do maternal experiences of childbirth influence infant ... · carmen power claire williams amy...
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Do maternal experiences of childbirth influence infant behaviour?
Experiences of 1000 mothers An internet survey
Carmen Power Claire Williams Amy Brown
Department of Human and Health Sciences
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Health implications of childbirth interventions
Background:
Rising rates of childbirth interventions, e.g. C sections increased pain relief intake
Direct responses (and physical risks):
Mother – e.g. PPH, infection, increased pain
Baby – e.g. injury, hypoxia or cerebral palsy; also C sections may respiratory problems
– unsettled after obstetric complications – pain/effects of pharmacological pain relief
– Normal birth is associated with optimal physical health outcomes for Mum & Baby
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Indirect responses to childbirth complications
Mother – increased risk of postnatal depression or PTSD (perceptions) affecting bonding & baby behaviour Baby – circulating cortisol during birth may overstimulate infant’s HPA axis (hypothalamic-pituitary-adrenal) could affect future stress reactivity – However – suggested that mother’s response to the birth might mediate this effect (Taylor, Fisk & Glover, 2000)
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Research question: Do maternal experiences of childbirth influence infant behaviour?
AIM: to examine impacts of childbirth upon infant behaviour in UK, and how these might be mediated by mothers’ perceptions of their birth experiences
1. Interviews with 18 health professionals & 22 mothers TRENDS
2. A large scale online survey developed with detailed questioning:
a) Physical experience of pregnancy, childbirth and postnatal period
b) Psychological experience of pregnancy, birth and postnatal period
c) Baby behaviour post birth (Mother and Baby Scales, Wolke & James-Roberts, 1987)
d) Sociodem. Vs, EPDS, TIPI (Big 5 - personality) & Spielberger’s STAI (State) – Posted to relevant UK sites e.g. netmums.com and social media sites e.g. Twitter
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Over 1000 initial participants 999 mothers
Excluding those who did not complete the survey or meet the study inclusion criteria, final number: 999 participating mother-infant dyads
Analysed data (SPSS version 22): PCA (to condense data), correlations and MANOVAs, then multiple linear regressions for each of 10 DVs:
- We devised 24 Hour Baby Scales: Alert-Content Baby & Cry-Fuss Baby
- Mother & Baby Scales (MABS) 0-6 months: 5 baby behavioural measures (e.g. Alert-Responsive/Unsettled-Irregular/Easy) + 3 maternal confidence measures: Caretaking, Breastfeeding & Global Confidence
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Physical & Psychological factors affected 24 hr baby behaviour
• Foetal Distress during birth baby cried & fussed more (β = .100, p = 0.002)
• Assisted birth babies cried & fussed more than after a
normal birth or planned Caesarean section (Gitau et al., 2001)
(β = .161, p < 0.001)
• Newborn babies also cried & fussed more when their mothers felt distressed after the birth (β = .304, p < 0.001)
• Postnatal Maternal Distress – associated with a more
difficult birth experience – both physically + feeling Anxious-Afraid (r = .549, p < 0.001) or Neglected (r = .587, p < 0.001)
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Mothers who experienced Positive Birth Emotions
• Mothers who felt Happy, Strong, Focused & Confident during birth reported a more Alert-Content 24 hour baby (β = .189, p < 0.001)
• Babies were also more alert,
content and breastfed more easily if their mothers felt physically Relaxed & Alert post birth (β = .110, p = 0.001)
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Results for Mother & Baby Scales: Babies 0-6 months • Mothers who felt Strong, Happy, Focused & Confident during birth
reported more Alert and Responsive babies (β = .160, p < 0.001)
• Conversely, mothers who felt Anxious and Afraid during their birth had more Unsettled and Irregular routine babies (β = .138, p < 0.001)
• Mothers who scored higher on the Edinburgh Postnatal Depression Scale also had more Unsettled - Irregular babies (β = .351, p < 0.001)
• EPDS scores were inter-correlated with Anxious – Afraid (r = .375), Neglected (r = .284), some physical interventions, not having a Gentle Birth of Head (r = –.152) and not having Skin2Skin with baby (r = –.195)
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We also found… Where mothers felt positive
emotions post birth, e.g. Euphoric, Exhilarated, Enamoured and Proud, they perceived Baby as ‘easier’ (β = .133, p < 0.001)
These positive postnatal feelings
were related to a Positive Birth Experience (r = .470, p < 0.001), including a more Gentle Birth of Baby’s Head (r = .274, p < 0.001)
Positive birth experience in turn was
associated with a positive pregnancy
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Mothers felt greater Global Confidence in caring for their baby post birth if they… • felt Positive Postnatal (PN)
Emotions (β = .112, p = 0.001)
• felt Alert & Relaxed PN (β = .103, p = 0.002)
• had Emotional Stability (β = .134, p = 0.001)
• But they tended to have reduced confidence in their mothering abilities if felt sad or depressed PN (β = -.206, p < 0.001)
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To conclude:
• Physical birth factors, e.g. birth mode, interventions & pain relief – independently associated with 24 Hour Baby
• Physical birth events were related to MABS (0-6 months)
• Impacts on baby behaviour mostly decreased with B age
• Overall, subjective maternal perceptions of childbirth & PN days predicted MABS scores (baby behaviour 0-6 months)
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Implications for practice may include to…
• Provide extra support during labour and birth for more emotionally vulnerable mothers (screened in pregnancy)
• Provide extra support for mothers experiencing obstetric complications or interventions (to reduce negative impact)
• Provide an accessible debriefing service to all mothers, particularly after a difficult/traumatic birth experience
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Strengths and Limitations
• Retrospective questionnaire, thus potential for memory errors
• Potentially a biased sample as mothers were self-selecting and, true to online research methods, tended to come from a higher socio-economic background than the general population – therefore results cannot be generalised to wider population
• Self-report measures
• A large sample group, therefore adequate power for statistical procedures
• Socio-demographic variables did not significantly affect results
• Self-report infant behaviour measures were highly associated with one another, giving the study strong internal validity. Furthermore, 24 Hour Baby was associated with Apgar scores
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Bibliographic references
• Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: A meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121-1134.
