Mother Care Research Articles

Shock, response, and resilience of COVID-19 on Kangaroo Mother Care service utilisation in public health facilities in Bangladesh: An interrupted time series analysis

Shock, response, and resilience of COVID-19 on Kangaroo Mother Care service utilisation in public health facilities in Bangladesh: An interrupted time series analysis

Kangaroo Mother Care in Term and Late Preterm Neonates: A Systematic Review.

This systematic review aims to investigate the efficacy of kangaroo mother care (KMC) in term and late-preterm babies. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, seven studies were analyzed, which covered a wide range of outcomes, from the post-vaccination serum bilirubin level and pain during the vaccination to the prevention of hypothermia and long-term neurodevelopmental outcomes. Results point out that KMC might come with some advantages such as the reduction of neonatal bilirubin levels, a painless and quicker vaccination process, and better prevention of hypothermia. Moreover, initial and lengthy KMC also plays a possible role in the better long-term brain development of low-birth-weight neonates. Furthermore, the limitation of smaller numbers of studies and variability in results remains to be solved. The next step is working to build stronger evidence and creating proper conditions for the implementation of KMC in future healthcare.

Effect of One-on-one Structured Counselling of Mothers and Family Members Using GALPAC Technique Compared to Standard Counselling on Post-discharge Kangaroo Mother Care and Related Outcomes in Low-birth-weight Infants: A Quasi-randomised Controlled Trial

Background and Objectives Kangaroo mother care (KMC) improves low-birth-weight neonatal survival. It is recommended for low-birth-weight babies in all settings and should be continued at home as well. Counselling of mothers and family members is necessary for successful initiation and continuation of KMC. This study aims to use the greet, ask, listen, praise, advise, check understanding (GALPAC) method of counselling to improve the outcome of home-based KMC. Methods This quasi-randomised controlled trial was done in 266 stable low-birth-weight neonates born in the hospital. In the intervention group, GALPAC counselling was done by trained nurses and paediatricians during the hospital stay, through telephone after discharge and by local ASHA during home visits. The control group received routine counselling during discharge and on follow-up visits by the treating paediatrician. Both groups were examined on the 15th, 30th and 60th day post-discharge for weight changes and were monitored for morbidity, mortality, breastfeeding and continuation of KMC. Results The neonates were divided randomly in two groups: 132 in the intervention group and 134 in the control group. The basic demographic parameters were comparable in both the groups. On the 15th day of follow-up, breastfeeding rate was 86% in the intervention group and 80% in the control group, morbidity was 13.4% and 15.7%, KMC continuation was 84% and 71.3% and re-admission rate was 6.1% and 7.04%, respectively. By the 60th day, the breastfeeding rate was 67.6% and 55.05%, morbidity 3.8% and 19.1%, KMC continuation 65% and 47% and re-admission rate 1.8% and 20.2% in the intervention and control groups, respectively. Mortality was 11.2% in the control group and 1.8% in the intervention group by the 60th day. Weight gain was more in the intervention group than in the control group (1,055.30 ± 122.46 g and 745.77 ± 99.34 g) by day 60. Interpretation and Conclusion The outcome of KMC in the intervention group was better in comparison to the control group for all parameters studied. Therefore, one-on-one structured counselling with regular communication and follow-up is an effective intervention to improve maintenance of KMC at home.

Effect of Kangaroo Mother Care on Retinopathy of Prematurity in Neonates Less Than 1,800 g or Below 34 Weeks of Gestation

Introduction KMC (Kangaroo Mother Care) is an established intervention to reduce mortality and morbidity in low birth weight (LBW) neonates. A multitude of risk factors and preventive strategies for ROP (retinopathy of prematurity) have been studied, however, the effect of KMC on ROP has not been reported. This study aims to study the effect of KMC on ROP in neonates with birth weights between 1,000 and 1,800 g. Methods The babies who received effective KMC (>6 hours per 24 hours for three consecutive days) were analysed in the intervention group and those with ineffective KMC were analysed in the control group. Variables significant in univariate analysis were entered into backward regression models in multivariate analysis. Odds ratios and 95% confidence intervals were calculated. P values < .05 are taken as significant. Results Of 783 neonates enrolled, 66 (8.4%) developed ROP (any stage). The incidence of ROP requiring intervention was 1.02%. Effective KMC reduced the risk of ROP by 95%, RR 0.05 (0.02–0.12) and number needed to treat = 5. The proportion of neonates with ROP in zone 1 and stage 3 was more in the ineffective KMC (42.4% vs. 1.5%) group than in the effective KMC group (51.5% vs. 0%) ( P < .001). Ineffective KMC, gestation <30 weeks, small for gestation, obstetric complications, asphyxia, sepsis, higher initial PEEP and lack of breastfeeding were significant risk factors for developing ROP. Conclusion KMC, an effective intervention to improve the mortality and morbidity in LBW neonates, was significantly associated with the reduction of any stage ROP and ROP needing intervention, potentially preventing a significant cause of childhood blindness.

