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

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

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)

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

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

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)

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)

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)

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

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)

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)

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

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

Bibliographic references

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carmenpower7@gmail.com

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