Maternal Feelings Research Articles

Joan Sherwood, Infection of the Innocents: Wet Nurses, Infants, and Syphilis in France, 1780–1900, McGill-Queen's/Associated Medical Services Studies in the History of Medicine, Health and Science, 37 (Montreal: McGill-Queen's University Press, 2010), pp. xiii + 214, $75.00, hardback, ISBN: 978-0-7735-3741-5.

Until the advent of safe artificial feeding, a good wet-nurse made all the difference to the survival of an infant whose own mother was unable to breastfeed. However, as detailed historical examination has shown over the past thirty years, the practice of wet-nursing was once widespread and by no means limited to emergencies. George D. Sussman’s ground-breaking work in France brought out both the economic contribution that routine wet-nursing made to both nurses and mothers and its association with different attitudes to infants; interpretations taken up by other authors, particularly by Valerie Fildes in her comprehensive overview of the topic from classical Greece to the present. However, although there is currently increasing interest in medical involvement in wet-nursing, there has been little examination of a small but significant aspect, the transfer of infection between nurse and nursling, the theme of Joan Sherwood’s new book. Infection of the Innocents uses detailed examinations of the records of the Vaugirard Hospital in Paris, and of nineteenth-century legal cases, to focus on a failed experiment to treat congenital syphilis by mercurialising breastmilk and its long-term impact on French medicine. Infection of the Innocents falls into two parts. The first locates the establishment of the Hospital in 1780 within contemporary understanding of venereal disease and its management. Government-sponsored, it was founded specifically to discover whether infants with congenital syphilis could be cured by being fed the milk of syphilitic nurses treated with mercury, then believed to be an effective treatment. As such, it was envisioned primarily as a ‘clinical workshop’, and displayed a stark attitude towards its patients, in contrast to contemporary British voluntary hospitals. Outside, women typically enjoyed an independent role in both healing and childcare, but inside Vaugirard, Sherwood stresses they were seen only as the ‘technology’ of cure, under strict medical control and following an almost military regime. Nonetheless, she argues that some moral rehabilitation was still expected; citing the Hospital’s belief that supervised wet-nursing would encourage maternal feelings and high-quality care. Sadly, the extremely high mortality among foundlings led rather to despair and even suicide among their young nurses, feelings presumably compounded by their own ill health. Detailed analysis of all patients from the first and final years of the Hospital’s life in fact demonstrates wide variation in outcome – there was a contrasting higher-than-average survival rate among children cared for by their own mothers. However, this reader would have appreciated both a firmer guiding hand through the data, and the making of closer connections with events outside the Hospital. By 1790, the revolutionary government considered the experiment a failure, and Vaugirard Hospital was closed. Yet its unsuccessful treatment lived on, and the second part explores the changing attitudes among the medical profession revealed through a number of compensation cases brought against their employers by wet-nurses infected with syphilis by their nurslings, some of whom had also been treated with mercury without their knowledge or consent. Here, Sherwood illustrates developing medical ethics, arguing that, although initially the doctor felt loyalty only to the family that retained him, and thus might not inform the wet-nurse either of the infant’s condition or the nature of any medicines she was asked to take, by 1870, he was considered to have an over-riding duty of care towards public health in general. Such arguments combine with the earlier exploration of the Hospital to suggest that, while on the surface Infection of the Innocents describes a minor aspect of both wet-nursing and venereal disease, it nevertheless makes a much deeper contribution to the history of medicine.

Maternal attachment feelings mediate between maternal reports of depression, infant social–emotional development, and parenting stress

Objective: The current study examined whether having a positive maternal postpartum depression screening was associated with maternal report of poorer infant social–emotional development and more negative maternal report of parent–child interaction, and whether scores on a measure of maternal feelings of attachment influenced this relationship. Methods: Two hundred and thirty-two first-time mothers and their infants were assessed using self-reporting questionnaires when infants were 2 and 6 months of age. At 2 months, mothers were screened for postpartum depression and their feelings of attachment to their infants were also measured. At 6 months, mothers reported on infant social–emotional development and the parent–child interaction. Results: Findings revealed an association between having a positive screening for maternal depression at 2 months, and reports of both at-risk infant social–emotional development and parent–child dysfunctional interaction at 6 months. Further analyses indicated that maternal feelings of attachment mediated rather than moderated these relationships. Conclusions: These results suggest that the association of maternal postpartum depression with later child outcomes may be the result of the negative effects of maternal depression on maternal feelings of attachment to her infant.

