Coping Behaviors,Parenting, and Perceptions of Children's Internalizing and Externalizing Problems in Rural African American Mothers

Abstract: We tested a hypothetical model linking maternal education and maternal coping behavior with parent‐child relationship quality, and in turn, children's self‐regulatory behavior and mental health difficulties. Consistent with predictions, mothers’ use of active coping behaviors predicted more positive parent‐child relationship quality, greater child self‐regulatory behavior, and fewer perceived behavioral and emotional difficulties in children. Implications of these findings for intervention with rural African American mothers are discussed.     

‘My special time’: Australian women's experiences of accessing a specialist perinatal and infant mental health service

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal–infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face‐to‐face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, ‘my special time’ and three sub‐themes, ‘there is someone out there for me’, ‘it wasn't just a job’ and ‘swimming or stranded: feelings about leaving the service’, were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self‐determination in all therapeutic processes, including discharge, if recovery and self‐efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.     

Notions of child health: mothers' accounts of health in their young babies

This paper is concerned with mothers’ understandings of child health in their young babies. To explore how child health is depicted, explained and contextualised by mothers, altogether 29 mothers in Stockholm and London were interviewed through the baby's first months about day-to-day experiences of the baby's health and well-being. The analysis of the mothers’ accounts reveals how the mothers, in the process of assessing health, try to ‘read’ the bodily signs and reactions in their babies. Some major themes emerge on how the mothers identify and characterise threats to the health of the baby; here described as threats of abnormalities, threats to the survival of the baby, threats to the thriving of the baby and threats from illnesses. Notions of child health are discussed in relation to the ‘bodily’ and the ‘social’, and how the embodied images of child health are intertwined with the mothers’ presentations of themselves as responsible for the health of their children and as ‘worthy’ parents.     

Working on the interface: identifying professional responses to families with mental health and child-care needs

The gaps between mental health and child-care services constitute a recognised barrier to providing effective services to families where parents have mental health problems. Recent guidance exhorts professionals to coordinate and collaborate more consistently in this area of work. The present study aimed to identify the barriers to inter-professional collaboration through a survey of 500 health and social care professionals. The views of 11 mothers with severe mental health problems whose children had been subject to a child protection case conference were also interrogated through two sets of interviews. The study found that communication problems were identified more frequently between child care workers and adult psychiatrists than between other groups. Communication between general practitioners and child-care workers was also more likely to be described as problematic. While there was some support amongst practitioners for child-care workers to assume a coordinating or lead role in such cases, this support was not overwhelming, and reflected professional interests and alliances. The mothers themselves valued support from professionals whom they felt were 'there for them' and whom they could trust. There was evidence from the responses of child-care social workers that they lacked the capacity to fill this role in relation to parents and their statutory child-care responsibilities may make it particularly difficult for them to do so. The authors recommend that a dyad of workers from the child-care and community mental health services should share the coordinating key worker role in such cases.     

How rates of perinatal mental health screening in Australia have changed over time and which women are missing out

Objectives : To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013–2017). Methods : A longitudinal community‐based study of self‐reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. Results : From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52–0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60–0.99) were less likely to have been screened both antenatally and postnatally. Conclusions : Despite improvements, perinatal mental health screening is not yet universal. One‐in‐five women are not screened both antenatally and postnatally, including women in high‐risk populations such as those who have reported emotional distress. Implications for public health : Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.     

The baby and the bath water: disabled women and motherhood in social context

The aim of this paper is to explore key dimensions of the reproductive experiences of disabled women who are, or who are thinking about becoming, mothers. The paper reports a qualitative study which involved semi-structured interviews with 17 disabled women who were contemplating childbearing, or were pregnant, and/or had young children. The interpretation of these women's experiences is situated with reference to current debates on the meaning and nature of disability, and draws attention to the ways in which these experiences can be understood as manifestations of disablism. More specifically, the paper considers three themes which emerged in the data analysis: the women's engagement with the medical ‘risk’ discourse; the pressure felt by disabled women to demonstrate that they are, or could be, ‘good enough mothers’; and their experiences of receiving unhelpful ‘help’ from health and social care workers.     

Adolescent pregnancy and young motherhood in rural Zimbabwe: Findings from a baseline study

Pregnant adolescents and young mothers comprise a vulnerable group, particularly in low and middle income countries, yet there is limited research describing this population, particularly in rural Zimbabwe. Using tablet-administered questionnaires concerning maternal and child health, sexual and reproductive health, psychosocial well-being and parenting, we recruited 442 pregnant and young mothers (14–24 years) with the support of social workers from health facilities. We found high levels of poverty amidst increased rates of marriage, including child marriage (almost 20%). Participants had poor sexual and reproductive health knowledge and uptake of contraception was low (only 35% respondents reported current use). Although almost 60% girls had completed Form 2, 24% had only completed Grade 1 and just 4% were still engaged in schooling. Girls reported inadequate social support amidst high caretaking responsibilities and change in relocation for marriage, compromising mental health. Most of the pregnancies were unintended (approximately 60%) which had consequences on attachment and parenting where roughly 40% of our sample reported difficulties and lack of enjoyment in caring for their babies. Investments in interventions that address these vulnerabilities for pregnant adolescents and young mothers, and capitalise on available resources, are critical to improve health and interrupt cycles of risk for the next generation.     