Understanding the burden of teenage pregnancy: A five-year analysis at a tertiary care center of northern Karnataka in India

: The present study was planned to comprehensively investigate the epidemiological aspects and clinical feto-maternal outcomes associated with teenage pregnancy, to provide a holistic understanding of teenage pregnancy and the possible solutions. : This is retrospective record-based research conducted over a five-year period, spanning from January 2018 to December 2022, in the department of Obstetrics and Gynaecology of a tertiary care centre in northern part of Karnataka, India. The teenage pregnancy was considered as all pregnancies that occurred in women aged between 13 to 19 years who visited the institute for delivery during the study period. A comprehensive analysis was conducted, encompassing various facets of their antenatal experiences, delivery methods, postpartum complications, as well as the well-being of the new-borns. : A total of deliveries 52,715 deliveries had been recorded in our institute during the study period. Among these deliveries, 1,754 were among teenagers, resulting in a prevalence rate of 3.33%. Nearly one-fifth (19.16%) of teenage mothers were short stature whereas only 7.02% of adult mothers were short stature. The relatively higher proportion of teenage mothers were underweight. Maternal and fetal complication were comparatively higher among teenage mothers whereas caesarean sections were relatively more among adult mothers. : The present study emphasizes the importance of targeted healthcare interventions, including improved prenatal care, nutritional support, and education for teenage mothers, to mitigate these risks and improve the overall health and well-being of both mothers and their infants.

Effectiveness of kangaroo mother care before clinical stabilisation versus standard care among neonates at five hospitals in Uganda (OMWaNA): a parallel-group, individually randomised controlled trial and economic evaluation

Preterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends kangaroo mother care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing up to 2000 g. We conducted a parallel-group, individually randomised controlled trial in five hospitals across Uganda. Singleton or twin neonates aged younger than 48 h weighing 700-2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver's chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432. Between Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74-1·28]; p=0·85). From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71-1·09]; p=0·23). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care. KMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa. Joint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.

An Autoethnography on Intergenerational Relationships and Transnational Care for Older Parents

I employ autoethnography to undertake a broader scholarly inquiry on intergenerational relationships and transnational care shaped by global migration and aging. Specifically, I reflect on the dynamics of my relationship with my mother, beginning with my departure from my home and spanning a period of 40 years, 8 in China and 34 outside China. In doing so, I contemplate theoretical models of intergenerational solidarity, ambivalence, and role ambiguity. I also challenge cultural assumptions of filial piety. The geographical distance, passage of time, and acculturation process have profoundly influenced my perception of filial piety, which differs markedly from my mother’s. However, this divergence in consensual solidarity—marked by variations in attitudes, beliefs, and values—does not translate into weakened affectual solidarity, characterized by positive sentiments and emotions. Furthermore, aided by advancements in transportation and social media technology, I have been able to extend crucial emotional and some “instrumental” care to my mother, along with financial support if needed, despite limited hands-on care. Nevertheless, I must negotiate my care for my mother and navigate a delicate balance in coordinating my care efforts with those of my non-migrant siblings.

Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022.

Adequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia. A cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation. The study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits. Addressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates' overall well-being and long-term outcomes.

