Infant Well-being Research Articles

Translating family systems care into neonatology practice: A mixed method study of practitioners’ attitudes, practice skills and implementation experience

BackgroundFamily-centered care interventions are a recommended part of high-quality neonatal intensive care. Evidence suggests that engaging and supporting families improves parental and infant health outcomes. Enabling practitioners to work with families in a relational, strength-oriented way is thus vital to ensure quality care. However, implementing family-centered care remains a challenge, and its uptake is often slow and inconsistent. ObjectivesTo examine the impact of family systems care implementation activities on neonatal nurses’ and physicians’ attitudes and skills in working with families, and to explore their implementation experience. DesignMixed method design. Setting and participantsTwo neonatal intensive and one intermediate care unit in a Swiss, university-affiliated hospital. A total of 65 practitioners participated in the pre-post study, and 17 in focus group interviews. MethodsQuantitative data was obtained before, mid-, and post-implementation through an online questionnaire. Attitudes were measured with the Families’ Importance in Nursing Care – Nurses’ Attitudes Scale. Skills and reciprocity in working with families was assessed with the Family Nursing Practice Scale. Four focus group interviews were conducted post-implementation. Data analysis included descriptive statistics, group comparison, and qualitative content analysis. ResultsA statistically significant increase in practice skills and reciprocity, but not in attitudes was found mid- and post-implementation. Practitioners reported new ways of working with families, which included enhanced awareness of the extended family, intentional relationship-building, augmented family involvement, and systemic interventions, such as therapeutic listening. They experienced implementation as a wheel that moved forward or stood still, depending on the challenges faced and the predominance of enabling versus limiting organizational factors. Practitioners felt not only challenged regarding the meaning of being-acting in family-centered ways, but also in delivering family systems care consistently and collaboratively. While practitioners experienced the educational workshop as helpful, they felt left alone during consolidation. ConclusionsFindings demonstrate that the inter-professional implementation of family systems care is highly relevant for practitioners’ clinical practice. Implementation strategies yielded an increase in practice skills/reciprocity and new ways of working with families, but no quantifiable impact on attitudes. Adoption fluctuated and was ongoing, hindered by organizational constraints and lack of consolidation support. Nonetheless, practitioners gave numerous examples of family-centered practices. A combination of implementation strategies offered over time and supported by organizational structures are the most likely means to enable teams to work in partnership with families, and to promote infant and family well-being in neonatal care.

Early Emotional, Behavioural and Social Development of Infants and Young Children with Congenital Heart Disease: A Systematic Review.

The experiences of diagnosis of congenital heart disease (CHD), cardiac surgery and hospitalisation(s) are distressing and represent a significant stressor for a child and family, which may impact psychosocial development. This systematic review provides a synthesis of psychosocial outcomes of infants and young children with congenital heart disease who had cardiac surgery early in life. Twenty-eight studies related to infant and young children's psychosocial development, specifically emotional, social and behavioural functioning were identified. Variability was related to methodological factors including differences in study design, varying measurement tools and heterogeneous samples. Despite these limitations, the majority of studies were of high quality. The most common finding was a high prevalence of low-severity emotional and behavioural dysregulation. Young children with severe CHD or comorbid conditions experienced greater impairment, with higher rates of externalising behaviour problems, although internalising behaviour problems were also evident. This review integrates findings from literature in the past 28years on the psychosocial well-being of infants and young children with CHD and demonstrates a risk for emotional, social and behavioural development difficulty, and, importantly, that symptoms of psychosocial impairment are detectable very early in infancy. We advocate for assessment and monitoring of emotional and behavioural regulation and social development to be routinely conducted from infancy to enable prevention and early intervention.