Racial Disparities in Children’s Health: A Longitudinal Analysis of Mothers Based on the Multiple Disadvantage Model

This secondary data analysis of 4373 mothers and their children investigated racial disparities in children’s health and its associations with social structural factors, social relationships/support, health/mental health, substance use, and access to health/mental health services. The study drew on longitudinal records for mother–child pairs created from data in the Fragile Families and Child Wellbeing Study. Generalized estimating equations yielded results showing children’s good health to be associated positively with mother’s health (current health and health during pregnancy), across three ethnic groups. For African-American children, good health was associated with mothers’ education level, receipt of informal child care, receipt of public health insurance, uninsured status, and absence of depression. For Hispanic children, health was positively associated with mothers’ education level, receipt of substance-use treatment, and non-receipt of public assistance. Implications for policy and intervention are discussed.     

Silenced voices: hearing the stories of parents bereaved through the suicide death of a young adult child

The current paper reports findings from a qualitative research project that aimed to explore parents’ experiences following the suicide death of their young adult child. Twenty‐two Australian parents told of the suicide death of their son or daughter during the data collection period (2003 to late 2004). One narrative theme drawn from the interview data is reported here: the way in which suicide‐bereaved parents feel unable to talk about their child’s life and death, their experience of suicide and their resultant bereavement. Parents reported being silenced by others and silencing themselves in relation to talking about their bereavement. Parents’ private stories are used to explain the difficulties they faced given the contemporary social and cultural context of grief and suicide. Then follows an examination of the impact these difficulties had on their ongoing grief narrative and availability of social support. Implications for health and social care intervention are presented to assist in better preparing support workers in their interactions with parents bereaved in this manner.     

Female Sex Workers’ Experiences Selling Sex during Pregnancy and Post‐Delivery in South Africa

Nearly 75 percent of female sex workers (FSWs) in Port Elizabeth, South Africa are mothers, many of whom engage in sex work during pregnancy or after delivery. We conducted in‐depth interviews with 22 postpartum and 8 pregnant FSWs in Port Elizabeth. Interview guides were used to probe women's experiences, challenges, and concerns about selling sex during pregnancy and post‐delivery in a high‐HIV‐prevalence context. Interviews were transcribed, translated, and coded using thematic analysis. FSWs experienced and feared violence by clients during pregnancy, highlighting the need for safe work environments. Further, FSWs expressed concerns about HIV acquisition and vertical transmission during the perinatal period. Physical challenges related to pregnancy affected women's ability to work. Returning to work post‐delivery presented barriers to initiating and practicing exclusive breastfeeding. As a result, many FSWs practiced mixed feeding. Interventions, tailored to respond to FSW's challenges and experiences, may offer improved health outcomes in this context.     

Development of the Child's Challenging Behaviour Scale (CCBS) for mothers of school‐aged children with disabilities

Background Caring for a child with a disability can be especially difficult when the child exhibits challenging behaviours. Childhood disability often calls for the mother to be conscientious, capable and organized to meet the child's health and developmental needs. Mothers are known to feel particularly stressed when their child also behaves in ways that are difficult to manage. In these circumstances maternal mental health may be compromised and mothers therefore need more support. The Child's Challenging Behaviour Scale (CCBS) is an 11‐item scale that measures a mother's report of challenging behaviours exhibited by their child with disability, that are associated with compromised maternal mental health and caregiving difficulties. This paper describes the initial development and psychometric evaluation of the CCBS. Methods A mixed methodology instrument design model was used to develop the CCBS. A qualitative study generated items, and quantitative data were collected from 152 mothers of a child with a disability. Results The CCBS showed excellent internal consistency (Cronbach's alpha = 0.89) and factor analysis supported its unidimensionality. Construct validity was supported by correlations with the PedsQL Psychosocial Health Summary Score (rho =?0.51) and cooperation taking medication (rho = 0.40). There were significant differences in CCBS scores between groups of children with and without either autism or psychiatric conditions. The CCBS showed moderate correlations with self‐reported health status; the mother's sense of empowerment (rho =?0.44); and family cohesion (rho =?0.30). Mothers with a mental health condition recorded significantly higher CCBS scores. Conclusions The CCBS is a brief, psychometrically sound instrument that provides clinicians with a new tool that measures a mother's rating of their child's behaviours that are challenging and associated with reduced maternal well‐being. The CCBS assists professionals to identify mothers and family situations who may be in need of more support and interventions.     

