento por trastornos por uso de opioides (OUD; n=150; 100% afroamericanas; edad promedio=49 meses). El estudio se propuso identificar la distribución de las representaciones dentro de estos grupos de población, diferencias en la crianza entre madres clasificadas con representaciones equilibradas y no equilibradas, y conductas de crianza distintivas asociadas con representaciones distorsionadas y desconectadas. La Entrevista del Modelo de Trabajo del Niño se usó para evaluar las representaciones y se grabaron en video las interacciones madre-niño. La distribución de representaciones equilibradas, distorsionadas y desconectadas fue 59%, 25% y 15% entre madres jóvenes, y 21%, 39% y 40% entre madres con OUD. Las representaciones equilibradas (coherentes, generosas, participativas, respetuosas) se asociaron con una crianza positiva, incluyendo sensibilidad, apoyo de autonomía, apoyo cognitivo y menos consideración negativa entre madres jóvenes, y sensibilidad y estímulo en el grupo OUD. Las madres con representaciones desconectadas (emocionalmente distantes, con falta de detalles, indiferentes) demostraron menos apoyo en el aprendizaje comparadas con madres con representaciones distorsionadas (participativas pero inconsistentes, negativas o extrañas descripciones del niño).

Les représentations des mères reflètent la manière dont elles font l'expérience de leur enfant et de leur relation, et peuvent dguider le comportement de parentage. Alors que les études sur les représentations se focalisent typiquement sur la petite enfance cette étude examine les liens entre les représentations des mères et le comportement de leurs enfants d'âge pré-scolaire en utilisant deux échantillons : des jeunes mères (n=201;42% afro-américaines, 42% de culture latine américaine, 8% européennes-américaines, 8% multi-ethnic; Mâge=32mois) et des mères en traitement pour un trouble de consommation d'opioïde (TCO; n=150; 100% afro-américaines; Mâge=49mois). Cette étude s'est donnée pour but d'identifier la distribution des représentations au sein de ces populations, les différences dans le parentage entre les mères classifiées comme ayant des représentations équilibrées ou non-équilibrées, et les comportements distincts de parentage liés à des représentations déformées et désengagées. Le Modèle Fonctionnel de l'Entretien de l'Enfant a été choisi afin d'évaluer les représentations et les interactions mère-enfant ont été filmées à la vidéo. La distribution de représentations équilibrées, déformées et désengagées était de 59%, 25%, et 15% chez les jeunes mères et de 21%, 39%, et 40% chez les mères avec un TCO. Les représentations équilibrées (cohérentes, riches, engagées, respectueuses) étaient liées au parentage positif, y compris à la sensibilité, au soutien de l'autonomie, au soutien cognitif et à moins d'égard négatif chez les jeunes mères, et à la sensibilité et à l'encouragement dans l'échantillon TCO. Les mères avec des représentations désengagées (émotionnellement distantes, manquant de détail, indifférentes) ont fait preuve de moins de soutien à l'apprentissage comparées aux mères avec des représentations déformées (impliquées mais descriptions incohérentes, négatives ou bizarres de l'enfant).

Making meaning of motherhood: Self and life transitions among African American adolescent mothers.

Although adolescent childbearing is widely viewed as a major social problem, and research suggests that young mothers and their children are at risk for poor economic and academic outcomes, these ideas may be in need of revision. Recent scholarship has pointed out that young mothers have been unfairly blamed and stigmatized for problems that should be attributed to social and economic inequality, racism, and poverty. The present study extends that research by listening to the voices of young mothers. In total, 179 urban African American women were asked at 4, 12, and 24 months after giving birth to describe how their lives had changed since becoming a mother. A team of coders content coded themes with rigorous checks for intercoder reliability. Positive themes were far more prevalent than negative themes. Motherhood was often described as a positive developmental change, providing the young women with a sense of maturity, responsibility, motivation, and commitment to placing the baby's needs ahead of their own. Motherhood was sometimes described as a life-turning point whereby young women turned away from undesirable activities and became focused on school, work, and their family's future. Challenges reflected common stresses of parenting for people of all ages, such as lack of sleep and burden of caregiving, but also limited time to socialize with friends. Findings suggest that although policymakers and professionals view adolescent parenthood as a social ill to be eradicated, for the mothers themselves, the experience is more complex, meaningful, and positive. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Educare intervention: Outcomes at age 3.