Gender Gaps in Birth Weight Across Latin America: Evidence on the Role of Air Pollution

Recent estimates indicate that more than 100 million people in Latin America and the Caribbean are exposed to air pollution levels exceeding World Health Organization guidelines. Air pollution persists because of a development process centered around high rates of urbanization and congestion, geographically concentrated industrialization, and biomass burning. This paper focuses on a relatively understudied consequence of this pollution-intensive development process: its gender impact. The analysis provides systematic evidence across the region on the impact of in utero exposure to air pollution on infant health and well-being, a period when the medical literature suggests male fetuses are more delicate than female fetuses. Health at birth is known to have long-term consequences, so this investigation seems warranted and aids the understanding of future gender gaps in socioeconomic development. The empirical analysis combines satellite and survey data from three countries in the region: Bolivia, Colombia, and Peru. Based on sibling comparisons, the analysis finds that a 10% increase in pollution exposure in utero reduces the male–female birth weight gap by approximately 50 g. This weight reduction is equivalent to the impact of smoking five cigarettes a day (versus none) during pregnancy.

Does childbirth experience affect infant behaviour? Exploring the perceptions of maternity care providers

ObjectiveHigh levels of childbirth interventions are known to increase risk of health complications for mother and infant, alongside having a negative impact upon maternal wellbeing. However less is understood about how childbirth experience may affect infant behaviour (e.g. how calm or unsettled an infant is). This study explores maternity care provider perceptions of how and why childbirth experience may affect infant behaviour. DesignA qualitative semi-structured interview study. SettingBristol, Swansea and West Wales, UK. Participants18 maternity care providers. Measurements and findingsA semi-structured interview schedule was developed to explore maternity care providers’ perceptions of how maternal experience of childbirth could influence infant behaviour. Findings highlighted how maternity care providers perceived childbirth experience to sometimes impact positively or negatively on infant behaviour. A calmer birth and postnatal experience was believed to lead to a calmer infant, whilst physical and emotional stress was associated with more challenging infant behaviours such as crying and being unsettled. Pathways were perceived to be direct (pain and stress during birth might physiologically affect the infant) and indirect (birth was perceived to affect maternal wellbeing and subsequently her interactions with her baby). However, postnatal factors such as skin to skin, postnatal environment and emotional support were believed to mediate these impacts. Key conclusionsBirth experience was considered to affect infant behaviour. Promoting as positive a birth experience as possible, including postnatal care, was viewed as significant in supporting positive infant behaviours. Maternity care providers believed this could help facilitate bonding, attachment, and mother–infant wellbeing in the postnatal period. Implications for practiceThe findings highlight maternity care providers’ views concerning supporting normal birth and protecting emotional wellbeing during birth and postnatally. Where interventions are necessary, ensuring a calm environment, and enabling normal postnatal behaviours such as skin to skin and breastfeeding were perceived as important. Midwives, it was claimed, need time to nurture mothers alongside providing physical care. LimitationsParticipants were self-selecting and might therefore have been biased.

Australian early childhood educators and infant feeding: a qualitative analysis using social cognitive theory

ABSTRACT Early Childhood Education and Care (ECEC) services are vital in the establishment of optimal infant and young child feeding (IYCF) practices and long-term health. This qualitative study, informed by Social Cognitive Theory, aimed to describe ECEC infant feeding environments. Nineteen formal long day care and family day care ECEC services and 124 educators in metropolitan and regional Queensland, Australia participated in interviews and professional conversations. Inductive and deductive analysis identified three key themes: ‘agency’, ‘IYCF environment’, and ‘monitoring/surveillance’. This research has identified the key environmental, behavioural and cognitive factors that contribute to optimal IYCF practices in Australian ECEC. Tensions and negotiation between educators, parents, infants and the regulatory framework operate to develop collective agency. Key recommendations are: increasing the visibility of infants in ECEC policy frameworks and building educator and parent self-efficacy in supporting infant agency in order to meet shared goals related to optimal infant health and well-being.

Strategies to Promote Postpartum Visit Attendance Among Medicaid Participants.

