Development and Psychometric Testing of the Fathers' Self-Efficacy Scale for Newborn Care.

PURPOSE: Fathers' involvement in newborn care positively affects both work sharing between parents, newborn quality of life, and the relationship between father and newborn. However, there is no valid and reliable measurement tool to evaluate fathers' self-efficacy levels for newborn care. This study aimed to develop the fathers' self-efficacy scale for newborn care (FSSNC) and to examine its psychometric properties. METHODS: This study is an instrument development and validation study. After a comprehensive literature review, expert opinion, and pilot application stages, an item pool was developed. For validity and reliability analyses, data were collected between March and December 2022 from 442 individuals, including fathers with newborn babies and expectant fathers whose partners are pregnant. Validity assessments included content, exploratory and confirmatory factor analyses, and convergent validity. The scale was also evaluated for its internal consistency, and two-half-test reliability. In this study, the STROBE checklist was used as a guideline. RESULTS: The final version of the scale consisted of three subdimensions (hygiene, safety, and nutrition). The total number of items is 17. Confirmatory factor analysis results confirm the results of exploratory factor analysis. There was a strong correlation between the scale score and the participants' self-assessment score. CONCLUSIONS: The study demonstrates that the FSSNC was a valid, reliable, and user-friendly measurement tool used to evaluate fathers' self-efficacy regarding hygiene, safety, and nutrition in newborn care.

Mothers' perception of the care of newborn in the home environment.

OBJECTIVES: to identify mothers' perceptions about caring for newborns in the home environment, from the perspective of complexity thinking. METHODS: qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique. RESULTS: the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment. FINAL CONSIDERATIONS: the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.

The Relation of Maternal Psychosocial Risk Factors to Infant Safe Sleep Practices.

OBJECTIVES: Sleep-related infant deaths are a common and preventable cause of infant mortality in the United States. Moreover, infants of color are at a greater risk of sleep-related deaths than are White infants. The American Academy of Pediatrics (AAP) published safe sleep guidelines to minimize the number of sleep-related infant deaths; however, many families face barriers to following these guidelines. Research on the role of psychosocial risk factors (i.e., depression, stress, domestic violence, substance use) in mothers' engagement in safe sleep practices is limited. The present study examined the role of maternal psychosocial risk factors on maternal safe sleep practices and the moderating effects of maternal race on this relationship. METHODS: Participants in this study were mothers (N = 274) who were recruited from a Midwestern hospital postpartum. Data on the participants' psychosocial risk factors, and safe sleep practices were collected via telephone interview 2-4 months following the birth of their infant. RESULTS: Predictive models indicated that depression and stress impacted mothers' engagement in following the safe sleep guidelines. Specifically, higher levels of maternal depression predicted greater likelihood of co-sleeping, regardless of mothers' race. Higher levels of maternal stress also predicted lower engagement in safe sleep behaviors for White mothers only. CONCLUSION FOR PRACTICE: Early interventions to address stress and depression may help to increase maternal adherence to the AAP's safe sleep guidelines. Additional research on the underlying mechanisms of depression and stress on maternal safe sleep engagement is needed.

Giving parents support: a randomized trial of peer support for parents after NICU discharge.

BACKGROUND: Peer support during inpatient hospitalization has been recommended for NICU parents and can improve maternal mental health. Less is known about the impact of peer support after NICU discharge on parental mental health and infant healthcare utilization. METHODS: Three hundred families of infants approaching discharge from a Level IV NICU were randomized to receive a care notebook (control) or care notebook plus peer support for 12 months (intervention). Participants reported on measures of stress, depression, anxiety, self-efficacy, and infant healthcare utilization. Analysis compared outcomes between control and treatment groups. RESULTS: Parental depression, anxiety, stress, and self-efficacy improved significantly for all participants, yet there were no differences between control and intervention groups. Infant ED visits, hospitalizations, immunization status, and developmental status at 12 months did not differ between groups. CONCLUSIONS: Peer support after NICU discharge did not improve self-reported parental mental health measures or infant healthcare utilization. CLINICAL TRIAL REGISTRATION: NCT02643472.

Coverage and factors associated with mother and newborn skin-to-skin contact in Nigeria: a multilevel analysis.

