The Impact of Mode of Birth, and Episiotomy, on Postpartum Sexual Function in the Medium- and Longer-Term: An Integrative Systematic Review.

(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual dysfunction. This review examined the impact of mode of birth on sexual function in the medium- (≥6 months and <12 months postpartum) and longer-term (≥12 months postpartum). (2) Methods: Literature published after January 2000 were identified in PubMed, Embase and CINAHL. Studies that compared at least two modes of birth and used valid sexual function measures were included. Systematic reviews, unpublished articles, protocols and articles not written in English were excluded. Quality was assessed using the Newcastle Ottawa Scale. (3) Results: In the medium-term, assisted vaginal birth and vaginal birth with episiotomy were associated with worse sexual function, compared to caesarean section. In the longer-term, assisted vaginal birth was associated with worse sexual function, compared with spontaneous vaginal birth and caesarean section; and planned caesarean section was associated with worse sexual function in several domains, compared to spontaneous vaginal birth. (4) Conclusions: Sexual function, in the medium- and longer-term, can be affected by mode of birth. Women should be encouraged to seek support should their sexual function be affected after birth.

Disgust sensitivity in early pregnancy as a response to high pathogen risk.

Introduction: Considered a part of the behavioral immune system (BIS), disgust sensitivity is expected to be adjusting as a response to the actual level of the environmental health risks. Methods: In this preregistered study, we tested the hypothesis that disgust sensitivity would be higher during the COVID-19 pandemic compared to the pre-pandemic period in pregnant women. In this between-subject study with a longitudinal trend design, we administered the Disgust Scale-Revised to 200 pregnant women before the pandemic and to 350 pregnant women during the pandemic. Results: We found a small but significant effect of the pandemic on disgust sensitivity, such that higher disgust sensitivity was found in women pregnant during the pandemic. This effect was stronger in primiparae, however, the interaction between parity and the pandemic period was not significant. Disgust sensitivity decreased with age. No differences in terms of nausea and vomiting were found between the women pregnant before and during the pandemic. Discussion: Our findings indicate that although BIS is presumed to function as a complex mechanism to prevent health-threatening behaviors, its activation in pregnant women during the COVID-19 pandemic is rather weak.

The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review.

(1) Background: A traumatic birth can lead to the development of childbirth-related posttraumatic stress symptoms or disorder (CB-PTS/D). Literature has identified the risk factors for developing CB-PTS/D within the first six months postpartum thoroughly. However, the impact of mode of birth on CB-PTS/D beyond 6 months postpartum is scarcely studied. (2) Methods: A systematic search of the literature was conducted in the databases PubMed, Embase and CINAHL and PRISMA guidelines were followed. Studies were included if they reported the impact of mode of birth on CB-PTS/D beyond 6 months postpartum. (3) Results: In total, 26 quantitative and 2 qualitative studies were included. In the quantitative studies the percentage of women with CB-PTS/D ranged from 0.7% to 42% (between six months and five years postpartum). Compared with vaginal birth, operative vaginal birth, and emergency caesarean section were associated with CB-PTS/D beyond 6 months postpartum. Qualitative studies revealed that some women were suffering from CB-PTS/D as long as 18 years after birth. (4) Conclusions: Long- term screening of women for PTSD in the postnatal period could be beneficial. More research is needed on models of care that help prevent CB-PTS/D, identifying women at risk and factors that maintain CB-PTS/D beyond 6 months postpartum.

Associations of Maternal Prenatal Stress and Depressive Symptoms With Childhood Neurobehavioral Outcomes in the ECHO Cohort of the NICHD Fetal Growth Studies: Fetal Growth Velocity as a Potential Mediator.

OBJECTIVE: Maternal prenatal stress and mood symptoms are associated with risk for child psychopathology. Within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies (ECHO-FGS), a racially and ethnically diverse cohort, we studied associations between prenatal stress and depressive symptoms with child neurobehavior, and potential mediation by fetal growth velocity (FGV) in low-risk pregnancies. METHOD: For 730 mother-child pairs, we had serial ultrasound measurements, self-reports of prenatal stress and depression, observations of child executive functions and motor skills from 4 to 8 years, and maternal reports of child psychiatric problems. We tested associations between prenatal stress and depressive symptoms with child neurobehavior in regression analyses, and associations with FGV in mixed effect models. Post hoc we tested severity of prenatal symptoms; FGV at 25th, 50th, and 75th percentiles; and moderation by biological sex and by race and ethnicity. RESULTS: Prenatal stress and depressive symptoms were associated with child psychiatric problems, and prenatal depressive symptoms with decrements in executive functions and motor skills, especially in biological male children. Neither prenatal stress nor depressive symptoms were associated with FGV. CONCLUSION: In one of the largest cohorts with observed child outcomes, and the first with broad representation of race and ethnicity in the United States, we found that prenatal stress and depressive symptoms were associated with greater reports of child psychiatric symptoms. Only prenatal depressive symptoms were associated with observed decrements in cognitive abilities, most significantly in biological male children. Stress during low-risk pregnancies may be less detrimental than theorized. There was no mediation by FGV. These findings support the need to attend to even small changes in prenatal distress, as these may have long-lasting implications.