“Telling what’s o’er”: Remaking the Sonnet Cycle in Augusta Webster’s Mother and Daughter

In her 1878 essay Poets and Personal Pronouns, Augusta Webster proposed that poets adopt new pronoun: use of instead of I might have some effect as sort of disclaimer of writer's personality.' (1) This neologism would allow writers constantly to remind their readers that poetry is not to be as autobiographical unless explicitly marked as such by big I. Although essay quickly acknowledges that the printers would never stand for this proposal, Webster would soon embark on her own experiment with authorial 'T' in unfinished sonnet sequence Mother and Daughter (1895), which takes up sonnet's familiar preoccupations with love, temporality, death, absence, and language. Recasting these issues in context of mother/daughter relationship, speaker in Webster's sonnets celebrates her relationship with her daughter and mourns its evanescence. Though she employs conventional capital I, this speaker not only analyzes her own subjectivity as mother but also theorizes maternal subjectivity more generally; in doing so, she reimagines conventions of sonnet cycle. Webster would probably have availed herself of little i in these sonnets had been recognized as modest disclaimer of writer's personality, but in absence of such disclaimer poems' earliest reader blithely ignored poet's previously published caveats against conflating speaker and poet. William Michael Rossetti, in his introduction to posthumous 1895 publication, wrote: Nothing certainly could be more genuine than these sonnets. A Mother is expressing her love for Daughter.... The theme is as beautiful and natural one as any poetess could select. So natural is it, indeed, that it seems surprising that Mrs. Webster had not been forestalled--and to best of my knowledge she never was forestalled--in such treatment. But some of poetesses have not been Mothers. (2) Attributing her choice of theme to her maternity, Rossetti clearly suggests that Webster not only writes from but about her own experience. The temptation to read speaker in sonnets as Webster herself is understandable. Most of poems depict relationship between mother and her only daughter, and Webster had one child, daughter. Moreover, what dates we have support biographical reading; while some sonnets describe girl's infancy and early childhood, others show speaker looking back on her daughter's youth after has passed. The only three sonnets in twenty-seven-poem cycle that bear dates were composed in 1880s (I in 1881, XIII in 1882, and XXIV in 1886); Webster's daughter was born in 1864 (Portraits, p. 10). So these sonnets would have been written when she was in her late teens and early twenties. However, as we have seen, Webster herself warns readers against autobiographical interpretation; in Poets and Personal Pronouns, she not only wishes for an orthographical means of differentiating poet and persona, but also insists that poet should not be taken as offering his readers presentment of himself, his hopes, his loves, his sorrows, his guilt and remorses, his history and psychology generally (Portraits, p. 369). Rather than interpreting Webster's sonnet sequence as transparent display of maternal feeling, then, I read as an innovative reconsideration of both genre in which she was working and discursive dimensions of maternal subjectivity. To speak as mother is already to figure oneself as subjective, personal, and domestic. Webster challenges this equation through her innovative use of sonnet cycle, simultaneously exploiting and resisting what Natalie Houston terms a widespread understanding of sonnet form itself as truthful and documentary. (3) Moreover, even as many of Mother and Daughter sonnets seem to invite us to identify poet with speaker, cycle refuses to limit its analysis of motherhood to speaker's--or any one woman's--experience of this institution. …

Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. This longitudinal study focused on 74 preterm infants (age of <36 weeks) and their mothers who were part of a larger study of high-risk infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.

