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.

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.