Emergency cesarean section is a risk factor for depressive symptoms when breastfeeding is limited.

OBJECTIVE: Previous studies indicated associations between cesarean section (CS), breastfeeding, and depressive symptoms. There is, however, little research integrating these variables into one model to analyze their interrelations. The aim of this observational prospective longitudinal study is to examine whether the effect of CS on postpartum depressive symptoms is mediated by difficulties with breastfeeding. METHODS: The participants were recruited in 5 maternity hospitals during their prenatal medical check-ups. Breastfeeding status was self-reported by the mothers six weeks postpartum. Screening for depressive symptoms was performed at six weeks (N = 404) and nine months (N = 234) postpartum using the Edinburgh Postnatal Depression Scale. Path analysis was used to model the relations between CS, breastfeeding, and depressive symptoms. RESULTS: No direct effects of CS on depressive symptoms at six weeks or nine months postpartum were found. CS was associated with a lower probability of exclusive breastfeeding, which was, in turn, associated with higher levels of depressive symptoms six weeks postpartum. The analysis stratified by type of CS revealed that the effect on breastfeeding only occurred with emergency, not planned, CS. The effect of CS on breastfeeding was noticeably stronger in women without versus with a history of depression. CONCLUSION: Emergency CS predicts breastfeeding difficulties, which are, in turn, associated with higher levels of depressive symptoms. Support should be provided to mothers with emergency CS and breastfeeding problems to reduce the risk of postpartum depressive symptoms in the early postpartum period.

Parity moderates the effect of delivery mode on maternal ratings of infant temperament.

OBJECTIVE: Cesarean section (CS) rates are rising rapidly around the world but no conclusive evidence has been obtained about the possible short- and long-term effects of CS on child behavior. We evaluated prospectively the association between CS and infant temperament across the first 9 postpartum months, controlling for indications for CS and investigating parity and infant sex as moderators. METHODS: The sample consisted of mothers and their healthy infants. Infant temperament was measured using the Infant Characteristics Questionnaire completed by the mothers at 6 weeks (n = 452) and 9 months (n = 258) postpartum. Mode of birth was classified into spontaneous vaginal birth (n = 347 for 6 weeks sample; 197 for 9 months sample), CS planned for medical reasons (n = 55; 28) and emergency CS (n = 50; 33). RESULTS: Multiple regression analysis revealed no main effects of birth mode, but showed a significant interaction between birth mode and parity indicating that emergency CS in firstborn infants was associated with more difficult temperament at 6 weeks. There were no significant associations between indications for CS and infant temperament, although breech presentation predicted difficult temperament at 9 months. CONCLUSION: We largely failed to support the association between CS and infant temperament. Although our results suggest that emergency CS may be associated with temperament in firstborns, further research is needed to replicate this finding, preferably using observational measures to assess child temperament.

The Effects of Intrapartum Administration of Synthetic Oxytocin on Breastfeeding in the First 9 Months Postpartum: A Longitudinal Prospective Study.

Background and Objective: Synthetic oxytocin (synOT) is a widely used drug to induce or accelerate labor and to prevent postpartum hemorrhage. Although some studies indicate there are associations between intrapartum synOT and impaired breastfeeding initiation or earlier cessation, the long-term effects of synOT on breastfeeding are largely understudied. The aim of this study was to examine the effects of synOT on breastfeeding status during the first 9 months postpartum. Materials and Methods: The women were recruited from five maternity hospitals during prenatal medical checkups or postpartum hospital stay. They reported their breastfeeding status on discharge from maternity hospital (mean 4.54 days postpartum) (N = 439), at 6 weeks (N = 439), and at 9 months postpartum (N = 274). The data related to synOT administration were extracted from the medical records. Results: In the analysis adjusted for maternal age, parity, educational level, marital status, child's sex, delivery mode, and labor analgesia/anesthesia, intrapartum administration of synOT predicted a lower probability of exclusive breastfeeding on discharge from maternity hospital (odds ratio = 0.37; p = 0.006), but we observed no effect on breastfeeding status at 6 weeks or 9 months postpartum. Conclusion: Our results suggest that adverse effects of synOT on breastfeeding do not persist beyond the first postpartum days.