• Baibazarova, E., Van de Bee, C., Cohen-Kettenis, P. T., Buitelaar, J., Shelton, K. H., & Van Goozen, S. H. (2013). Influence of prenatal maternal stress, maternal plasma cortisol and cortisol in the amniotic fluid on birth outcomes and child temperament at 3 months. Psychoneuroendocrinology, 38(6), 907-915.
• Brown, A., & Jordan, S. (2013). Impact of birth complications on breastfeeding duration: an internet survey. Journal of advanced nursing, 69(4), 828-839.
• Douglas, P. S., & Hill, P. S. (2013). A neurobiological model for cry-fuss problems in the first three to four months of life. Medical hypotheses, 81(5), 816-822.
• Figueiredo, B., Costa, R., Pacheco, A., Pais, Á. (2008). Mother-to-infant emotional involvement at birth. Maternal and Child Health Journal, 13(4), 539-549.
• Fisher, J.R., Hammarberg, K., Baker, H. G. (2005). Assisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties. Fertility and Sterility, 84(2), 426-430.
• Ford, E., Ayers, S. (2009). Stressful events and support during birth: the effect on anxiety, mood and perceived control. Journal of Anxiety Disorders, 23(2), 260-268.
• Garthus-Niegel, S., Ayers, S., Martini, J., von Soest, T., & Eberhard-Gran, M. (2017). The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study. Psychological Medicine, 47(1), 161.
• Gitau, R., Menson, E., Pickles, V., Fisk, N. M., Glover, V., MacLachlan, N. (2001). Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology, 98(1), 14-17.
• Hansen, A. K., Wisborg, K., Uldbjerg, N., Henriksen, T. B. (2008). Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. British Medical Journal, 336(7635), 85-87.
• Hofemeyr, G. J., Nikodem, V. C., Wolman, W. L., Chalmers, B. E. & Kramer, T. (1991). Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. British Journal of Obstetrics & Gynaecology, 98(8):756-64.
• James-Roberts, I.S., Conroy, S. (2005). Do pregnancy and childbirth adversities predict infant crying and colic? Findings and recommendations. Neuroscience & Biobehavioral Reviews,
29(2), 313-320.
• Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. (2000). Association Between Method of Delivery and Maternal Rehospitalization. JAMA 283(18), 2411-2416.
• McGrath, J. M., Records, K., Rice, M. (2008). Maternal depression and infant temperament characteristics. Infant Behavior and Development, 31(1), 71-80.
• McIntyre, S., Taitz, D., Keogh, J., Goldsmith, S., Badawi, N., Blair, E. V. E. (2013). A systematic review of risk factors for cerebral palsy in children born at term in developed countries. Developmental Medicine & Child Neurology, 55(6), 499-508.
• McMahon, C. Barnett, B., Kowalenko, N., Tennant, C., Don, N. (2001). Postnatal Depression, Anxiety and Unsettled Infant Behaviour. Australian & New Zealand Journal of Psychiatry, 35(5), 581 – 588.
• NHS Maternity Statistics England, 2016-17. ttps://www.gov.uk/government/statistics/nhs-maternity-statistics-england-2016-to-2017
• NICE (National Institute for Health and Care Excellence) guideline (2015). Safe midwifery staffing for maternity care settings.
• NMPA Project Team (2017). National Maternity and Perinatal Audit: Clinical Report 2017. RCOG London, 2018.
• Ransjö-Arvidson, A. B., Matthiesen, A. S., Lilja, G., Nissen, E., Widström, A. M., Uvnäs-Moberg, K. (2001). Maternal analgesia during labour disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth, 28(1), 5-12.
• Rowe‐Murray, H. J., Fisher, J. R. (2001). Operative intervention in delivery is associated with compromised early mother‐infant interaction. BJOG: An International Journal of Obstetrics & Gynaecology, 108(10), 1068-1075.
• RCM: Interventions in Normal Labour and Birth Survey Report, 2016.
• Ryding, E. L., Wijma, B., Wijma, K. (1997). Posttraumatic stress reactions after emergency cesarean section. Acta Obstetricia et Gynecologica Scandinavica, 76(9), 856-861.
• Taylor, A., Fisk, N. M., Glover, V. (2000). Mode of delivery and subsequent stress response. The Lancet, 355(9198), 120.
• Welsh Government: Maternity Statistics Wales, 2015-16. http://gov.wales/statistics-and-research/maternity-statistics/?lang=en
• World Health Organization (2018). WHO recommendations: intrapartum care for a positive childbirth experience. Geneva. Licence: CC BY-NC-SA 3.0 IGO.