Maternal appraisals of the birth of a child: Portuguese version of the Stress Appraisal Measure.

Objective: We assessed (1): the factorial and convergent validity of the Portuguese version of the Stress Appraisal Measure (SAM); (2) maternal primary and secondary appraisals of the birth of a child; and (3) the influence of appraisals on stress.Background: Parental stress is common during transition to parenthood and may be detrimental for parents and infants. Following Lazarus and Folkman's transactional model, the degree of stress is influenced by cognitive appraisals of an event, which are assessed by the SAM.Methods: This was an observational, cross-sectional study. Two hundred and forty-five women with a child of up to 24 months of age filled out several self-report measures, in an online platform.Results: The SAM factorial structure included three primary (Threat, Centrality, and Challenge) and two secondary (Controllable-by-Self and Controllable-by-Others) appraisals. All subscales had adequate internal consistency. The birth of a child was mainly perceived as a challenge, and seldom appraised as a threat. Threat and centrality appraisals positively predicted stress.Conclusion: Assessing maternal appraisals of the birth of a child is relevant to foster adaptation to parenthood. The SAM is an adequate assessment tool. As cognitive appraisals are modifiable, women with higher threat appraisals should be targeted for psychological interventions.

Mothers' and fathers' attachment and caregiving representations during transition to parenthood: an actor-partner approach.

OBJECTIVE: This study aimed to investigate the effect of one's attachment representations on one's and the partner's caregiving representations. BACKGROUND: According to attachment theory, individual differences in parenting and caregiving behaviours may be a function of parents' caregiving representations of the self as caregiver, and of others as worthy of care, which are rooted on parents' attachment representations. Furthermore, the care-seeking and caregiving interactions that occur within the couple relationship may also shape individuals' caregiving representations. METHODS: The sample comprised 286 cohabiting couples who were assessed during pregnancy (attachment representations) and one month post-birth (caregiving representations). Path analyses were used to examine effects among variables. RESULTS: Results showed that for mothers and fathers, their own more insecure attachment representations predicted their less positive caregiving representations of the self as caregiver and of others as worthy of help and more self-focused motivations for caregiving. Moreover, fathers' attachment representations were found to predict mothers' caregiving representations of themselves as caregivers. CONCLUSIONS: Secure attachment representations of both members of the couple seem to be an inner resource promoting parents' positive representations of caregiving, and should be assessed and fostered during the transition to parenthood in both members of the couple.

Medical information concerning an infant's congenital anomaly: Successful communication to support parental adjustment and transition.

BACKGROUND: When a diagnosis of congenital anomaly (CA) is made, parents are confronted with new and complex medical information, which may impact their parental adjustment. However, few studies have explored the role of information concerning the CA in parental adjustment, during the transition to parenthood. OBJECTIVE/HYPOTHESIS: This study aimed to characterize both parents' perceptions of information concerning the CA and to investigate their role in maternal and paternal adjustment, one month after the disclosure and six months post-birth. METHODS: Thirty six couples whose infants were prenatally- or postnatally diagnosed with a CA participated in this prospective longitudinal study. During both assessment times (Time 1: one-month after the disclosure; Time 2: six-month post-birth), they answered the Brief Symptom Inventory-18, the EUROHIS-QOL-8, and other specific questions to assess parents' information perceptions. RESULTS: Mothers were more satisfied than fathers (p < .01) with the amount of information that was received at the disclosure, although mothers and fathers reported similar levels of comprehension of information. Six-month post-birth, both parents were similarly satisfied with the information that was received, although mothers sought significantly more (p < .01) additional information. Both maternal and paternal adjustment were significantly associated with maternal perceptions of information concerning CA. CONCLUSION: Health professionals should recognize the important role of information concerning CA in parental adjustment and tailor their communication practices in order to promote parents' satisfaction and comprehension of the medical information. Despite the prominent influence of maternal perceptions on parental adjustment, both parents should be included in the communication process.

Parenting an infant with a congenital anomaly: how are perceived burden and perceived personal benefits related to parenting stress?