Social support buffers the effects of maternal prenatal stress on infants' unpredictability.

OBJECTIVE: Exposure to stress in pregnancy has been shown to affect fetal development with short- and long-term physiological and behavioral consequences for the offspring. Although social support is known to lower perceived stress, no prior study has investigated the buffering role of social support in the context of prenatal stress effects on infant temperament. The aim of this study was to examine interactive effects of prenatal stress and social support on several dimensions of infant temperament at 9 months postpartum. STUDY DESIGN: A total of 272 mothers completed the Perceived Stress Scale and the Perceived Social Support Scale in the 3rd trimester of pregnancy. Infant temperament was assessed by mothers at 9 months postpartum using the Infant Characteristics Questionnaire. Linear regression models were performed to assess the effects of perceived stress, social support, and their interaction on infant temperament. RESULTS: Prenatal stress interacted with social support, such that prenatal stress increased infant unpredictability when social support was below -0.5 SD. CONCLUSIONS: Prenatal stress was found to be a risk factor for infant temperamental unpredictability when combined with low social support perceived by the mother during pregnancy. Support of others, not previously examined in this context, can reduce the impact of prenatal stress.

Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Cohort Study.

The aim of this prospective longitudinal study was to examine the association between Cesarean section (CS) and child development and behavior. The sample consisted of 256 children who were born at term without serious perinatal pathologies. Their development and behavior was assessed at the age of four using Ages and Stages Questionnaire (ASQ-3), Children's Behavior Questionnaire and Strength and Difficulties Questionnaire. Multivariate linear regression analyses were conducted to assess the association between CS and child outcomes. CS was associated with better scores in the Problem Solving domain of the ASQ in the whole sample. After stratifying by child sex, the positive association between CS and the Problem Solving domain was significant in boys, while no association was found in girls. Girls were rated less optimally in the Gross Motor domain of the ASQ when born via CS. Mode of birth was not associated with behavioral outcomes.

The effects of pre- and post-partum depression on child behavior and psychological development from birth to pre-school age: a protocol for a systematic review and meta-analysis.

BACKGROUND: Pre- and post-partum depression is a common mood disorder with detrimental effects on both mother and child. The aim of the proposed review is to summarize evidence related to the effects of both pre- and post-partum depression on child behavior and development from birth to preschool age. In particular, our review will address mutual relations between pre- and post-partum depression in order to determine whether pre- and post-partum depression predict child psychological outcomes independently, whether there is an effect of timing of depression on child outcomes, whether pre- and post-partum depression interact to affect child outcomes, and whether the effect of pre-partum depression is mediated by depression after child's birth. METHODS: We will include prospective longitudinal studies that report data about the effects of both pre- and post-partum depression on child psychological outcomes as published in peer-reviewed academic journals since January 1998. We will search EMBASE, MEDLINE, PsycARTICLES, PsycINFO, ISI Web of Science, Scopus, and Wiley Online databases to identify original research articles written in English. Two independent reviewers will screen search results in two stages: (i) titles and abstracts and (ii) full text. The first one will extract data into tables, while the latter will verify whether the data extracted are correct. We will assess the risk of bias in the selected studies using the Critical Appraisal Skills Programme (CASP), Cohort Study Checklist. The results of the review will be reported in a narrative form. If there are sufficient data available, a meta-analysis will be conducted using metaSEM package in R. DISCUSSION: The proposed review will be the first systematic review summarizing the effects of both pre- and post-partum depression on child psychological development and behavior from birth to preschool age. The results of such a review may contribute to a better understanding of mutual relations between pre- and post-partum depression in their effects on child outcomes. They may also shed light on what periods in early human development are most vulnerable to the effects of maternal depression. TRIAL REGISTRATION: PROSPERO CRD42018106269.

Early infant temperament shapes the nature of mother-infant bonding in the first postpartum year.