The effectiveness of Educare, a center-based early education program, in improving child outcomes at age 3 was evaluated in a randomized clinical trial. Educare programs serve children from birth to age 5 and are designed to reduce the achievement gap between children from low-income families and their more advantaged peers. This study began following 239 children from low-income families who were randomly assigned as infants (<19 months) to Educare or a business-as-usual control group. At age 3, assessments of the skills of 202 children remaining in the study revealed significant differences in favor of children in the treatment group on auditory language skills, early math skills, and parent-reported problem behaviors. Effect sizes were in the modest range, although not as strong as the previously reported age 2 findings. No effects were found for observations of parent-child interactions, observer-rated child behaviors, or parent-rated social competence. For English-language skills, children who were dual language learners (DLLs) benefitted more from treatment than non-DLLs. Analyses of outcomes by child care type, regardless of treatment group assignment, showed that children in Educare had better language, math, and behavioral scores than children in less formal care, whereas children in other center-based care only had higher language scores than children in less formal care. Differences in outcomes between Educare and other center-based care were not significant.

Increasing parenting self-efficacy: The Fussy Baby Network® intervention.

High levels of infant crying place families at risk for disrupted relationships, parenting stress, and even for child maltreatment. We conducted an evaluation of the Fussy Baby Network® (FBN), a program supporting families struggling with infant crying and related concerns. The study contrasted 29 families who sought help from FBN with 27 families with excessively crying infants who did not seek services. Researchers measured parenting self-efficacy, depression, and stress in each group before and after the intervention. Results from hierarchical multiple regression analysis indicated greater improvements over time in parenting self-efficacy for parents receiving FBN services. Furthermore, the greater improvements in parenting self-efficacy in the intervention group were not directly attributable to reductions in infant crying. These findings provide preliminary evidence that the FBN approach may be effective at boosting the confidence of parents struggling with caring for their infants. Future research with larger samples with baseline equivalence and stronger research designs should explore this intervention further. This study also suggests that interventions for families with excessively crying infants should move beyond the focus of reducing infant crying to a broader strategy of supporting parents and strengthening relationships between parents and their infants to build parenting capacity.

Young First-Time Mothers' Parenting of Infants: The Role of Depression and Social Support.

OBJECTIVES: This study examines the contributions of social support and depressive symptoms on sensitive parenting behaviors, parenting attitudes and parenting stress among first-time young mothers. Additionally, the study tests the moderating role of depression in associations between various types and sources of social support and parenting outcomes. METHODS: Young (M = 17.4 years), low-income, African American mothers (n = 192) were interviewed and video-recorded interacting with their 4-month-old infants. RESULTS: Regression analyses showed that depressive symptoms (CES-D) were associated with less sensitivity observed during mother-infant interactions, less sensitive attitudes (AAPI) and greater parenting stress (PSI), but the role of social support was more nuanced. Direct infant care support from the mother's parent figure (typically her own mother) was related to more sensitive parenting behaviors and attitudes, while general support and direct infant care support from the father of the baby were related to reduced parenting stress. Depressive symptoms moderated the relationship between general support from the parent figure and parenting outcomes. Specifically, higher levels of general support contributed to more sensitive maternal behaviors and attitudes only when depressive symptoms were low. CONCLUSIONS FOR PRACTICE: For young mothers, their parent figure and the father of the baby can be important sources of support in promoting positive parenting and reducing parenting stress. Young mothers with depression, however, are at risk for problematic parenting and may have difficulty taking advantage of the support offered by their parent figure.

Teenage Childbearing, Reproductive Justice, and Infant Mental Health.

Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.