BACKGROUND: Mother and newborn skin-to-skin contact (SSC) is an immediate postpartum intervention known to improve the health of newborn and mothers alike. Albeit, there is paucity of data that explored the coverage or factors associated with SSC in Nigeria. Therefore, we aimed to explore the coverage and hierarchical nature of the factors associated with SSC among women of reproductive age in Nigeria. METHODS: The 2018 Nigeria Demographic and Health Survey (NDHS) data was used for this study. Data on 29,992 women who had ever given birth were extracted for analysis. SSC was the outcome variable as determined by women's report. A multivariable multilevel logistic regression model was used to estimate the fixed and random effects of the factors associated with SSC. Statistical significance was determined at p< 0.05. RESULTS: The coverage of SSC was approximately 12.0%. Educated women had higher odds of SSC, when compared with women with no formal education. Those who delivered through caesarean section (CS) had 88% reduction in SSC, when compared with women who had vaginal delivery (OR= 0.12; 95%CI: 0.07, 0.22). Women who delivered at health facility were 15.58 times as likely to practice SSC, when compared with those who delivered at home (OR= 15.58; 95%CI: 10.64, 22.82). Adequate ANC visits and low birth weight significantly increased the odds of SSC. Women from richest household were 1.70 times as likely to practice SSC, when compared with women from poorest household (OR= 1.70; 95%CI: 1.04, 2.79). There was 65% reduction in SSC among women with high rate of community non-use of media, when compared with women from low rate of community non-use of media (OR= 0.35; 95%CI: 0.20, 0.61). CONCLUSION: SSC coverage was low in Nigeria. Moreover, individual, household and community level factors were associated with SSC. More enlightenment should be created among women to bring to limelight the importance of SSC specifically to newborn's health.

Maternal-fetal attachment in pregnant Italian women: multidimensional influences and the association with maternal caregiving in the infant's first year of life.

BACKGROUND: Maternal-Fetal Attachment (MFA) describes the cognitive-representational, emotional, and behavioral aspects of the mother-fetus relationship that develops during pregnancy. We present two studies conducted on pregnant Italian women. In Study I, we aimed to explore multifaceted associations of MFA with variables important for a healthy pregnancy (e.g., maternal mental health, the couple's relationship). In Study II, we investigated the predictive role of MFA on observed maternal caregiving during the first months of the infant's life. METHODS: In Study I, 113 pregnant Italian women were assessed on MFA (Maternal Antenatal Attachment Scale, MAAS), maternal depression (Beck Depression Inventory-II, BDI-II), maternal anxiety (State Trait Anxiety Inventory - State version, STAI), adjustment of the couple (Dyadic Adjustment Scale, DAS), and perceived parental care (The Parental Bonding Instrument, PBI). In Study II, 29 mother-infant pairs were followed up at 4 months to assess observational variables of maternal caregiving through the Emotional Availability Scale (EAS) and to test for an association with MFA in pregnancy. RESULTS: Study I showed a significant association between MFA and the quality of the couple relationship (ß = .49, P < .001) and between MFA and the recall of memories of care received in childhood (ß = .22, P = .025). Study II showed a predictive effect of MFA on maternal structuring observed during mother-infant interactions at 4 months of age (ß = 0.36, P = .046). CONCLUSION: The study points out relevant relationship contexts that might receive care and support throughout pregnancy to protect MFA. The findings also provide thoughtful insights on the role of MFA in early maternal caregiving, suggesting that MFA might be a candidate as one putative antecedent of mother-infant interaction processes.

Ecological factors affecting Infant at Work policies and programs in university settings.

OBJECTIVES: This study identifies the ecological (ie, policy, environment, intrapersonal, and interpersonal) factors affecting the implementation of an Infant at Work program in a university setting. METHODS: Data were collected among faculty, staff, and graduate students at a large Midwestern university from February to July 2020 via focus group (FG) discussions with university employees (n = 22) and semistructured interviews with university administrators (n = 10). We used techniques from expanded grounded theory, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS: Three themes emerged from the FG data: (i) program and policy scope, (ii) employee and employer benefits, and (iii) workplace concerns. Onsite daycares, flexible schedules and participation, and expanded childcare options were some of the programs and policies employees desired. However, barriers to implementing these types of programs include cost, safety, and structure of the work environment. CONCLUSIONS: Findings offer practical recommendations and strategies to improve work/life balance among parents transitioning back to work in a university environment. Findings also provide insight into the feasibility of family-friendly workplace policies and environments. Additionally, findings provide a framework for other organizations to implement similar Infant at Work programs to improve employee work/life balance.