OBJECTIVE: This study examined longitudinal relations between maternal bonding and infant temperament in the first nine months after birth. DESIGN: Our sample consisted of 281 women, enrolled at five maternity hospitals, who completed questionnaires during the first week (T1), at six weeks (T2) and nine months postpartum (T3). Maternal bonding was assessed using the Mother-to-Infant Bonding Scale at T1 and T2 and the Postpartum Bonding Questionnaire at T3. Infant temperament was measured using the Infant Characteristics Questionnaire, completed by the mothers at T2 and T3. RESULTS: The results of a path model showed a long-term effect flowing from the child to the mother, with infant temperament at T2 predicting maternal bonding at T3 over and above stability in bonding. At T3, bonding was linked more strongly to child temperament at T2 than to child temperament assessed concurrently at T3. Maternal bonding did predict infant temperament, but this was true only of bonding reported at T1 and infant temperament at T2, that is, not of bonding assessed at T2 and infant temperament at T3. CONCLUSION: Our results indicate that maternal bonding in the first week postpartum may temporarily affect child temperament, but infant's temperament several weeks after birth - rather than several months postpartum - plays a pervasive role in shaping the long-lasting nature of the mother-child relationship. Our findings thus seem to support the suggestion that the early postpartum weeks represent an important period in the development of maternal bonding.

Systemic Approach to the Development of Reading Literacy: Family Resources, School Grades, and Reading Motivation in Fourth-Grade Pupils.

The successful early acquisition of reading literacy represents a crucial learning process determining the further course of academic development (Stanovich, 2009). During this process, interactions between children and their proximal social environment are of utmost importance. Therefore, we introduce a systemic framework for the development of learning potential (e.g., Mudrak et al., 2019a, b; Ziegler and Stoeger, 2017) and explore the interactions between the social and motivational processes associated with reading literacy development in school-age children. We base our analysis on a representative Czech sample of fourth-grade pupils involved in the Progress in International Reading Literacy study (PIRLS, Martin et al., 2017). On the basis of the systemic framework, we hypothesized hierarchical relationships among family socioeconomic status, related developmental resources (including parental support, expectations, and reading resources), children's reading motivation (including reading engagement and reading confidence), and manifested learning outcomes (including school grades and reading competence). We implemented three structural equation models to test the hypothesized relationships. The first model tested the direct effect of developmental resources on reading competence. The second model included the motivational variables as mediators between resources and competence. The third model included school grades as mediators between resources and motivational variables. Our analyses indicated the good fit of the proposed models. The final model explained 37.8% of the variance in children's school grades and 46.5% of the variance in reading literacy test scores (compared to 34.8% in the first model). Moreover, parental socioeconomic status was strongly associated with parental expectations, which were associated with reading confidence, partially through the effect of parental expectations on children's school grades. Reading confidence was the main predictor of reading literacy within the model, followed by the direct effects of parental resources. The results illustrate complex processes through which the family environment affects the development of learning competencies such as reading literacy by providing children with the relevant social and material resources associated with their motivation and school outcomes. We discuss some of the reasons that these relationships may take place and consider their implications for educational practice.

Assessing longitudinal pathways between maternal depressive symptoms, parenting self-esteem and infant temperament.

BACKGROUND: Previous studies of relations between parenting self-concepts, parental adjustment and child temperament have been ambiguous regarding the direction of influence; and have rarely followed families from pregnancy through the first year of life. The current study examines change and stability in maternal depressive symptoms, parenting competences and child temperament through the perinatal period until nine months postpartum. METHODS: Czech mothers (N = 282) participated at three time points: the third trimester of pregnancy (Time 1), six weeks (Time 2) and nine months postpartum (Time 3). Questionnaire data concerned depressive symptoms (T1, T2, T3), maternal parenting self-esteem (T1, T2) and sense of competence (T3), and child temperament (T2, T3). A path model was used to examine concurrent and longitudinal relations between these variables. RESULTS: The analyses indicated longitudinal stability of all constructs, as well as concurrent relations between them. Longitudinal relations supported child-to-parent, rather than parent-to-child, effects: child difficult temperament predicted decreases in perceived maternal parenting competences, but maternal variables did not predict change in infant temperament. In addition, we observed weak mutual relations between maternal depression levels and parenting competences, such that maternal depression diminished perceived parenting competences that in turn contributed to higher levels of depression. CONCLUSION: Mothers' confidence in their ability to parent is influenced by their experience with a difficult infant and by their depressive symptoms during the child's first year of life. Depressive symptoms are, in turn, aggravated by mothers' low perceived competences in the parenting role.

The effects of intrapartum synthetic oxytocin on maternal postpartum mood: findings from a prospective observational study.