A ultrassonografia obstétrica e suas implicações para a relação materno-fetal

O objetivo desta pesquisa foi investigar as implicações emocionais da ultrassonografia obstétrica para a relação materno-fetal, no contexto de normalidade fetal. Participaram 11 gestantes primíparas, com idades entre 18 e 35 anos e idades gestacional entre 11 e 24 semanas, que estavam sendo submetidas pela primeira vez à ultrassonografia. Elas responderam a uma entrevista semiestruturada e à Escala de Apego Materno-Fetal, antes e depois do exame. Análise de conteúdo qualitativa das entrevistas mostrou que a ultrassonografia, além de modificar a visão da mãe sobre o bebê, que passou a vê-lo de uma forma mais real e concreta, intensificou os comportamentos de interação mãe-bebê, ou seja, ampliou as diferentes maneiras de interagir e fortificou os sentimentos maternos, fazendo com que a mãe se sentisse mais apropriada de seu papel. Análise estatística revelou um aumento significativo na média dos escores da escala de apego após o exame. Juntos, os resultados indicam que a ultrassonografia parece ter exercido um impacto importante nas gestantes influenciando a relação mãe-bebê.Palavras-chave: ultrassonografia; relação materno-fetal; normalidade fetal.

Early Childhood Professionals as a Source of Social Support: The Role of Parent–Professional Communication

FORTY MOTHERS PARTICIPATED IN this Australian study of maternal perceptions of early childhood professionals (ECPs) as a source of social support in formal, centre-based infant/toddler care settings. Social support was defined as both emotional support (for example, providing understanding, encouragement, acceptance) and instrumental support (for example, providing practical information). Of particular interest was how the nature of communication between mothers and ECPs influences maternal feelings of support. ECPs in the study were defined as all early childhood staff—unqualified and qualified—identified by the mothers as working with their child in the centre. Quantitative data obtained by surveys and questionnaires was augmented by case studies of selected mothers based on interviews. It was found that most mothers perceived ECPs to be a source of social support, and that the content and frequency of mother–ECP communication determined how much support mothers considered they received. The case studies provided evocative insights into what it is like for mothers to ‘be’ in supportive and unsupportive childcare spaces. Among other things, the outcomes of this study encourage policymakers and ECPs to consider the extent to which childcare services provide social support for mothers, and how they might identify those who have the greatest need for it.

Parental Depressive Feelings, Parental Support, and the Serotonin Transporter Gene as Predictors of Adolescent Depressive Feelings: A Latent Growth Curve Analysis

Parental support and parental depressive feelings are found to be associated with depressive feelings in adolescent boys and girls, but results are inconsistent. In addition, the 5-HTTLPR genotype has been found to interact with environmental stressors in predicting adolescents’ depressive feelings, but this has not been examined longitudinally. Therefore, the present study examined the relationships between parental support, parental depressive feelings, and adolescent depressive feelings. In addition, the relationships between the 5-HTTLPR genotype and adolescent depressive feelings were explored, as well as gene-environment interactions. Adolescents (N = 306; Girls = 53.3%; M age T1 = 13.4) filled out questionnaires at five annual waves and provided saliva samples for DNA. Latent growth curve modelling (LGCM) was used to examine the baseline level and the change in depressive feelings over time. Maternal support was related to baseline levels of depressive feelings in girls, whereas paternal support was related to baseline levels in boys. Paternal depressive feelings were only related to boys’ depressive feelings at baseline, and maternal depressive feelings were not related to any outcome measures. Furthermore, no associations were found between 5-HTTLPR genotype and adolescent depressive feelings, and no gene-environment interactions emerged. Limitations of the study and implications of the findings are discussed.

Patronal Care and Maternal Feeling: New Correspondence between Ann Yearsley and Hannah More

Ann Cromartie, later Yearsley, was born in Clifton in 1753, and came to prominence in the 1780s as ‘The Bristol Milkwoman’, a poetical phenomenon ‘discovered’ by Hannah More in the autumn of 1784. Little is known about Yearsley’s early years, but what is known has been carefully recorded by Mary Waldron in her 1996 biography, Lactilla, Milkwoman of Clifton.1 Taught to read by her mother and to write by her brother, Ann Cromartie was married at 21 to John Yearsley, a yeoman. Although their marriage seems to have begun well enough, with five children born between 1775 and 1782, by the winter of 1783–4 the Yearsley family were in extreme difficulties (Waldron, 18). Starving in a barn, Yearsley, her husband, her mother, and the five children were rescued at the last by a local man, Mr. Vaughan, though too late to save the life of Mrs. Cromartie, who died shortly afterwards. The family’s fortunes recovered, and by autumn 1784 Yearsley was selling milk and collecting hogswash door to door. Her extraordinary story came to the attention of Hannah More, whose cook was one of those on whom Yearsley called for hogswash.

Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS

In this study, we investigated the reliability and validity of three self-report questionnaires measuring the early emotional bond between a mother and her newborn infant: the Maternal Postpartum Attachment Scale (MPAS), the Postpartum Bonding Questionnaire (PBQ) and the Mother-to-Infant Bonding Scale (MIBS). In a monocentric prospective observational cohort study, 263 mothers completed the MPAS, the PBQ and the MIBS at 8-12 and at 20-25 weeks postpartum. The participants also completed measures of mental health and, during their pregnancy, measures of recalled parental bonding, adult romantic attachment, antenatal attachment and social desirability. In our study, the internal reliabilities of the PBQ and the MPAS were high at 8-12 weeks postpartum but dropped significantly at 20-25 weeks postpartum. Moderately strong correlations between the scales of the PBQ, the MPAS and the MIBS supported their construct validity. Further, weak correlations were found with social desirability and adult attachment representations, whereas moderate correlations were found with antenatal feelings of attachment and antenatal attitudes to motherhood. Finally, maternal feelings of bonding were also moderately associated with maternal mood. Overall, our findings suggest that the MPAS, the PBQ and the MIBS provide a reliable and valid indication of the early emotional tie between a woman and her newborn infant.

Parenting in families with a child with autism spectrum disorder and a typically developing child: Mothers’ experiences and cognitions

The parenting experiences of mothers in a family with a child with autism spectrum disorder (ASD) and a typically developing (TD) child were studied using a qualitative analysis of mothers’ perceptions of the impact of autism on family and personal life. An additional quantitative comparison was performed to evaluate the effect of ASD on mothers’ parenting cognitions about their other, TD child. Mothers differentiated clearly in parenting cognitions about their child with ASD and about their TD child. Strong associations were found between mothers’ symptoms of stress and depression, and their parenting cognitions about both their children. To maximize intervention outcome, family interventionists should consider parenting experiences and should become aware of interfering maternal feelings and cognitions, such as guilt or low parental self-efficacy beliefs.

ASSOCIATION BETWEEN MATERNAL FEELING ABOUT PREGNANCY AND CHILD'S LIFESTYLE

The number of children with undesirable lifestyles has recently increased. We tested the hypothesis that maternal feelings about pregnancy might be associated with their attitude towards promoting healthy lifestyles in their children. We used a city database collected from guardians of 204 randomly selected children aged 1 to 3 years in Nihonmatsu City, Fukushima. Maternal feeling about pregnancy was measured using a 10-point scale, and a child lifestyle score was calculated as the sum of desirable lifestyle habits (sleeping, eating, watching TV/videos, and tooth brushing). Associations between maternal feeling and her child's lifestyles were examined with multiple logistic regression analysis. For all lifestyle items, proportion of children with undesirable lifestyle habits was higher in the "unhappy group" (those who scored 1 to 9) than in the "happy group" (those who scored 10). In particular, a child's short sleeping hours (odds ratio [OR]=3.01) and lifestyle score of less than 3 ([OR] =3.60) were significantly associated with unhappy feelings. This was apparent among mothers aged 29 (median age) or younger. Our results indicate an association between a mother's unhappy feelings about pregnancy and her child's undesirable lifestyle, especially among relatively younger mothers. These findings provide public health implications important for early familial intervention to improve children's lifestyles.