Infants' stress responses and protest behaviors at childcare entry and the role of care providers.

During the transition from home to childcare, 70 15-month-old infants were videotaped, and their negative emotions were rated. Infants' attachments to mothers were assessed prior to child care entry and to care providers five months later using the Strange Situation Procedure (SSP). Infant heart rate was monitored at home, during adaptation to childcare (mothers present), and during subsequent separations. Respiratory sinus arrhythmia (RSA) was computed from the beat-to-beat measures of heart rate to reflect vagal tone, which is reduced during chronic states of stress, and was collected upon Arrival, during in-group Play, and when in the Group more generally. All infants responded to childcare entry with low RSA levels indicating stress. However, during adaptation with the mother present, RSA was higher for securely attached infants. On the first separation day, 35.3% of the infants fussed and cried extensively. These intense protests predicted later secure attachments to care providers, which adaptively helped to reduce stress, especially in infants who protested extensively, as if summoning their mothers back. Because extensive protest suggests limited regulatory capacities, infants risk overburdening the stress system when left unsupported.

The Association Between Maternity Waiting Home Use and Maternal-Newborn Knowledge: Latent Class Analysis.

BACKGROUND AND PURPOSE: An exploratory latent class analysis (LCA) was performed assessing the association between maternity waiting home (MWH) use and maternal-newborn care knowledge. METHODS: A two-group comparison design using a face-to-face interview (n = 250) was conducted to understand if MWH use was associated with greater maternal knowledge of newborn care. RESULTS: High levels of maternal knowledge of newborn care were associated with MWH use. Mothers with low levels of knowledge were less likely to use an MWH prior to delivery and more likely to have fewer pregnancies, attend less than four antenatal care (ANC) visits, and receive no education about newborn health problems during ANC. CONCLUSIONS: Nurses need to target younger, primigravida mothers attending fewer ANC visits with educational opportunities while advocating for expansion of health education at MWHs to potentiate long-term benefits for improved maternal-newborn health and delivery outcomes.

Osteopathic manipulative treatment to improve exclusive breast feeding at 1 month.

OBJECTIVE: Previous studies have assessed breastfeeding-support programmes. Among these, osteopathic manipulative treatment (OMT) is a frequently used approach, although without strong evidence of efficacy. METHODS: A double-blind randomised controlled trial was conducted between July 2013 and March 2016. Breastfed term infants were eligible if one of the following criteria was met: suboptimal breastfeeding behaviour, maternal cracked nipples or maternal pain. The infants were randomly assigned to the intervention or the control group. The intervention consisted of two sessions of early OMT, while in the control group, the manipulations were performed on a doll behind a screen. The primary outcome was the exclusive breastfeeding rate at 1 month, which was assessed in an intention-to-treat analysis. Randomisation was computer generated and only accessible to the osteopath practitioner. The parents, research assistants and paediatricians were masked to group assignment. RESULTS: One hundred twenty-eight mother-infant dyads were randomised, with 64 assigned to each group. In each group, five infants were lost to follow-up. In the intervention group, 31 of 59 (53%) of infants were still exclusively breast fed at 1 month vs 39 of 59 (66%) in the control group, (OR 0.55, 95% CI 0.26 to 1.17; p=0.12). After adjustment for suboptimal breastfeeding behaviour, caesarean section, use of supplements and breast shields, the adjusted OR was 0.44 (95% CI 0.17 to 1.11; p=0.08). No adverse effects were reported in either group. CONCLUSION: OMT did not improve exclusive breast feeding at 1 month. TRIAL REGISTRATION NUMBER: NCT01890668.

Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals.