Postpartum depression (PPD) affects up to 19% of all mothers, with detrimental effects on both mother and child. The antidepressant and anxiolytic effects of plasma oxytocin are well-documented, but it is still disputable whether synthetic oxytocin (synOT) may protect women against postpartum mood alterations. The current study examined the association between synOT intrapartum and maternal mood postpartum using a prospective design. Two hundred sixty women were screened for depressive symptoms in the last trimester of pregnancy and then again 6 weeks and 9 months postpartum using the Edinburgh Postnatal Depression Scale. They also completed Maternity Blues Questionnaire in the first postpartum week. The data concerning the intrapartum interventions and health status of the newborn were extracted from the medical records. Cox proportional hazards regression adjusted for a history of depression, mode of delivery, and childbirth experience showed that synOT predicted a significantly lower risk of PPD (HR = 0.65, 95% CI 0.45-0.95, p = 0.025). The risk factors for PPD included a history of depression (HR = 3.20, 95% CI 2.33-4.40, p < 0.001) and negative childbirth experience (HR = 1.39, 95% CI 1.01-1.90, p = 0.040). Logistic regression adjusted for the same covariates found no significant effect of synOT on maternity blues (OR = 0.64, 95% CI 0.31-1.32, p = 0.23). While synOT administered intrapartum does not affect maternal mood immediately, it may come to effect some weeks after childbirth to protect mothers from developing PPD symptoms.

Women's psychological experiences of physiological childbirth: a meta-synthesis.

OBJECTIVE: To synthesise qualitative studies on women's psychological experiences of physiological childbirth. DESIGN: Meta-synthesis. METHODS: Studies exploring women's psychological experiences of physiological birth using qualitative methods were eligible. The research group searched the following databases: MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX and Psychology and Behavioural Sciences Collection. We contacted the key authors searched reference lists of the collected articles. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography. RESULTS: Eight studies involving 94 women were included. Three third order interpretations were identified: 'maintaining self-confidence in early labour', 'withdrawing within as labour intensifies' and 'the uniqueness of the birth experience'. Using the first, second and third order interpretations, a line of argument developed that demonstrated 'the empowering journey of giving birth' encompassing the various emotions, thoughts and behaviours that women experience during birth. CONCLUSION: Giving birth physiologically is an intense and transformative psychological experience that generates a sense of empowerment. The benefits of this process can be maximised through physical, emotional and social support for women, enhancing their belief in their ability to birth and not disturbing physiology unless it is necessary. Healthcare professionals need to take cognisance of the empowering effects of the psychological experience of physiological childbirth. Further research to validate the results from this study is necessary. PROSPERO REGISTRATION NUMBER: CRD42016037072.

Social psychological predictors of satisfaction with intrapartum and postpartum care - what matters to women in Czech maternity hospitals?

OBJECTIVE: To identify the social psychological factors affecting women's evaluation of care provided in Czech maternity hospitals using following criteria: satisfaction with intrapartum and postpartum care, willingness to return to a given hospital and to recommend the hospital to others. METHODS: 762 women completed a 71-item original Czech questionnaire KLI-P designed to measure the psychosocial climate in both delivery and after-birth unit on six scales. The sample was representative of the Czech parturients population. Multivariate logistic regression was used to investigate the predictive value of the questionnaire scales for maternal satisfaction, willingness to return to and to recommend a given hospital. RESULTS: For delivery unit, the satisfaction predictors were: helpfulness and empathy of midwives (Χ2=48.9), communication of information and availability of caregivers (Χ2=16.6), helpfulness and empathy of physicians (Χ2=10.9), symmetrical and respectful attitude of staff members (Χ2=9.7) and physical comfort and services (Χ2=7.6). The predictors of satisfaction with after-birth unit included helpfulness and empathy of the staff (Χ2≥42.1), communication of information and availability of caregivers (Χ2=52.5), physical comfort and services (Χ2=30.6), control and involvement in decision-making (Χ2=6.6) and parity (Χ2=8.6). The factors influencing women's willingness to return to and to recommend a hospital differed from the predictors of general satisfaction. CONCLUSIONS: The satisfaction factors revealed in this research correspond predominantly to the results of studies conducted in other countries (warm, non-formal and supportive approach, sufficient and well-timed provision of information and explanation, availability of caregivers, physical environment). However, participation in decision making, which has been repeatedly shown to be among the strongest predictors of childbirth satisfaction, was not important for the Czech parturients' satisfaction with intrapartal care. This finding can be explained by different attitudes and expectations of both parturients and caregivers in a post-totalitarian country.