Perinatal mental health in lesbian mothers: a review of potential risk and protective factors

Postpartum depression and other perinatal mental illnesses are common complications of childbirth. The majority of research on these conditions has been conducted in heterosexual women; however, increasing numbers of women are choosing to parent in the context of lesbian relationships. Although many of the fundamental aspects of the transition to parenthood are shared between lesbian and heterosexual mothers, lesbian mothers may differ from heterosexual parents on a number of variables that have been previously associated with perinatal mental health. Lesbian mothers may be more likely than their heterosexual peers to lack social support, particularly from their families of origin, and may be exposed to additional stress due to homophobic discrimination. However, the likelihood that lesbian pregnancies will be planned, together with the relatively equal division of child-care labour observed in lesbian couples, may offer protection from perinatal depression. The study of perinatal mental health in lesbian mothers is warranted, both to ensure that the mental health needs of this largely invisible population are being met, and to further illuminate the role of psychosocial stress in perinatal mental health in all women.     

Mellow Futures – An adapted parenting programme for mothers with learning difficulties in England and Scotland. Professionals' views on the outcomes

The Mellow Futures programme is a specially adapted parenting programme for mothers with learning difficulties that combines group work with home-based support. This paper reports on the findings of prospective and retrospective interviews with professionals who had referred mothers to the programme in England or Scotland between 2013 and 2015. The aim was to explore their perceptions of the programme as a whole, and its impact on the mothers they had referred to it. Mothers attending the Mellow Futures programme were invited to consent for a key professional to be contacted as part of the evaluation, generally those social workers who had referred the mothers to the programme. The ‘referrers’ were interviewed at the start and end of the programme. Thirty referrers contributed their views on the impact of the programme. Twenty-six were very positive about the impact of the Mellow Futures programme on the mothers: the programme was thought to have increased the mothers' confidence and self-esteem; supported them to work through issues; and helped them strengthen their relationship-building skills. Four referrers felt that the programme had not had any impact on the mothers they were supporting. The Mellow Futures programme focused on relationships, rather than parenting techniques, and three fundamentally important relationships in the mothers and babies' lives were targeted: the relationship/attachment between mother and baby; the supportive, ongoing relationships between the mothers in the group; and the mothers' more positive engagement with the professionals concerned with the welfare of their baby. The research confirms that, from the perspectives of referrers, linking group and home-based support can successfully help mothers with learning difficulties to care for their children.     

The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question ‘what is the nature of the evidence relevant to the provision of mental health interventions by midwives?’ To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife‐led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife‐led counselling interventions are effective. Further research is needed to test midwife‐led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.     

Psychosocial impact of perinatal loss among Muslim women

ABSTRACT: BACKGROUND: Women of reproductive age are vulnerable to psychosocial problems but these have remained largely unexplored in some groups especially amongst Muslims in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. METHODS: A qualitative study was conducted in specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was captured using focus group discussion and in-depth unstructured interview until the saturation point met. RESULTS: Sixteen mothers participated, having had one recent perinatal loss of a wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Two of them showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support was reported. The majority agreed that the decision makers were their husbands and families rather than themselves alone. The respondents felt that repetitive reminder by husband, family or friends that whatever happened was a test from God improved their sense of self-worth. CONCLUSION: Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Health care providers should provide psychosocial support in hospital, and ongoing support should be available where needed. Majority said that their husbands and family members were the main decision makers.     

Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors

ABSTRACT

Postpartum depression and other perinatal mental illnesses are common complications of childbirth. The majority of research on these conditions has been conducted in heterosexual women; however, increasing numbers of women are choosing to parent in the context of lesbian relationships. Although many of the fundamental aspects of the transition to parenthood are shared between lesbian and heterosexual mothers, lesbian mothers may differ from heterosexual parents on a number of variables that have been previously associated with perinatal mental health. Lesbian mothers may be more likely than their heterosexual peers to lack social support, particularly from their families of origin, and may be exposed to additional stress due to homophobic discrimination. However, the likelihood that lesbian pregnancies will be planned, together with the relatively equal division of child- care labour observed in lesbian couples, may offer protection from perinatal depression. The study of perinatal mental health in lesbian mothers is warranted, both to ensure that the mental health needs of this largely invisible population are being met, and to further illuminate the role of psychosocial stress in perinatal mental health in all women.     

A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980–1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women’s access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation’s promise that all children—no matter their income or race/ethnicity—will have the opportunity to be born well.     

Fathers' Involvement in Child Health Care: Associations with Prenatal Involvement,Parents' Beliefs,and Maternal Gatekeeping

Using data from 182 dual‐earner couples experiencing the transition to parenthood, this study examined associations between prenatal involvement, gender‐role beliefs, and maternal gatekeeping and new fathers' involvement in child health care. Results indicated that prenatal father involvement was associated with fathers' direct engagement in child health care and perceived influence in child health‐related decision making. Fathers also demonstrated greater direct engagement in child health care when mothers held more nontraditional beliefs about gender roles. Moreover, when mothers were more encouraging of fathers' involvement in childrearing, fathers felt more influential in child health‐related decision making, whereas when mothers engaged in greater gate‐closing behavior, fathers with more traditional gender‐role beliefs felt less influential in child health‐related decision making. This study suggests that fathers' prenatal involvement, mothers' beliefs, and maternal gatekeeping may play a role in the development of new fathers' involvement in child health care at the transition to parenthood.