Healthy Maternal Ambivalence

This paper critically reviews the psychoanalytic omission in theorizing maternal subjectivity and the subsequent idealisation of the early mother-baby bond that excludes negative maternal feelings. It suggests that painful maternal experiences of resentment, persecution and hatred remain under-explored. Perhaps, even more alarming, this exclusion compels mothers to hide conflictual and shameful feelings from professionals – and from themselves. The paper suggests that healthy maternal ambivalence is an inevitable feature of mothering. Drawing on psychoanalytic theoretical accounts and on empirical study it offers a model of different manifestations of maternal ambivalence. Facilitator, Regulator, Reciprocator and Conflicted maternal orientations manifest antenatally, preceding knowledge of the child’s actual characteristics. The various permutations of ambivalence in parenting are a function of the mother's inner world and the child's affective communications.

Reliability and validity of the Dutch version of the maternal antenatal attachment scale

In this study, we investigated the psychometric qualities of the Dutch version of the Maternal Antenatal Attachment Scale (MAAS). In a monocentric prospective observational cohort study, 403 expectant mothers completed a booklet with questionnaires in the first (T1), second (T2), and third (T3) pregnancy trimesters. In addition to the MAAS (T1-T3), the following measures were used: the Marlowe-Crowne Social Desirability Scale (T1), the Parental Bonding Inventory (T1), the Relationship Questionnaire (T1) the Facilitator scale and the Regulator scale (T3), the Edinburgh Postnatal Depression Scale (T1-T3) and the Pregnancy Related Anxiety Questionnaire (T1-T3). In this study, the mean of the MAAS scales increased as the pregnancy progressed. Good internal reliabilities were found for the Total MAAS scale, the Quality subscale and the Preoccupation subscale. Small-to-moderate correlations were found with social desirability, maternal orientation, parental care and adult attachment. Maternal mood was weakly associated with the quality but not with the intensity of the maternal attachment feelings. Overall, our findings suggest that the Dutch version of the Maternal Antenatal Attachment Scale is a reliable and valid measure of the early emotional tie between a pregnant woman and her unborn child.

Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial

Background Preterm birth often negatively influences mother–infant interaction. Skin-to-skin contact postbirth has positive effects on maternal feelings toward their preterm infants and on infant development and family interaction. However, little is known about the long-term effects of skin-to-skin contact on mother–late preterm infant interaction when skin-to-skin contact was experienced early postbirth and intermittently throughout the next five days. Objective The purpose of this report was to examine the effect of skin-to-skin contact on mother–late preterm infant interaction through 18 months. Design Randomized controlled trial with follow-up. Setting Two hospitals in the United States of America. Participants 100 mothers and their late preterm infants, 32 to <37 weeks’ gestation, were recruited. Mother–preterm infant interactions were assessed in 69, 70, and 76 dyads at 6, 12, and 18 months. Methods Mothers and their preterm infants were videotaped during a feeding session at 6 and 12 months, and a teaching session at 6, 12, and 18 months. Their interactions were then scored using the Nursing Child Assessment Satellite Feeding Scale and Teaching Scale. Results Skin-to-skin contact and control dyads had comparable feeding scores at 6 and 12 months. Skin-to-skin contact infants had lower infant teaching scores at six months, a difference that disappeared thereafter. Conclusions These inconclusive results call for additional studies with larger doses of skin-to-skin contact, larger sample sizes, and other outcome measures of mother–late preterm infant interactions. Such measures include the Parent–Child Early Relational Assessment and behavioral coding during play.

Psychological suffering interfering in the maternal desire of taking care of a child hospitalized in the Pediatric Intensive Care Unit

