- [Show abstract] [Hide abstract] ABSTRACT: Objective: This study examined the association between breastfeeding initiation and maternal sensitivity, efficacy, and cognitive stimulation among young, low-income, African American mothers. Subjects and methods: Two hundred twenty-one mothers were interviewed during pregnancy, at birth, and at 4 months postpartum regarding breastfeeding and parenting. Medical records were collected after birth, and mother-infant interactions were videotaped at 4 months. Propensity score matching was used to address selection bias by matching breastfeeding and nonbreastfeeding mothers on characteristics measured prior to breastfeeding. Results: One hundred twenty-four (56%) mothers initiated breastfeeding. After matching, mothers who initiated breastfeeding reported greater parenting efficacy (effect size, d=0.44) and were observed to be more sensitive with their 4-month-old infants (effect size, d=0.42) than nonbreastfeeding mothers. Breastfeeding was marginally associated with less maternal intrusiveness (effect size, d=0.28) but was not related to parenting attitudes or cognitive stimulation. Conclusions: This study presents evidence supporting the claim that breastfeeding may enhance maternal efficacy and sensitivity. Providing breastfeeding support to young mothers may have effects that extend beyond maternal and child health outcomes to parenting and mother-child interactions.
- [Show abstract] [Hide abstract] ABSTRACT: This article examines the extent and nature of father participation in a perinatal, community-based doula home-visiting intervention that served young, African American mothers from low-income backgrounds and their infants. Home-visitor service records were used to assess the quantity, setting, and content of father-attended visits. Correlates of fathers' participation and thematic insights from mothers' and home-visitors' perspectives on how fathers perceived and interacted with the home-visiting program were analyzed to further characterize the nature of father participation. Although the community-doula home-visiting model does not include special outreach to increase father participation, almost half of the mothers had a doula visit at which their baby's father was present, many of which took place in medical settings. Mothers and doulas reported that fathers were generally positive about the doula, but expressed that fathers viewed the doula as a substitute provider of support that fathers seemed reticent to provide themselves. These results suggest that community doulas who visit pre- and postpartum in multiple settings have unique opportunities to have contact with fathers that traditional home visitors or early childhood specialists may not have. © 2014 Michigan Association for Infant Mental Health.
- [Show abstract] [Hide abstract] ABSTRACT: Despite recent efforts to increase breastfeeding, young African American mothers continue to breastfeed at low rates, and commonly introduce complementary foods earlier than recommended. This study examines the effects of a community doula home visiting intervention on infant feeding practices among young mothers. Low-income, African American mothers (n = 248) under age 22 years participated in a randomized trial of a community doula intervention. Intervention-group mothers received services from paraprofessional doulas: specialized home visitors trained as childbirth educators and lactation counselors. Doulas provided home visits from pregnancy through 3 months postpartum, and support during childbirth. Control-group mothers received usual prenatal care. Data were obtained from medical records and maternal interviews at birth and 4 months postpartum. Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers (64% vs 50%; P = .02) and were more likely to breastfeed longer than 6 weeks (29% vs 17%; P = .04), although few mothers still breastfed at 4 months. The intervention also impacted mothers' cereal/solid food introduction (P = .008): fewer doula-group mothers introduced complementary foods before 6 weeks of age (6% vs 18%), while more waited until at least 4 months (21% vs 13%) compared with control-group mothers. Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines. The intervention's success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting, and the doula's presence at the birth, where she supports early breastfeeding experiences.
- [Show abstract] [Hide abstract] ABSTRACT: Doulas, whose traditional role is to support women during labor and delivery, are being increasingly utilized within community-based programs where a primary goal is supporting mother-infant relationships. The present study investigated the effect of doula services on parenting among young, low-income mothers. A total of 248 pregnant women were randomly assigned to receive either doula services or routine medical and social services. The doulas provided prenatal home visitation, support during labor and delivery, and 3 months of postpartum home visitation. Parenting was assessed through video recordings of mother-infant interaction at 4, 12, and 24 months of child age and maternal report of parenting attitudes and stress. Intent-to-treat analyses showed that mothers who had received doula services endorsed more child-centered parenting values, showed more positive engagement with their infants, and were more likely to respond to infant distress at 4 months. Their infants were less likely to show visible upset during observed interactions. Most effects of the program on parent and child behavior faded over time. Community doula intervention is a promising practice for supporting parenting and parent-infant interaction. Integration of doulas into longer term home-visiting models might sustain the early impact of doula services and enhance parenting services offered by traditional home-visiting programs.