Los defensores de la justicia reproductiva enfatizan los derechos de la mujer de escoger tener niños, decidir las condiciones bajo las cuales dan a luz, y criar sus niños con apoyo, seguridad y dignidad. Este ensayo examina lo que una perspectiva de justicia reproductiva contribuye al trabajo de salud mental infantil con madres adolescentes y sus familias. El ensayo explora el marco histórico del embarazo adolescente en el que las jóvenes mamás son la causa de una variedad de problemas sociales y para el que el principal acercamiento de la política y práctica es la prevención del embarazo. El estudio ofrece alternativas para enmarcar la maternidad adolescente, con base en los principios de la justicia reproductiva, la cual se enfoca en las condiciones sociales que rodean la maternidad adolescente y el significado de maternidad en la vida de las mujeres jóvenes. Estos marcos alternativos cambian la agenda práctica a erradicar las condiciones sociales injustas y proveer apoyo a las mujeres jóvenes en su papel de madres. El estudio describe a continuación maneras por medio de las cuales dos programas de salud mental infantil han incorporado principios de justicia reproductiva en su trabajo con familias jóvenes: el modelo comunitario de Chicago de mujeres que acompañan y ayudan durante el embarazo (Doulas) y el Proyecto de Madres Jóvenes de Florida para progenitores adolescentes involucrados en asuntos legales. Finalmente, el ensayo extrae una serie de principios que se derivan de una perspectiva de justicia reproductiva que son relevantes para el trabajo de salud mental infantil con familias jóvenes.

Les avocats de la justice reproductive mettent l'accent sur les droits des femmes à choisir d'avoir des enfants, à décider des conditions dans lesquelles elles vont donner naissance, et à parenter leurs enfants avec soutien, sécurité et dignité. Cet article examine qu'une perspective de justice reproductive contribue au travail de santé mentale du nourrisson avec des mères adolescentes et leurs familles. Nous explorons le contexte historique de la grossesse adolescente qui veut que les jeunes mères soient la cause d'une variété de problèmes sociaux et au sein duquel la politique primaire et la pratique d'approche consistent en prévention de grossesse. Cet article offre des contextes ou des encadrements alternatifs de la grossesse adolescente, basée sur les principes de justice reproductive, mettant l'accent sur les conditions sociales qui entourent le parentage adolescent et la signification de la maternité dans les vies des jeunes femmes. Ces perspectives alternatives déplacent le but de la pratique vers l'éradication de conditions sociales injustes et l'offre de soutien à ces jeunes femmes dans leurs rôles de parents. Nous décrivons ensuite des manières dont deux programmes de santé mentale du nourrisson ont incorporé des principes de justice reproductive dans leur travail avec des jeunes familles: le modèle de doula communautaire de la ville de Chicago aux Etats-Unis et le Projet de Jeunes Parents pour les parents se trouvant dans un tribunal, programme de l'état de Floride aux Etats-Unis. Enfin, nous présentons un ensemble de principles dérivés d'une perspective de justice reproductive qui sont pertinent pour le travail de santé mentale du nourrisson avec les jeunes familles.

Correction to: Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health.

The article "Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health", written by Sydney L. Hans, Renee C. Edwards and Yudong Zhang, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 18 July 2018 to

Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health.

Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

Child and Parenting Outcomes After 1 Year of Educare.

Educare is a birth to age 5 early education program designed to reduce the achievement gap between children from low-income families and their more economically advantaged peers through high-quality center-based programming and strong school-family partnerships. This study randomly assigned 239 children (< 19 months) from low-income families to Educare or a business-as-usual control group. Assessments tracked children 1 year after randomization. Results revealed significant differences favoring treatment group children on auditory and expressive language skills, parent-reported problem behaviors, and positive parent-child interactions. Effect sizes were in the modest to medium range. No effects were evident for observer-rated child behaviors or parent-rated social competence. The overall results add to the evidence that intervening early can set low-income children on more positive developmental courses.

Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex.

Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother-child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity.

Prenatal depression and young low-income mothers' perception of their children from pregnancy through early childhood.