This study aimed to characterize parents' negative (perceived burden) and positive (perceived personal benefits) perceptions about parenting an infant with a congenital anomaly (CA), and to investigate their role in parenting stress. Forty-three couples (43 mothers and 36 fathers) whose 6-month-old infants had a CA completed several questionnaires: the Impact on Family Scale-Revised, the Positive Contributions Scale, and the Parenting Stress Index-Short Form. The results showed similarities between maternal and paternal perceptions. For mothers, higher levels of burden and lower levels of personal benefits were found to predict higher levels of parenting stress. For fathers, greater burden was associated with higher levels of parenting stress. Some dimensions of personal benefits moderated the relationship between burden and parenting stress, for both genders. Specific strategies targeting negative and positive perceptions should be considered when developing psychological interventions to promote the family's adaptation to the experience of parenting an infant with a CA.

The role of satisfaction with social support in perceived burden and stress of parents of six-month-old infants with a congenital anomaly: Actor and partner effects.

This exploratory study examined the role of satisfaction with support from family and friends on the burden and stress of parents of infants with a congenital anomaly (CA). The effects of social support were examined within the couple (actor and partner effects). A total of 36 couples whose six-month-old infant has a CA participated in this study. The parents completed questionnaires regarding satisfaction with support, burden (Impact on Family Scale - Revised), and parenting stress (Parenting Stress Index). The results showed that fathers directly benefited from the support they received from friends in reducing their burden, while mothers only indirectly benefited from it through the father's adjustment. The pattern was different for stress: mothers directly benefited from the support they received from their family in reducing their stress levels, while fathers benefited both directly from the support they received from friends and indirectly from the support that their partners received from family. These results highlight that (1) the different support needs of mothers and fathers (due to their different roles during transition to parenthood) and (2) the diffusion of benefits of social support within the couple should be taken into account when developing strategies to promote support to families of six-month-old infants with a CA.

Parenting an infant with a congenital anomaly: An exploratory study on patterns of adjustment from diagnosis to six months post birth.

The present study examined psychological adjustment in parents of infants with congenital anomalies (CAs), focusing on the interval from the disclosure of the diagnosis to six months after the infant's birth and considering the effects of the parent's gender and the timing of diagnosis (pre- vs postnatal). Within-group diversity was also examined by identifying distinct patterns of individual adjustment over time. Parents of 43 infants (43 mothers and 36 fathers) with a pre- or postnatal diagnosis of a CA answered questionnaires assessing psychological distress and quality of life one month after the disclosure of the diagnosis and six months after the infant's birth. Results showed a significant reduction in psychological distress and a significant increase in physical quality of life over time, for both parents, regardless of the timing of diagnosis. In all, 57% of parents presented a pattern of recovery from diagnosis to six months post birth and 26.6% presented a pattern of resilience. However, 15.2% of parents showed chronic adjustment difficulties. Findings suggest that most parents tend to adjust to their infant's CA, although some experienced difficulties and should be targeted for specialised counselling. Both members of the couple should be acknowledged, as both experience similar patterns of adjustment.

Clinical determinants of parents' emotional reactions to the disclosure of a diagnosis of congenital anomaly.

OBJECTIVE: To examine parents' emotional reactions (high intensity vs. low intensity) and the intensity of each emotion when a prenatal or postnatal diagnosis of a congenital anomaly is disclosed DESIGN: Cross-sectional study. SETTING: Two urban Portuguese hospitals. PARTICIPANTS: The parents (60 mothers and 50 fathers) of 60 infants prenatally or postnatally diagnosed with a congenital anomaly. METHODS: One month after the disclosure of the diagnosis, the parents answered questionnaires regarding sociodemographic and clinical variables and their emotional experiences at the disclosure. RESULTS: Gender differences in the parents' emotional reactions were not found, and intracouple congruence was frequent. When there was uncertainty regarding the diagnosis, no prior knowledge about the diagnosis (for fathers only), and no history of pregnancy loss (for mothers only), parents presented significantly more frequently with a pattern of high-intensity negative emotional reactions to the disclosure. Type of congenital anomaly, timing of diagnosis, and parity were not found to be significantly associated with the patterns of emotional reactions, but differences in the intensity of specific emotions were found for all variables. CONCLUSION: Both parents' emotional experiences should be acknowledged at the disclosure. Clinical variables were found to define the stressful situation (the diagnosis). When the diagnosis was perceived as more threatening (i.e., more unexpected, less controllable, and predictable), parents presented a pattern of high-intensity emotional reactions.