Background: Postpartum care is important for promoting maternal and infant health and well-being. Nationally, less than 60% of Medicaid-enrolled women attend their postpartum visit. The Strong Start for Mothers and Newborns II Initiative, an enhanced prenatal care program, intended to improve birth outcomes among Medicaid beneficiaries, enrolled 45,599 women, and included a variety of approaches to increasing engagement in postpartum care. Methods: This study analyzes qualitative case studies that include coded notes from 739 interviews with 1,074 key informants and 133 focus groups with 951 women; 4 years of annual memos capturing activities by each of 27 awardees and 24 Birth Center sites; and a review of interview and survey data from Medicaid officials in 20 states. Results: Strong Start prenatal care included education and support regarding postpartum care and concerns. Key informants identified Strong Start services and other strategies they perceived as increasing access to postpartum care, including provider and/or care coordinator continuity across prenatal, delivery, and postpartum visits; efforts to address information gaps and link women to appropriate resources; enhancing services to meet needs such as treatment for depression; addressing barriers related to transportation and childcare; and aligning incentives to encourage prioritization of postpartum care among patients and providers. They also identified ongoing barriers to postpartum visit attendance. Conclusions: Postpartum care is essential to maternal and infant health. Medicaid enrolls many high-risk women and is the largest payer for postpartum care. Using lessons from Strong Start, providers who serve Medicaid-enrolled women can advance strategies to improve postpartum visit access and attendance.

Migrant Burmese women living in southern Thailand and motherhood: An ethnographic study.

Migrants to Thailand come from low-income border countries, such as Burma (Myanmar). Generally, migrant women experience difficulties obtaining high-quality health care due to socioeconomic barriers and conflicts with their practices. The aim of this study was to explore migrant Burmese women's experiences of becoming a mother while living in Thailand and their perceptions of motherhood, family support, and traditional postpartum practices. The study used an ethnographic design. In 2015, data were gathered through individual interviews with 10 migrant Burmese women before and after birth. Interview and field note data were analyzed using thematic analysis. Four themes emerged from the data: (i) the more children, the stronger the family; (ii) finding ways to promote baby's health and growth; (iii) sharing responsibility to fulfill parenting role; and (iv) peer and family support. Becoming a mother was important to the Burmese women interviewed; however, as migrants in Thailand, they had to juggle work and care for young children. Most decided that once their child was school age they would be sent to Burma to live with relatives. They engaged in a range of traditional practices to support their infant's health and well-being and protect their baby from evil spirits. Support from family, and the ability to participate in postpartum practices, were important for Burmese migrant women becoming mothers in Thailand.

Place of sanctuary: an appreciative inquiry approach to discovering how communities support breastfeeding and parenting

BackgroundSignificant efforts by governments at a global and national level have not resulted in a significant increase in the duration of breastfeeding to six months. The views of family and social networks, and community attitudes particularly around breastfeeding in public, influence infant feeding decisions. Yet many interventions designed to increase breastfeeding focus on the individual woman and have not been developed from the ‘ground up’ in consultation with women and communities. This study aimed to identify the key components of Mother Infant Caring Communities that promote and support breastfeeding and early parenting.MethodsAppreciative Inquiry was used to facilitate a ‘Community Conversation’ workshop in two local councils in Australia. Thirty-five participants attended the community conversation workshops including new parents, grandparents, children’s services, local government, and representatives from maternity and child health services. In addition, one focus group discussion was conducted with six retail business owners or managers. Qualitative content analysis was used to analyse data. This paper presents the findings of the first phase (the Discovery phase) of the study.ResultsFour major themes emerged: “PLACE – A community for everyone”; “A PLACE for children and families”; “Sometimes a PLACE to breastfeed” and “The parent room: a hidden and unsafe PLACE to breastfeed”. Participants described the characteristics of communities that provided a sanctuary and fostered well-being for parents and infants including, open green spaces, safe playgrounds, walking tracks and community hubs. Shopping centres were described as having the potential to be the ‘village’. Community-based services to support breastfeeding and parenting were highly valued. Yet in both sites, participants stated that breastfeeding was rarely observed in public and bottle feeding was more evident.ConclusionBreastfeeding and parenting are embedded in the places where women and families live. Community spaces including shopping centres, should be designed to include infants and young children and offer appropriate facilities such as safe and clean parenting rooms. Health services must work with local government, businesses, and diverse community members to identify what parents’ value about their community and design and implement innovative local strategies to support breastfeeding.

Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force

(Abstracted from JAMA 2019;321(6):588–601) Perinatal depression is a common condition that was estimated in 2012 to affect more than 180,000 new mothers (11.5%) annually in the United States and that can have serious impact on mother and infant well-being. Numerous interventions have been proposed to prevent perinatal depression, but there is no commonly agreed-on prevention method, creating a scenario with substantial variation in clinical practice.

Associations Between Health-related Quality of Life, Eating Behavior and Gastrointestinal Tolerance Among Exclusively Breastfed Infant-Mother Dyads in the Philippines (P11-107-19)

ObjectivesBreastmilk offers the most optimal nutrition for infants in first year of life, and breastfeeding may offer additional benefits promoting psychological well-being of infants and mothers. Relationships between infant and maternal quality of life (QoL), baby eating behaviors and gastrointestinal (GI) tolerance have not been widely studied. MethodsHealthy term infants whose mothers had decided to exclusively breastfeed from birth until 6 months (m) of age, were enrolled at 21–26 days (d) of age from a single center in the Philippines. Parents completed the Infant Toddler Quality of Life Questionnaire (ITQoL), Short Form Health Survey (SF-36v2) (assessing maternal QoL), Baby Eating Behavior Questionnaire (BEBQ) (assessing appetite), and Infant Gastrointestinal Symptoms Questionnaire (assessing GI burden) at enrollment and when infants were 2.5 m, 4 m, and 6 m of age. ResultsAmong 75 enrolled infants, 70 completed the study at age 6 m. At enrollment, only 1 statistically significant moderate correlation (ρ = 0.46, P < 0.01, Table 1) was seen between maternal Physical Health Summary with infant QoL Impact on Parents-Time. However, most infant QoL concepts became moderately associated with maternal Mental Health Summary scores at 6 m. Statistically significant moderate and positive correlations were detected between maternal Mental Health Summary with Satisfaction with Child’s Overall Growth and Development, Temperament and Moods, Overall Health, and with 3 Child’s Impacts on Parents concepts. At 6 m, statistically significant moderate and positive correlations were seen between BEBQ concepts (Enjoyment of Food and General Appetite) with Temperament and Moods (ρ = 0.47 and 0.40, respectively, P < 0.01). No moderate correlations between BEBQ concepts and maternal QoL were found. Surprisingly, no correlations between GI tolerance measures and maternal/infant QoL concepts was detected except 1 weak correlation between flatulence and infant QoL Impact on Parents-Emotional at enrollment. ConclusionsIn this cohort, relationships between infant and maternal health-related quality of life evolved as infants grew older. Infant temperament and moods positively correlated with both maternal mental and physical health and with infant eating behaviors, suggesting that infant temperament and mood may be an important factor affecting maternal and child health. Funding SourcesNestec Ltd. Supporting Tables, Images and/or Graphs▪

Exploring maternal and health professional beliefs about the factors that affect whether women in Saudi Arabia attend antenatal care clinic appointments

ObjectiveEffective antenatal care is important for the health and wellbeing of pregnant women and infants. However, in Saudi Arabia, attendance rates are low, increasing the risk of negative birth outcomes. The aim of this research is to understand the beliefs of pregnant women and health professionals about the factors leading to these low attendance rates. MethodologyA qualitative exploratory study-using semi structured face-to-face interviews. Interviews were conducted exploring (a) attitudes to the use of antenatal care by pregnant Saudi women, (b) beliefs of women regarding the value of antenatal care and (c) perceived barriers to attendance. SettingData were collected from three hospitals in two regions of Saudi Arabia. ParticipantsWomen at any stage of their pregnancy attending for antenatal care or ultrasound, women attending postnatal clinic, and health professionals (obstetricians) who support women during pregnancy and birth. FindingsAlthough mothers viewed antenatal care as important for maternal and infant health, several barriers to attending care were identified by mothers and professionals. These factors were classified into three themes: physical barriers (e.g., lack of transport), low maternal education, and inadequate healthcare facilities (including negative staff attitudes and poor communication). These factors were exacerbated by the beliefs of partners and family. Notably, the theme of low maternal education was raised only by health professionals, whilst the theme of staff attitudes and communication was raised only by mothers. Key conclusionsBarriers to antenatal care exist at the personal, social, socioeconomic and health services level. Some health professionals may be unaware of the importance of their communication style. Interventions to improve attendance must be multifaceted rather than focussing on individual women alone. Implications for practiceBarriers for women attending antenatal healthcare must be addressed in order to increase attendance rates. Specific practice-based interventions may involve changing the time or location of services and exploring changes to staff communication with women.