- [Show abstract] [Hide abstract] ABSTRACT: Background and Purpose: Evidence suggests that breastfeeding provides infants, mothers, families, and society with numerous health, developmental, psychological, and economic benefits. It has often been claimed that mothers who breastfeed show greater warmth while interacting with their infants and are more attuned to their infants' cues. Yet there are few empirical data examining the correlations between breastfeeding and maternal feelings and behavior among racial minority, low income, or adolescent mothers, even though these mothers are often the recipients of perinatal support services that include a breastfeeding component. Therefore, the purpose of this study was to examine the association between breastfeeding initiation and parenting efficacy and behavior in a sample of young, low income mothers. Methods: Young, African American mothers (n=248) were recruited from the prenatal clinics of an urban teaching hospital to participate in a study of a doula home visiting intervention. Mothers were administered interviews during pregnancy, at the birth, and at 4 months postpartum. Mothers ranged in age from 14 to 21 years (M=18.3, SD=1.7) at the birth, and 94% were receiving Medicaid. At 4 months postpartum, mothers (n=221) completed the Maternal Self-Efficacy Scale, a well-validated, 10-item measure of maternal self-efficacy related to infant care. Mothers were also videotaped interacting with their 4 month old infants. Observers masked to mother information coded videos for maternal sensitivity and positive and negative regard for the infant using global rating scales developed for the NICHD Study of Early Child Care. Inter-rater reliability exceeded .9 for each dimension of parenting behavior. Results: 56% (n=139) of the mothers initiated breastfeeding, with a mean duration of 7.1 weeks (SD=10.9) among those who initiated. 7% (n=15) of mothers were still breastfeeding at 4 months postpartum. After controlling for a variety of covariates, including maternal age, vocabulary score, depression, prenatal self efficacy, and current breastfeeding, regression analyses showed that breastfeeding initiation was associated with greater maternal self-efficacy at 4 months postpartum (t=2.90, p<.01). Mothers who initiated breastfeeding also showed more positive regard (t=2.61, p<.01) and were observed to be more sensitive towards their infants (t=1.98, p<.05) than mothers who never breastfed. Conclusions and Implications: Past research has shown that low income, adolescent mothers are much less likely to initiate breastfeeding than older, more socially advantaged mothers, though the benefits associated with breastfeeding may be most important for young mothers and their infants. Although causal claims cannot be made, the results of this study showed that breastfeeding was related to greater feelings of parenting efficacy and positive parenting behaviors several months after the birth among the young mothers in this sample. Social workers are often part of the perinatal team that provides support services to vulnerable mothers, and these findings suggest that breastfeeding support and education may serve as an important avenue for enhancing parenting outcomes and the parent-infant relationship.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of this longitudinal study was to examine changes in young mothers' depressive symptoms from pregnancy through the first two postpartum years and how supportive relationships with key individuals were related to mothers' depressive symptoms over time. Data were collected from young, low-income African American mothers (N = 248) during pregnancy and at 4, 12, and 24 months postpartum. Hierarchical Linear Modeling (HLM) analyses revealed that depressive symptoms were highest during pregnancy and declined through 24 months postpartum. Supportive relationships with the father of the baby and the mother's parent figure were related to lower levels of depressive symptoms. Although the association between father support and the mother's depressive symptoms remained consistent over time, support from the parent figure became increasingly more important during the young mother's transition to parenting. Further analyses also revealed that the association between support and depressive symptoms depended on other aspects of these relationships. Greater support from the baby's father was only related to fewer depressive symptoms for mothers who were partnered with the father of the baby. Greater support from the parent figure was only related to fewer depressive symptoms for mothers who were coresiding with the parent. Finally, having a repeat pregnancy during the early postpartum years was related to higher levels of depressive symptoms during the subsequent pregnancy. These findings suggest that screening and interventions for depression in young mothers should begin during pregnancy and include a focus on her proximal social relationships.