This study investigates the role of prenatal depression on young mothers' perception of difficulty in child behavior and parent-child interaction from pregnancy through the first two years of child development. 248 low-income, African American women aged between 13 and 21 years reported on their perceptions of child behavior, parent-child interaction, and on depressive symptoms at the third trimester of pregnancy and at 4-, 12- and 24-months postpartum. During pregnancy, a high percentage (47%) of the young mothers scored above the clinical level of prenatal depressive symptoms. These mothers anticipated and perceived significantly more child difficulty and parent-child interaction difficulty than did non-depressed mothers during pregnancy and over the first two years of the child's development. Moreover, prenatal depression uniquely predicted negative maternal perception throughout the early years of child development even after adjusting for postpartum depression history. The enduring association between prenatal depression and a mother's perception of her child is discussed with respect to the importance of pregnancy in mothers' developing mental schema about their children and the emerging parent-child relationship.

Infant risk factors associated with internalizing, externalizing, and co-occurring behavior problems in young children.

The purpose of the current study was to examine the unique and interactive contributions of infant negative emotionality and family risk factors in the development of internalizing-only, externalizing-only, and co-occurring behavior problems in early childhood. The sample included 412 infants and their primary caregivers. Interviews and temperament assessments took place when infants were 5-7 months old, and primary caregivers completed child behavior ratings at ages 2 1/2 and 5 years. Mixed-effects multinomial logistic regression was used to examine associations between infant risk factors and "pure" and co-occurring child behavior problems, and test whether these associations changed over time. The results of this study showed that hostile parenting during infancy increased the likelihood that children would develop internalizing-only problems, whereas infants who were highly distressed in response to novelty were at increased risk of developing externalizing-only problems. Multiple risk factors, including maternal anxious and depressive symptoms, family conflict, and younger maternal age, independently predicted early childhood co-occurring problems. Additionally, there was a significant interaction between infant anger/frustration and hostile parenting: In the context of hostile parenting, infants high in anger were at increased risk of developing early co-occurring problems, though this association faded by age 5. These findings point to the importance of considering the infant's family context, and differentiating between "pure" and co-occurring behaviors when examining the etiology of early childhood behavior problems.

The association of breastfeeding initiation with sensitivity, cognitive stimulation, and efficacy among young mothers: a propensity score matching approach.

OBJECTIVE: This study examined the association between breastfeeding initiation and maternal sensitivity, efficacy, and cognitive stimulation among young, low-income, African American mothers. SUBJECTS AND METHODS: Two hundred twenty-one mothers were interviewed during pregnancy, at birth, and at 4 months postpartum regarding breastfeeding and parenting. Medical records were collected after birth, and mother-infant interactions were videotaped at 4 months. Propensity score matching was used to address selection bias by matching breastfeeding and nonbreastfeeding mothers on characteristics measured prior to breastfeeding. RESULTS: One hundred twenty-four (56%) mothers initiated breastfeeding. After matching, mothers who initiated breastfeeding reported greater parenting efficacy (effect size, d=0.44) and were observed to be more sensitive with their 4-month-old infants (effect size, d=0.42) than nonbreastfeeding mothers. Breastfeeding was marginally associated with less maternal intrusiveness (effect size, d=0.28) but was not related to parenting attitudes or cognitive stimulation. CONCLUSIONS: This study presents evidence supporting the claim that breastfeeding may enhance maternal efficacy and sensitivity. Providing breastfeeding support to young mothers may have effects that extend beyond maternal and child health outcomes to parenting and mother-child interactions.

Father participation in a community-doula home-visiting intervention with young, African American mothers.

This article examines the extent and nature of father participation in a perinatal, community-based doula home-visiting intervention that served young, African American mothers from low-income backgrounds and their infants. Home-visitor service records were used to assess the quantity, setting, and content of father-attended visits. Correlates of fathers' participation and thematic insights from mothers' and home-visitors' perspectives on how fathers perceived and interacted with the home-visiting program were analyzed to further characterize the nature of father participation. Although the community-doula home-visiting model does not include special outreach to increase father participation, almost half of the mothers had a doula visit at which their baby's father was present, many of which took place in medical settings. Mothers and doulas reported that fathers were generally positive about the doula, but expressed that fathers viewed the doula as a substitute provider of support that fathers seemed reticent to provide themselves. These results suggest that community doulas who visit pre- and postpartum in multiple settings have unique opportunities to have contact with fathers that traditional home visitors or early childhood specialists may not have.