Continuum of maternal and new-natal health care: empirical evidence from 10 developing countries in South and South East Asia

Maternal and neonatal mortality and morbidity, particularly in developing countries, are high even in the twenty-first century, which is a cause for concern. Therefore, this paper examines the Continuum of Mother and Neonatal Health Care (MNH), i.e., at least four ante-natal care visits (ANC 4 +), skilled birth attendance at delivery (SBA), post-natal care (PNC), and its determinants in 10 developing countries in Asia. It uses Demographic and Household Survey data (2014–2021) and finds that only 46% of women received all the MNH services, and 8% did not receive any services. In Afghanistan, only 2.8% of women availed complete care of MNH services, followed by Timor-Leste (26.1%), Bangladesh (31.5%), Pakistan (35.1%), and Nepal (38.8%). Empirical analysis shows that women with higher education, those living in urban areas, from wealthy families, and female-headed households have higher odds of availing all MNH. Media exposure, ease of access to MNH services, and the women who have attended the first ANC at less than four months of pregnancy have higher odds of availing all three MNH services. Therefore, the MNH policy should target women in rural areas who have a lower level of education and come from low-income families to improve the mother and neonatal health situation in South and Southeast Asia.

ОХРАНА МАТЕРИНСТВА И ДЕТСТВА В ДЕМОГРАФИЧЕСКОЙ ПОЛИТИКЕ СОВЕТСКОЙ ВЛАСТИ В ГОРНОМ АЛТАЕ

The paper highlights the formation and further development of the system of maternity and childhood protection as one of the most important spheres of the Soviet healthcare in 1920s–30s. The field of child protection in the in Gorny Altai was in particular need of expanding the forms and methods of work, since child mortality rates at the beginning of the 20s were quite high. There was no specialized work on the protection of motherhood and childhood; there were no trained personnel. The development of diseases, and consequently mortality, was facilitated by unfavorable living conditions of the local population, lack of hygienic culture and regular movements of the population throughout the region. The solution to this problem was facilitated by the introduction of Soviet legislation on labor protection for pregnant and lactating women and their children. Since the mid-20s, commissions to promote the protection of motherhood and childhood were formed in the region, which carried out active educational and organizational work. The organization of mobile institutions for the protection of motherhood and childhood played a great role in solving the problem. In addition to a few stationary consultations, mobile institutions assumed the responsibility of providing assistance to the population of the region leading a nomadic and semi-nomadic lifestyle. In large population centers, the consultation stopped for more than a month, conducting surveys and providing ongoing assistance in remote areas of the mountainous terrain. Along with providing medical care, mobile consultation workers provided explanations about religious prejudices and superstitions. The data presented show the features of the formation of stationary institutions, the development of mobile services for mother and child care in the Oirot Autonomous Region. A positive result was a decrease in child and maternal mortality and an improvement in demographic indicators in the country.

Increasing the Resilience of Mothers With Preterm Infant: The Effect of Kangaroo Mother Care.

Having a preterm infant is a stressful experience for parents, especially for mothers. This study was conducted to identify the effect of kangaroo mother care on the resilience of mothers with preterm infant hospitalized in Neonatal Intensive Care Unit. In this randomized controlled trial study, 60 mothers with preterm infant hospitalized in Neonatal Intensive Care Unit were randomly selected and allocated to intervention and control groups (30 per group), in Fatemiyeh Hospital, Hamadan, Iran. Data collection tool included demographic information and Conner & Davidson Resilience Questionnaire (CD-RISC), which were completed by mothers before and after the intervention. Kangaroo Mother Care (KMC) as an intervention was run in at least one hour daily for a week in the intervention group. The mother-infant pairs in the control group only received conventional method of care (CMC). There was a significant increase in the total resilience score of the mothers in the KMC group (from 58.87±14.71 to 69.67±14.50) after intervention (P<0.001); however, resilience score decreased significantly in the mothers of CMC group (from 57.77±13.33 to 51.63±12.20). Kangaroo mother care could increase the resilience of mothers of preterm infants. Therefore using this approach as a complementary, effective, Low-cost, non-invasive care is recommended to maintain and promote the health of mothers with preterm infant.

A clinical guideline for the Iranian women and newborns in the postpartum period.