- [Show abstract] [Hide abstract] ABSTRACT: The involvement of 124 young mothers in a doula support program was measured in two dimensions—quantity of program contact and quality of mother–doula helping relationship. The study examined each dimension's differential associations with maternal outcomes, as well as the moderating effects of mother characteristics on these associations. Quantity of program contact was related to the quality of helping relationship, especially when rated by doulas. Both quantity and quality of involvement predicted the maternal outcomes, although not always in the expected direction. For mothers with limited vocabulary skills and better connections with the baby's father, program contact was more likely to promote positive birth experiences. A negative association between program contact and parenting behaviors was observed among mothers who were less mature or had less positive social relationships. The study suggests the multidimensionality of program involvement and the complexity of interactions between program and participant factors in producing program outcomes. © 2010 Wiley Periodicals, Inc.
- [Show abstract] [Hide abstract] ABSTRACT: Methods 124 urban African-American women between the ages of 14 and 21 participated in a research project where they were randomized to receive services from a doula. During pregnancy doulas visited mothers weekly in their homes or in the prenatal clinic. They were also present in the hospital during labor and delivery. Doulas were former teenage mothers from the same communities as the pregnant mothers. Doulas had been trained as childbirth educators and trained to offer physical comfort, information, and emotional support during labor. The first morning after birth, a research assistant visited each mother. Semi-structured interviews were conducted with mothers that asked them to recount their experiences of childbirth from the moments they first became aware of labor to the time when they first saw their infants. These birth stories lasted between ten and twenty minutes. They were tape recorded, transcribed, imported into a QSR data system, and content-coded for types of support provided by the doula. Results The most common type of support mentioned by mothers was instrumental aid around the progression of the labor and the relief of pain: she gave me a massage, she held my hand, she held me so I could push. Emotional support was also mentioned frequently: she made me believe I could do it, if it wasn't for her I would have been so scared. Mothers also reported that doulas offered informational support, usually explaining ongoing medical procedures or interpreting statements made by physicians. In addition to these traditional forms of support, mothers sometimes described the doula's actions as encouraging others present at the birth to support the mother. Doulas showed fathers and family members how to massage feet, put pressure on backs, or to support mothers as they pushed. Sometimes the doulas worked to resolve tensions between these different parties or took family members aside who were serving as a source of stress to the mothers. The doulas would let physicians know if they had not spent enough time explaining a procedure to a young mother. Conclusions and Implications In this demonstration project, the research team not only evaluated program outcomes, but provided ongoing feedback to supervisors about implementation of the program model. These birth stories provided insight into the mothers' valuing of the instrumental actions and emotional support that the doulas had been trained to provide. The stories complicated the picture however (in ways that were felt by the doulas themselves) with respect to the challenges and need for ongoing supervision about dealing with a broader network of relationships that included family members and medical providers.
- [Show abstract] [Hide abstract] ABSTRACT: Although theory and empirical research with middle-class, mostly White women have suggested that motherhood is an important developmental transition for women, rarely have investigations of adolescent motherhood systematically examined developmental change. This study examines one aspect of change during the transition to parenthood: the mother's emerging perception of her infant. During pregnancy and at 4 months' postpartum, 220 urban African American mothers between the ages of 13 and 21 years were asked to describe their infants. Content analysis of their responses and ratings of the affective tone of the responses suggest that there are changes from pregnancy to 4 months after the birth that parallel shifts noted in literature on women going through the transition to motherhood as adults. Between pregnancy and 4 months, there was a decreasing focus on infant health and physical appearance and an increasing focus on infant behavioral achievements and personality characteristics. Of particular importance to mothers was that their infants be “good” babies who were easy to care for and were easily accepted by the family. Mothers imagined physical similarities with their infants during pregnancy and describe aspects of their interaction and emotional bond with their infants at 4 months. Overall, mothers' descriptions of their babies were quite positive, increasingly positive over time, and offered little evidence that for these young African American women the transition to parenthood was problematic.