The effect of education on health: Evidence from the 1997 compulsory schooling reform in Turkey

This paper analyzes the relationship between education and health outcomes using a natural experiment in Turkey. The compulsory schooling increased from 5 to 8 years in 1997. This increase was accompanied by a massive construction of classrooms and recruitment of teachers in a differential rate across regions. As in previous studies, we confirm that the 1997 reform substantially increased education in Turkey. Using the number of new middle school class openings per 1000 children as an intensity measure for the 1997 reform, we find that, on average, one additional middle school class increases the probability of completion of 8 years or more of schooling by about 7.1 percentage points. We use this exogenous increase in the educational attainment to investigate the impact of education on body mass index, obesity, smoking behavior, and self-rated health, as well as the effect of maternal education on the infant's well-being. Using ordinary least squares, we find that there is a statistically significant favorable effect of education on health outcomes and behavior. However, this relationship becomes insignificant when we account for the endogeneity of education and health by instrumenting education with exogenous variations generated by the 1997 reform and the accompanying middle school class openings. The insignificance of the health effect may be due to lack of statistical power in our data, or to the fact that this policy affects only relatively low levels of schooling and the health effects of education need to be examined at higher levels of schooling.

Afghan families and health professionals’ access to health information during and after pregnancy

BackgroundHaving a baby in a new country can be challenging, especially if unable to communicate in a preferred language. The aim of this paper is to explore the provision of health information for Afghan women and men during pregnancy, childbirth and the first year after birth in Melbourne, Australia. MethodsCommunity engagement underpinned the study design. Qualitative study with bicultural researchers conducting semi-structured interviews. Interviews and focus groups were also conducted with health professionals. ResultsSixteen Afghan women and 14 Afghan men with a baby aged 4–12 months participated. Thirty four health professionals also participated. Verbal information provided by a health professional with an interpreter was the most common way in which information was exchanged, and was generally viewed favourably by Afghan women and men. Families had limited access to an interpreter during labour and some families reported difficulty accessing an interpreter fluent in their dialect. Availability of translated information was inconsistent and health professionals occasionally used pictures to support explanations. Women and men were unsure of the role of health professionals in providing information about issues other than pregnancy and infant wellbeing. ConclusionBoth individual and health system issues hinder and enable the availability and use of information. Consistent, understandable and ‘actionable’ information is required to meet the needs of diverse families. Health professionals need to be supported with adequate alternatives to written information and access to appropriate interpreters. Inconsistent provision of information is likely to contribute to low health literacy and poor maternal and child health outcomes.

Chinese American Women's Experiences with Postpartum Depressive Symptoms and Mental Health Help-Seeking Behaviors.

The objective of this study was to explore the perspectives of postpartum depression (PPD) and mental health help-seeking behaviors among Chinese American women. Using a qualitative design, Chinese American women, who had given birth in the past year, participated in a semistructured interview (English or Mandarin). Depressive symptoms and mental health services questionnaires were also conducted. All 15 participants were married and between 29 and 39 years of age. Content analysis revealed two main themes including culture-specific postpartum traditions and mental health help-seeking. Nine reported sadness or PPD symptoms, including three who scored above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS score ≥9) for risk of PPD and others who disclosed such information during the interview. Many women shared that they experienced postpartum depressive symptoms, but some did not believe depression was applicable to Chinese women. Healthcare professionals working with Chinese American women must be aware of culture-specific childbearing traditions to promote maternal-infant well-being outcomes.

Maternal Immigrant Status and Readiness to Transition to Home From the NICU.