The postpartum is a vital period for women, newborns, spouses, parents, caregivers, and families. Regarding the importance of postpartum care and the lack of comprehensive and up-to-date clinical guidelines in the country of Iran, the postpartum clinical guidelines have been adapted. Cultural adaptation was conducted in three stages. In the first stage, the adaptation team was formed and the process was approved. During the second stage, a systematic literature review was conducted using international databases to identify English-language clinical guidelines published within the last 10 years. Out of 17 guidelines and documents initially selected, 5 guidelines meeting the inclusion and exclusion criteria and published within the last 5 years were chosen following a thorough review by the search team. In the secondary selection, the guidelines were investigated by two subject-matter experts based on AGREE II Checklist, and regarding the high evaluation score obtained by the WHO Recommendations on Postnatal Care of the Mother and Newborn (2022), and the National Institute for Health and Care Excellence (NICE,2021) guideline for postnatal care were selected for cultural adaptation. In the third stage, the opinions of experts from all over the country were collected and scored using the Delphi method, and a final guideline was formulated. The adapted postpartum clinical guideline has offered 56 recommendations. The recommendations are categorized into four major themes including mother care, newborn care, health system and health promotion interventions and post caesarean care. Applying evidence-based recommendations for the care of mothers and babies in the postpartum period will enhance the health system, promote the provision of care after vaginal and caesarean births, and ensure a positive postnatal experience for mothers, fathers, babies, and families.

The road ahead for immediate kangaroo mother care in resource-constrained health systems

The road ahead for immediate kangaroo mother care in resource-constrained health systems

Profile and risk factors of sight-threatening retinopathy of prematurity: Experience from SNCU in North India.

This research aimed to identify the clinical profile and risk factors of retinopathy of prematurity (ROP) among "at-risk" newborns treated at a sick newborn care unit (SNCU) located at high altitude in North India, with the intention of contributing to formulate regional and national ROP screening guidelines. In a prospective observational study from 2021 to 2022, outborn and inborn babies eligible for ROP screening were screened. Total 39/122 screened neonates had laser for Type 1 ROP, and 22/39 (56.4%) had aggressive ROP (AROP). The average birth weight (BW) was 1803.87 g, and the average gestational age was 34 weeks. Respiratory distress, bronchopulmonary dysplasia, sepsis, and apnea were present in 57.3%, 13%, 52.5%, and 25.4%, respectively. Sight-threatening ROP was present in 50% below 28+6 weeks, 27% between 29 and 30+6 weeks, 52% between 31 and 33+6 weeks, and 15% with gestation >34 weeks. Two babies with Type 1 ROP weighed >2 kg and one had AROP. Upon regression analysis, BW <1500 g, gestation <32 weeks, oxygen >48 h, clinical sepsis, total SNCU stay >14 days, continuous positive airway pressure support with oxygen >50%, and >10 days to achieve full feeds were associated with severe ROP. Caffeine to treat apnea and kangaroo mother care reduced ROP. None had short-term unfavorable outcome. With similar infrastructure and work force shortage in most SNCUs, these findings can be generalized. The burden of Type 1 and AROP is increasing, as seen in higher gestation and BWs. This needs revision of ROP screening criteria at local and national level. It is crucial to emphasize on the importance of pediatrician and ophthalmologist collaboration, early ROP screening, diagnosis, and treatment to stop disease progression to severe ROP.

Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight

ObjectiveTo assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Design,...

Application Of Pbm-Nir Therapy For Postpartum Mother's Discomfort In Maternity Nursing Care

Normal post partum is post partum discomfort due to uterine involution. Uterine involution in patients can cause pain in the uterus called afterpains. Discomfort caused by uterine involution requires various treatments to minimize the pain felt by the mother so that the mother's comfort can return. This can be overcome with non-pharmacological pain management strategies through innovative near infrared phototherapy or near infrared photobiomodulation (PBM NIR). The aim of this research is to analyze the results of implementing pain management with non-pharmacological PBM NIR therapy in normal post-partum mothers with post-partum discomfort nursing problems. Case study that focuses on the implementation of non-pharmacological nursing pain management techniques with PBM NIR therapy. The case study subjects were 3 normal post-partum maternal patients with the same problem, namely post-partum discomfort in the obstetrics room at the Muhammadiyah Hospital in Palembang. The results of the study showed that the implementation of non-pharmacological pain management techniques with PBM NIR therapy had an effective effect on dealing with post-partum discomfort with complaints of decreased discomfort, decreased moaning, and strong uterine contractions. Implementation of pain management can improve the comfort status of normal postpartum mothers. This study makes an important contribution to understanding of the role of nonpharmacological techniques in postpartum pain management, as well as highlighting the importance of implementing innovative therapies for labor, as well as highlighting the importance of implementing innovative therapies to improve the quality of care in postpartum mothers.