Parental psychological distress and confidence after an infant's birth: the role of attachment representations in parents of infants with congenital anomalies and parents of healthy infants.

The present study aimed to examine parental psychological distress and confidence after an infant's birth, when parenting an infant with a diagnosis of a congenital anomaly, and to understand the role of attachment representations on parental adjustment. Parents of infants with a congenital anomaly (44 couples) and parents of healthy infants (46 couples) completed measures of adult attachment representations and of psychological distress and parental confidence (one month after the infant's birth). Results showed no group differences in psychological distress. Mothers in the clinical group presented lower confidence than mothers in the comparison group, while for fathers the inverse pattern was found, showing their involvement in the caretaking of the infant. Insecure attachment representations predicted parental psychological distress, and a moderator role of group was found only for fathers. These results highlight the role of secure attachment representations as an individual resource in stress-inducing situations.

Parental psychological distress and quality of life after a prenatal or postnatal diagnosis of congenital anomaly: a controlled comparison study with parents of healthy infants.

BACKGROUND: Parental early adjustment to a prenatal or postnatal diagnosis of congenital anomaly has been studied mainly within a pathological and deterministic perspective, giving us an inadequate view of the impact of the diagnosis. OBJECTIVES: Adopting a comprehensive approach on parental adjustment, we aimed to characterise the impact of the diagnosis on psychological distress and quality of life, in the early postdiagnosis stage. The effects of gender and the timing of the diagnosis were also examined. METHODS: In this cross-sectional study, 42 couples with healthy infants and 42 couples whose infants were prenatal or postnatally diagnosed with a congenital anomaly responded to the Brief Symptom Inventory-18 and to the World Health Organization Quality of Life-Brief instrument. RESULTS: In the early postdiagnosis stage, parents whose infants were diagnosed with a congenital anomaly presented higher levels of psychological distress than did the parents of healthy infants (F(2,79) = 6.23, p = .003), although they displayed similar levels of quality of life (F(4,78) = 0.62, p = .647). Mothers reported more adjustment difficulties than fathers in both groups. Receiving the diagnosis in the prenatal period was associated with higher maternal psychological quality of life (Z = -2.00, p = .045). CONCLUSION: The occurrence of a diagnosis of congenital anomaly during the transition to parenthood adds to an accumulation of stress-inducing events and manifests itself in psychopathological symptoms. Maintaining a positive evaluation of well-being may be understood as a parental resource to deal with the diagnosis. The importance of adopting a comprehensive perspective on parental adjustment is highlighted.

Changes in marital congruence and quality of life across the transition to parenthood in couples who conceived spontaneously or with assisted reproductive technologies.

OBJECTIVE: To investigate the relationship between changes in marital congruence (ie, level of agreement between partners about their relationship) and quality of life across the transition to parenthood in couples who conceived spontaneously and with assisted reproduction technology (ART). DESIGN: Prospective longitudinal cohort design using multilevel modeling. SETTING: Portuguese large public university-based hospital. PATIENT(S): Pregnant couples who conceived spontaneously and with ART. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): ENRICH Marital Inventory and the World Health Organization Brief Quality of Life Instrument. RESULT(S): For all couples, an increase in satisfaction with the marital relationship was associated with increases in all quality of life domains. For couples who conceived with ART only, a decrease from pregnancy to the postpartum period in congruence about the existence of conflicts in their relationship was associated with a decrease in psychologic quality of life. CONCLUSION(S): Couples who conceive with ART are usually satisfied with their marital relationship, but they may still disagree in their perceptions of this relationship, which may negatively impact their well-being. These results reinforce the role of couple-based interventions to prevent intracouple disagreement across the transition to parenthood, especially when conception is achieved with ART.