Evaluate effects of immigrant status on perceptions of discharge readiness in mothers of preterm infants <37 weeks' gestation and identify the impact of primary language and years in the United States. Immigrant (n = 176) and native (n = 556) mothers of preterm infants cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness questionnaire. Group comparisons were made on the basis of immigrant status. Regression models examined effects of immigrant status, primary language, and years in the United States on discharge readiness. Immigrant mothers were more likely to be older, gravida >1, multiracial or people of color, and non-English speaking; have less than a high school education; and receive Medicaid but less likely to have child protective services involvement, substance abuse, and mental health disorder (MHD). Whereas rates of non-English primary language, low education, and Medicaid decreased, rates of MHDs increased with years in the United States. At NICU discharge, immigrant mothers had poorer perceptions of infant well-being, maternal well-being, maternal comfort, and time impact. In adjusted analyses, immigrant status, non-English primary language, and MHD predicted unfavorable scores. Among immigrant mothers, increased years in the United States and MHD predicted unfavorable scores. Although findings suggest acculturation with increased years in the United States, immigrant mothers perceived less discharge readiness in multiple domains, highlighting the need for culturally competent care and discharge services specifically tailored to help this vulnerable population.

First-time mothers\u2019 experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

BackgroundAssisted reproductive technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan.MethodTwelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy.ResultsThe mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’, ‘ensuring health and safety of the foetus’, and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track.ConclusionFindings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes.

Good Mothering Before Birth: Measuring Attachment and Ultrasound as an Affective Technology

The idea that fetal ultrasound is useful for promoting a pregnant woman’s emotional attachment to her fetus is commonplace in the United States. While STS scholars have examined many facets of ultrasound, scholars have not analyzed the medical construction of ultrasound as an affective technology. This article fills that gap by bringing feminist STS and affect studies together to examine medical understandings of fetal ultrasound’s emotional utility. The project interprets a unique archive of published medical research on measuring maternal-fetal bonding and using ultrasound to promote that bonding. My discourse analysis shows that this medical research defines “optimal bonding” in a way that reflects the norms of intensive mothering. I argue that this medical research contributes to the creation of a new, presumably high-risk population of “sub-optimal bonders.” The research I examine also suggests that medical professionals may be able to use the technological fix of ultrasound to manage this new population’s emotions and behaviors. In the process, medical experts individualize the risks of infant well-being and locate those risks in women’s emotional state.

Acceptability of a family-centered newborn care model among providers and receivers of care in a Public Health Setting: a qualitative study from India

BackgroundFamily-centered care (FCC), based on collaborative participation of the family along with a team of health care providers, is found to increase the well-being of sick infants in neonatal critical care units. Over the last 4 years, the neonatal unit of Dr. Ram Manohar Lohia Hospital in Delhi has innovated and developed an implementation framework for FCC. This qualitative study assessed the acceptability of family-centered care among providers and family members of neonates to identify gaps and challenges in implementation.MethodsIn-depth interviews were conducted among a purposive sample of twelve family members of admitted neonates and six providers to examine their perceptions and experiences regarding FCC.ResultsFamily members and providers expressed a positive perception and acceptance of FCC based on the competencies and knowledge acquired by parents and other caregivers of essential newborn care. Family members reported being satisfied with the overall health care experience due to the transparency of care and allowing them to be by their baby’s bedside. Limitations in the infrastructure or lack of facilities at the public hospital did not seem to dilute these positive perceptions. Providers also perceived FCC as a good practice to be continued in spite of concerns around sharing of nursery space with parents, the need for constant vigilance of parents’ practices in handling of their newborns, and the need for separate, designated nursing staff for FCC.ConclusionBoth providers and receivers of neonatal care found FCC to be an acceptable form of care. Providers identified challenges and suggested possible solutions, such as need of periodic provider sensitization on FCC, improved staff organization, and provision of mother-friendly facilities to enable her to provide around-the-clock care by her baby’s bedside. Overcoming these challenges would allow for better integration of FCC within general clinical care in neonatal care units.

Maternal experience of their infants’ crying in the context of war trauma: Determinants and consequences

We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.

Healthy Mother & Child: Foundation of a Strong Nation.

Healthy Mother & Child: Foundation of a Strong Nation.