Intervention of Providing Iron Consumption Education to Prevent the Risk of Bleeding in Mrs. I Spontaneous Postpartum with Anemia

Postpartum hemorrhage is one of the leading causes of 150,000 maternal deaths each year worldwide, and nearly 4 out of 5 such deaths occur within 4 hours of delivery. One of the factors that can cause postpartum hemorrhage is the presence of anemia in pregnant women, which can be caused by iron and vitamin B12 deficiency. If anemia is not treated during pregnancy, it can impact the postpartum period by increasing the risk of uterine atony and significant bleeding. The purpose of this study was to explain nursing care in postpartum mothers with anemia using an educational intervention of iron consumption to prevent postpartum hemorrhage. The research method used is a qualitative approach with case studies as the main method, using observation sheets, interviews, and documentation studies. The subject of this study was one postpartum maternal patient with anemia at RSUD Waled Cirebon. The results of the case study showed clinical success in the absence of signs and symptoms of bleeding, improvement in the mother's condition, although breast milk expenditure was still not optimal. The implication of this study is that effective nursing care delivery can meet patient needs and prevent further complications such as postpartum hemorrhage.

Young women's social support networks during pregnancy in Soweto, South Africa.

Although studies from high-income countries have examined social support during pregnancy, it remains unclear what type of support is received by expectant mothers from low- and middle-income country settings. To explore young women's social support networks during pregnancy in Soweto, South Africa. This study was undertaken in an academic hospital based in the Southwestern Townships (Soweto), Johannesburg, in Gauteng province, South Africa. An exploratory descriptive qualitative approach was employed. Eighteen (18) young pregnant women were recruited using a purposive sampling approach. In-depth interviews were conducted, and data were analysed using inductive thematic analysis. Analysis of the data resulted in the development of two superordinate themes namely; (1) relationships during pregnancy and (2) network involvement. Involvement of the various social networks contributed greatly to the young women having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. Focusing on less-examined characteristics that could enhance pregnant women's health could help in the reduction of deaths that arise because of pregnancy complications and contribute in globally accelerating increased accessibility to adequate reproductive health.Contribution: This study's findings emphasise the necessity for policymakers and healthcare providers to educate the broader community about the importance of partner, family and peer support to minimise risks that may affect pregnancy care and wellbeing of mothers.

ASUHAN KEBIDANAN PADA IBU BERSALIN NY X DENGAN MENERAPKAN ASUHAN SAYANG IBU DI PUSKESMAS TANJUNG BALAI KARIMUN

Childbirth is an event that ends with the expulsion of a full-term baby, psychological changes, namely feeling afraid that if there is danger to themselves during childbirth, fear that is related to past experiences, for example experiencing difficulties in past deliveries (Rinata, 2018), , if the mother is not enthusiastic or experiences excessive fear, it will make the delivery process difficult. The aim is to provide midwifery care for mothers in a comprehensive and sustainable manner, with management of midwifery care in accordance with midwifery service standards. The midwifery care that was implemented was Midwifery Care for Mrs. X by Implementing Maternal Care. The practice report preparation method was descriptive research using the case study method. The research was conducted at the Tanjung Balai Karimun Health Center in March 2023. The subjects used in case studies with management this midwifery care is Mrs. X. Results and conclusions Evaluation of the care provided related to the Implementation of Midwifery Care for Mothers in Birth Mrs. X By implementing Mother-loving Care can increase mother's confidence in facing the birth process

PENERAPAN AROMATERAPI SEREH TERHADAP KECEMASAN MENGHADAPI PERSALINAN PADA NY D DI PUSKESMAS TANJUNG BALAI KARIMUN

Anxiety about childbirth is felt by all pregnant women before delivery. Essential oils in labor can improve coping strategies in birthing mothers. The main role of essential oils during labor and delivery is to help relieve pain, stress and anxiety. The aim is to provide midwifery care for mothers in a comprehensive and sustainable manner, with management of midwifery care in accordance with midwifery service standards. Midwifery care that is applied is the application of citronella aromatherapy to anxiety in facing childbirth. The practice report preparation method is descriptive research with the case study method conducted at the Tanjung Balai Karimun Health Center in February 2023. The subject used in this case study with midwifery care management was Mrs. D. Results and Conclusions Evaluation of the care provided related to the application of lemongrass aromatherapy to the anxiety of facing childbirth there is a reduction in the anxiety that the mother feels