Introduction: In order to take care of a hospitalized child a mother abdicates of her tasks, routines and family coexistence. The objective of the study was to apprehend aspects of a mother’s living while her child stays in the Pediatric Intensive Care Unit (PICU). Methodology: A descriptive study with qualitative approach that used the Assistant Convergent Research (ACRA) as methodological referential and the Transcultural Theory of Caring as theoretical referential. Participated in the study six mothers who had their children in the PICU of a University Hospital located in the Northwest of Paraná State. Data were collected from January to May 2007, through semi-structured interviews, orientation and participant observation. For analysis and interpretation of the data, the four generic processes of ACRA were used. Results: Belief and cultural values delineate the form how people take care and conceive caring, including during hospitalization. Three categories emerged: Maternal feelings facing hospitalization of a child; Family loss of orientation caused by the internment; and Deficit of the desire of taking care. Implications for Nursing: A child's hospitalization unchains in the family changes and sufferings that reflect directly upon the mother, for culturally, being the responsible person for the child care, including during hospitalization. This increases her psychological suffering, in such a way that she can feel impotent, unable and without will of taking care of her child in the hospital atmosphere. Health professionals, with views to an integral assistance, need to understand this limitation, support the mother in her needs, and help her to overcome this condition.

O REFLEXO DA ORIENTAÇÃO NA PRÁTICA DO ALEITAMENTO MATERNO

Objetivamos identificar o conhecimento das mães acerca da amamentação, visando investigar sentimentosmaternos a respeito dessa prática. Estudo exploratório-descritivo com abordagem qualitativa, realizado na Maternidade-Escola Assis Chateaubriand–MEAC, em Fortaleza-CE. Os sujeitos foram 10 mães assistidas por profissionais da MEAC.A coleta de dados foi de julho a agosto de 2005, com a observação participante e entrevista semi-estruturada. O conteúdofoi agrupado nas categorias: Orientações recebidas do serviço; Vantagens x desvantagens; Duração do aleitamentomaterno; Sentimento ao amamentar. Os dados obtidos permitiram compreender que as mulheres são conscientes dosbenefícios, mas se queixam de que a amamentação é difícil, contribuindo para a introdução de alimentos complementares,podendo haver um desvio no crescimento e desenvolvimento das crianças. Concluímos que estratégias de educação emsaúde são importantes, pois permitem desenvolver atividades de educar, facilitando a sensibilização das mulheres para atomada de consciência destes valores.

Maternal characteristics and feelings of distress resulting from the crying of high‐risk infants

AbstractAim: To analyze the extent of and factors associated with the range of mothers' feelings when they experienced the crying of their high‐risk (HR) infant.Methods: A cross‐sectional design was used. A mail survey yielded 127 mothers of HR infants from 61 institutions. The instruments were the: (i) Maternal Distress Score to measure feelings of maternal distress during the infant's crying scale; (ii) Maternal Emotion Scale; (iii) Japanese Beck Depression Inventory – Second Edition; (iv) Visual Analog Scale for the tendency toward anxiety; and (v) a demographic form. The data analysis used descriptive and inferential statistics.Results: There were no significant differences in maternal distress between the mothers of HR infants and those with normal infants. The high‐scoring items for feelings of difficulty in descending order were: “feeling of a gap from life before pregnancy”, “anxious about child‐care prospects for the future”, and “feeling of stress when the infant cries”. The low‐scoring items were: “child care is not enjoyable” and “I want to feel free when I hear the infant crying”. The factors relating to the mother's distress over her crying HR infant showed a significant positive correlation with the mother's tendency toward anxiety and with the effect of the infant's crying on others, infant feeding, other family members in the same residence, free time, emotions when hearing the infant crying, and feelings of depression.Conclusion: The emergence of these three high‐scoring items show promise for the further refinement of this multidimensional approach to understanding the range of responses experienced by mothers with HR infants. The results are useful for understanding the psychological tendencies of mothers with HR infants and, possibly, in the future might aid in the screening of mothers for those attributes.

Use of an Internet-Based Telemedicine System to Manage Underserved Women with Gestational Diabetes Mellitus

Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the Internet. Women with GDM were randomized to either the Internet group (n = 32) or the control group (n = 25). Patients in the Internet group were provided with computers and/or Internet access if needed. A website was established for documentation of glucose values and communication between the patient and the health care team. Women in the control group maintained paper logbooks, which were reviewed at each prenatal visit. Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery. Women in the Internet group accessed the system and sent on average 21.8 (+/- 16.9) sets of data. There was no difference between the two groups in regards either fasting or post-prandial blood glucose values, although more women in the Internet group received insulin therapy (31% vs. 4%; P <0.05). There were also no significant differences in pregnancy and neonatal outcomes between the two groups. Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study's end. The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system. Although system use was not associated with improved pregnancy outcomes, women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy.

