Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial

Objective  To examine the effects of antenatal education focussing on natural childbirth preparation with psychoprophylactic training versus standard antenatal education on the use of epidural analgesia, experience of childbirth and parental stress in first-time mothers and fathers.
Design  Randomised controlled multicentre trial.
Setting  Fifteen antenatal clinics in Sweden between January 2006 and May 2007.
Sample  A total of 1087 nulliparous women and 1064 of their partners.
Methods  Natural group: Antenatal education focussing on natural childbirth preparation with training in breathing and relaxation techniques (psychoprophylaxis). Standard care group : Standard antenatal education focussing on both childbirth and parenthood, without psychoprophylactic training. Both groups: Four 2-hour sessions in groups of 12 participants during third trimester of pregnancy and one follow-up after delivery.
Main outcome measures  Epidural analgesia during labour, experience of childbirth as measured by the Wijma Delivery Experience Questionnaire (B), and parental stress measured by the Swedish Parenthood Stress Questionnaire.
Results  The epidural rate was 52% in both groups. There were no statistically significant differences in the experience of childbirth or parental stress between the randomised groups, either in women or men. Seventy percent of the women in the Natural group reported having used psychoprophylaxis during labour. A minority in the Standard care group (37%) had also used this method, but subgroup analysis where these women were excluded did not change the principal findings.
Conclusion  Natural childbirth preparation including training in breathing and relaxation did not decrease the use of epidural analgesia during labour, nor did it improve the birth experience or affect parental stress in early parenthood in nulliparous women and men, compared with a standard form of antenatal education.     

Effective Interventions for Adolescent Mothers

This article reviews research on programs designed to reduce the adverse consequences of early childbearing. Programs that focus on the mothers' health and well-being have proved effective in changing life outcomes for the mothers and improving the childrearing environment they provide for their children. More narrowly focused programs designed to increase maternal em-ployability have been ineffective. Comparisons of effective and ineffective programs suggest that the timing of service delivery is a critical factor in program success, as is the choice of goals that are endorsed by the recipients. Future research should focus on means for preventing rapid repeated childbirth in this population and should determine effects of programs for the children as well as the mothers.     

Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility‐related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their “top 3” life goals. Only 40% reported fertility‐related discussions with their health care providers in survivorship. Given the importance of biological children among this cohort, future guidelines should encourage a more proactive approach to providing fertility counseling and offering testing, to mitigate distress and prevent unplanned pregnancies.     

“Not the Romantic,All Happy,Coochy Coo Experience”: A Qualitative Analysis of Interactions on an Irish Parenting Web Site

Support groups in online communities provide an anonymous place to exchange information and advice. Previous research has suggested that these groups offer a safe, nonjudgmental forum for new parents to share experiences and interact anonymously. This study investigated how participants in online parenting groups experience support via the Internet and what types of support they receive. All posts made over a 2‐week period on the parenting‐related discussion boards of an Irish parenting Web site were analyzed using content and thematic analyses. Exploratory, semistructured interviews were also conducted with 2 forum participants to discuss their experience of using the Web site. Themes uncovered from the data gathered included the attempts by posters to dispel the myths surrounding motherhood and the recognition of the superiority of the mother as caregiver. The results revealed that the parenting Web site was seen as a safe, supportive space, in which mothers could develop an enhanced frame of reference in which to better understand the role of parenting. The role of online support groups as a viable solution to the decreasing social networks created by modern society is discussed, along with the implications of the findings for future practice and research.     

Harmful alcohol use as a predictor of intimate partner violence during the transition to parenthood: Interdependent and interactive effects

Harmful alcohol use is known to increase the risk of intimate partner violence (IPV), however very little is known about the role of alcohol use during the transition to parenthood. The current study was designed to examine harmful alcohol use as a dyadic and interactive time-varying risk factor for psychological and physical IPV across the transition to parenthood using a sample of 98 couples assessed prenatally and again at one and two years postpartum. Longitudinal actor–partner interdependence models demonstrated that changes in harmful alcohol use during the transition to parenthood were significantly related to changes in psychological IPV for both men and women and with physical IPV for men only, whereas harmful alcohol use was actually negatively related to variations in women's physical IPV. Partners' harmful use of alcohol during the transition to parenthood also explained additional variance in psychological IPV for men and physical IPV for women over time. Time-varying interactions between actors' and partners' harmful alcohol use were additionally predictive of greater psychological IPV for women and greater physical IPV for both men and women. Contrary to some past research, time-varying discrepancies in levels of harmful alcohol use between men and women were related to a lower risk of psychological IPV for women and physical IPV for both genders. Findings from this study indicate that harmful alcohol use by both men and women combines in a dyadic and interactive manner to place couples at risk for IPV during the transition to parenthood. Prenatal interventions may benefit from strategies to reduce the harmful use of alcohol by both men and women during the prenatal and postpartum periods.     

Predictors of Change in Relationship Satisfaction during the Transition to Parenthood

Couple‐focused interventions have shown limited success at preventing relationship satisfaction decline in couples during transition to parenthood. More knowledge on what constitutes relationship risk may inform future practice. This study investigated the role of underexplored individual and contextual risk factors through interactive and additive models. Participating couples (N = 228) completed questionnaires during pregnancy and at 6 and 30 months postpartum. The authors used bootstrapped Bayesian information criterion analyses to select significant and reliable predictors of change in relationship satisfaction within three predefined sets of factors representing components of the vulnerability‐stress‐adaptation model. Anxiety and depression symptoms during pregnancy, shorter length of the relationship, and lower levels of constructive communication predicted declines in relationship satisfaction from pregnancy to 30‐months postpartum. When these risk factors were combined, additive rather than interactive risk models were supported. Practical implications of additive risk factors are discussed     

Close Relationships Predict Curvilinear Trajectories of Maternal Depressive Symptoms over the Transition to Parenthood

Trajectories of change in maternal depressive symptoms were examined in a sample of 98 mothers across the transition to parenthood. Latent class growth modeling revealed two unique trajectories: one characterized by consistently low depressive symptoms, the other characterized by a curvilinear pattern with initially elevated symptoms that declined around the time of childbirth then returned to elevated levels by 24 weeks postpartum. Mothers who recalled less paternal care and acceptance in childhood and who reported that they engaged in more avoidance and aggression in their own romantic relationships were more likely to experience the curvilinear trajectory. Mothers who reported that their partners engaged in more avoidance in their romantic relationships were also more likely to experience the curvilinear trajectory, but especially when mothers recalled low maternal care and acceptance. Partner's aggression did not predict the trajectory of maternal depressive symptoms. Results have implications for screening for maternal postpartum depression.     

The Influence of Father Involvement and Interparental Relationship Quality on Adolescent Mothers' Maternal Identity

Guided by maternal role attainment and identity theory perspectives, the authors examined the association between prenatal and postbirth father involvement and maternal identity for adolescent mothers and the moderating effects of interparental relationship quality. Mailed surveys were completed by 125 mothers age 14–19 years (67.2% White) who were recruited from a statewide school‐based program. Maternal identity was operationalized as a latent construct composed of three indicators representing role validation, role strain, and identity salience. Analyses revealed that prenatal father involvement was positively associated with fathers' postbirth engagement with their children and indirectly associated with maternal identity. The association between father involvement pre and post birth as well as the association between father–child involvement and maternal identity were moderated by the presence of a cooperative relationship between mothers and their child's father, consistent with a moderated mediation model. Implications for future research and practice are presented.