- [Show abstract] [Hide abstract] ABSTRACT: Doulas are women who provide comfort and emotional support to women during labor, delivery, and the postpartum period. Replicated evidence from randomized clinical trials suggests the presence of a doula shortens labor, reduces use of medication during labor and delivery, increases feelings of efficacy during labor, and decreases postpartum depressive symptoms. The goals of the present study is to evaluate whether a doula intervention for young urban mothers can have longer-term effects on maternal depression, parenting behavior, and parenting attitudes. Methods 248 young African-American women between the ages of 14 and 21 were recruited through obstetrics clinics at an urban teaching hospital, and 221 followed longitudinally until their infants were four months old. Most women were recipients of Medicaid benefits and giving birth for the first time. Following a baseline interview during pregnancy, women were randomized to receive a doula intervention or to be in a control group that received regular medical/social services and a monetary incentive. Doulas were women from the same communities as the mothers who had been teenage mothers themselves and who had received specialized training to provide prenatal education, labor support, breastfeeding counseling, and supporting the parent-child relationship. Doulas made weekly home visits during pregnancy, attended the birth, worked with the mother postpartum in the hospital, and made weekly home visits to three months postpartum. Mothers and infants were videotaped at four months postpartum while undressing and dressing their infants and playing with a rattle with their infants. Blinded coders used the Parent Child Observation Guide to code maternal sensitivity and maternal encouragement of learning. At four months, mothers also reported on their depressive symptoms (CES-D), parenting stress (Parenting Stress Inventory), and child rearing attitudes (Adult-Adolescent Parenting Inventory). Results Using intent-to-treat analyses, there were no differences between the doula and control groups with respect to maternal depression or parenting stress at four months after birth. Mothers who had received doula intervention showed greater encouragement of learning during interaction with their infants than young mothers in the control group. The effect was particularly large for those mothers under the age of 18. Mothers who received doula intervention also reported more appropriate developmental expectations and less role reversing attitudes than control group mothers, but did not differ with respect to attitudes about corporal punishment or empathy toward children. Conclusions and Implications There was no intervention effect on depression or parenting stress, although a limitation of the study is that the timing of the followup came after the window of time in which mothers are most likely to experience postpartum depression and before the toddler age period when mothers are most likely to experience parenting stress. The impact of the intervention on parenting behavior makes this model one of only a very small number of interventions to have documented effectiveness in improving mother-infant interaction during the first months of life. This is important, because parenting behavior during this period has been shown to be associated with later patterns of mother-child interaction and child development.
- [Show abstract] [Hide abstract] ABSTRACT: This paper explores the parenting of drug-dependent women and the contributions of comorbid psychopathology to their parenting. A sample of 32 children whose mothers were dependent on opioid drugs during pregnancy and 37 children whose mothers were not drug users were followed from birth to middle childhood. Multivariate regression analyses were conducted contrasting whether maternal substance abuse or psychopathology was more closely linked to parenting behaviors and continuity in parenting over time. Maternal drug dependence was related to whether mothers were able to remain primary caregivers for their children over time, even after controlling for psychopathology. Maternal drug use was related to unresponsive and negative parenting behavior during mother-infant interaction, but this relation was largely accounted for by the effects of comorbid maternal psychopathology on parenting, particularly symptoms of antisocial and related personality disorders. For those children whose mothers continued to care for them into middle childhood, perceptions of their mothers as rejecting were related to maternal antisocial personality and maternal depression. Substance-abuse treatment for women should be integrated with interventions addressing their mental health and parenting needs.
University of Chicago
Chicago, Illinois, United States
- School of Social Service Administration