Applied behaviour analysis: does intervention intensity relate to family stressors and maternal well‐being?

Interventions based on applied behaviour analysis (ABA) are commonly recommended for children with an autism spectrum disorder (ASD); however, few studies address how this intervention model impacts families. The intense requirements that ABA programmes place on children and families are often cited as a critique of the programme, although little evidence is available to support this claim. Using Pearlin's (1999) stress process model, this study assessed: (1) whether mothers of children participating in a home-based ABA programme reported elevated depressive symptoms; and (2) whether ABA intensity related to unmet family needs and maternal feelings of depression, personal strain and mastery. Forty-one mothers of children diagnosed with an ASD participated in this study by completing questionnaires about their child's ASD behaviours, unmet family needs, and maternal feelings of depression, personal strain and mastery. Additionally, mothers provided information about their child's intervention programme and their own level of involvement in the programme. At the time of data collection, all families had been running a home-based ABA programme for at least 6 months. Single-sample t-tests and multiple regression analyses were used to test the proposed hypotheses. Mothers of children participating in a home-based ABA programme reported more depressive symptoms than mothers of children with other developmental disabilities. Comparisons revealed comparable depressive symptoms between the mothers of the present sample and those in other ASD samples. When considering weekly ABA intensity, mothers reported fewer depressive symptoms when their child was older and when their child participated in more ABA therapy hours. Conversely, mothers who were more involved in their child's ABA programme reported more personal strain. The findings of this study supported the hypothesis that families participating in ABA experienced elevated depressive symptoms, much like any family raising a child with an ASD, suggesting a potential area for family-level intervention. Additionally, ABA intensity related to maternal depression and personal strain, and therefore deserves continued attention. Future studies should attempt to replicate these findings with a larger and more representative sample and seek to identify mechanisms through which ABA intensity may influence maternal and family well-being.

Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg

BackgroundThere are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory. The present study investigated the effect of different maternity home practices in St. Petersburg, Russia, as well as of physiological breast engorgement and maternal mood, on milk production in primi- and multiparous women on day four. The amount of milk was studied in relation to the duration of "nearly exclusive" breastfeeding.Methods176 mother-infant pairs were randomised into four groups according to an experimental two-factor design taking into account infant location and apparel. Data were recorded in the delivery ward at 25–120 minutes postpartum and later in the maternity ward. Group I infants (n = 37) were placed skin-to-skin in the delivery ward while Group II infants (n = 40) were dressed and placed in their mother's arms. Both groups later roomed-in in the maternity ward. These infants had the possibility of early suckling during two hours postpartum. Group III infants (n = 38) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in. Group IV infants (n = 38) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward. Equal numbers per group were either swaddled or clothed. Episodes of early suckling were noted. Number of breastfeeds, amount of milk ingested (recorded on day 4 postpartum) and duration of "nearly exclusive" breastfeeding were recorded. Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being "low/blue".ResultsOn day four, multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule (7 times a day; Group III). In contrast, there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on demand (Groups I, II and IV), although multiparas had higher numbers of feedings than primiparas. In addition during the first three days postpartum, multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling "low/blue" than primiparous mothers. Early suckling was shown to positively affect milk production irrespective of parity. Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not (284 and 184 ml respectively, SE = 14 and 27 ml, p = 0.0006).Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling, intensity of breast engorgement and number of breastfeeds on day 3 were most important. Intensity of feeling "low/blue" was negatively related to amount of milk ingested. The significant factor for multiparous women was early suckling. Similar results were obtained in Groups III and IV; however, in primiparous mothers, engorgement was the most important factor and in multiparous women it was rooming-in. Amount of milk produced on day 4 was strongly correlated to a duration of "nearly exclusive" breastfeeding (p < 0.0001).ConclusionThe present data show that ward routines influence milk production. As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors, further research is needed.