BACKGROUND: Decisions about treatments for extremely preterm infants (EPIs) born in the 'grey zone' of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine. METHODS: The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents' views based on profession and neonatal unit designation. Further questions explored respondents' conceptual understanding of viability. RESULTS: 336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks' gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be 'viable' if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team. CONCLUSION: Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks' gestation.

An Integrative Review of Fathers' Needs in the Neonatal Intensive Care Unit.

Having a child admitted to the neonatal intensive care unit (NICU) is traumatic for both parents, but mothers and fathers may have different experiences, and thus, different needs. The purpose of this integrative review was to identify the needs of fathers of premature infants. A systematic review of 7 databases was conducted, and studies were evaluated by the Critical Appraisal Programme checklist. To provide structure for searching and reporting findings, the Whittemore and Knafle interpretive methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were used. A total of 19 articles were identified. The resulting themes included: need to be close to infant and involved in infant's care; need for information; need for a better NICU environment; need for emotional support; and need for a relationship with the NICU staff.

Persian version of the Barkin Index of Maternal Functioning (BIMF): a cross-cultural adaptation and psychometric evaluation.

BACKGROUND: Postpartum maternal functioning has the potential to affect the quality of interaction between mother and child. A proper assessment of maternal functioning requires a comprehensive and accurate tool. The objective of this study was to prepare a Persian version of the Barkin Index of Maternal Functioning (BIMF) and evaluate its psychometric properties in order to determine its applicability in Iranian mothers. METHODS: The BIMF was translated into Persian and then culturally adapted for Iranian women. After evaluating face and content validity, to perform factor analysis, a cross-sectional study was conducted using the Persian version of BIMF. The data was collected from two unique groups of 250 mothers (in all 500 mothers) who had infants 2 to 12-months old and who were selected using a two-stage cluster sampling method. Factor analysis, Pearson's correlation, intra-class correlation coefficients (ICC), composite reliability (CR) and Cronbach's alpha were employed in order to evaluate structural validity and reliability. RESULTS: Exploratory factor analysis resulted in a five-factor structure consisting of 20 items. Subsequently, confirmatory factor analysis (X 2/ df = 1.61, RMSEA = 0.050, GFI = 0.91, CFI = 0.91) confirmed that the Persian version had satisfactory goodness of fit. Reliability and internal consistency were confirmed with a CR of 0.77, an ICC of 0.87 and a Cronbach's alpha of 0.81. CONCLUSIONS: The findings indicated that the Persian version of the BIMF is a valid and reliable instrument for assessing maternal functioning among Iranian mothers.

The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis' Transitions Theory Applied.

Quality care for individuals and families during periods of transition is one of the major issues facing health care systems and providers today. The transition-home from the neonatal intensive care unit (NICU) as experienced by adolescent mothers is poorly understood-placing young mothers and their infants at risk of poor outcomes following NICU discharge. Meleis' Transitions Theory offers a unique theoretical perspective for understanding this transition experience and also serves to highlight the complexity of the NICU-to-home transition for this population of young mothers that is not currently elucidated in the literature.

The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period: A Randomized Controlled Trial.

The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.

Dignity: The Cornerstone of Nursing Care Among Hospitalized Mothers of Infants in Neonatal Intensive Care Unit.

: One of the most important areas of nursing care delivery is "dignity." Because of the increase in hospitalized infants in neonatal intensive care units in recent years, this has led to an increased focus on "family care and maternal dignity." Given the importance of understanding the phenomenon of maternal dignity in order to improve cooperation in the care of their infants and promote family-centered care, this study aims to describe the lived experience of hospitalized mothers of infants within the context of dignity. This is a descriptive phenomenological qualitative research study. Twenty mothers were invited to participate in this study using purposeful sampling. The data were generated through individual, semistructured interviews and field notes were developed during the interviews. Data were analyzed using the Colaizzi method.Findings of the study were presented in 3 themes: "privacy," "respecting individual identity," and "authority," and 7 additional subthemes. Mothers in this study needed to take care of their infants in an environment where their personal privacy is preserved, their individual identity is respected, and they have sufficient authority in obtaining medical decisions. It is essential that healthcare teams and policy makers of health organizations provide an appropriate supportive environment in terms of promoting mothers' dignity in different dimensions and subsequently improving family-centered care.