Understanding Mothers of Late Preterm Infants

1. Understanding Mothers of Late Preterm Infants Brenda Baker, PhD, RNC, CNS Jacqueline McGrath, PhD, RN, FNAP, FAAN Rita Pickler, PhD, RN, PNP-BC, FAAN Nancy Jallo, PhD, RNC, FNP-BC, WHNP-BC, CNS Stephen Cohen, MD, MHA Acknowledgment: Supported by National Institute of Health, Ruth L. Kerschstein National Research Service Award Individual Fellowship F31NRo11268-02

2. Specific Aims Examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mother of full term infants

3. Who are Late Preterm Infants? • Infants born between 34 and 36 6/7 weeks gestation • Account for: • 75% of preterm births (Dong, 2011) • 9% of all births • Have limited compensatory resources that increase the risk of: • Temperature instability • Hypoglycemia • Respiratory instability • Sepsis • Feeding difficulties

4. Long Term Effects of Late Preterm Birth • Longitudinal study 767 LPIs delays in reading and math were significant through 5th grade (Chyi, 2008) • Systematic review of 10 studies examining early childhood outcomes of LPIs through age 7 identified: • more neurodevelopmental disabilities • delayed educational ability • greater need for early-intervention • more medical disabilities • delayed physical growth (McGowan, 2011)

5. Maternal Competence Defined as maternal intelligence that influences infant development and includes elements of sensitivity, responsiveness, and synchrony. Maternal competence continually changes as the infant grows and is based on verbal and non-verbal feedback from the infant. Maternal competence is influenced by: • infant behavior • support from others and • maternal well-being (Teti, 1991, Tarkka, 2003)

6. We also know • No difference in development of maternal competence based on: • infant gender (Flagler, 1988) • pregnancy risk status (Mercer, 1994) • experienced versus first time mothers (Mercer, 1995) • marital status, married versus single (Copeland, 2004)

7. Maternal Responsiveness The mothers ability to be warm and soothing with her infant, leading to a synchronous relationship where the mother reads her infant’s cues, is responsive to the infant’s needs, sees her infant respond with positive behaviors and over time influences development of the relationship and ultimately growth and development of the infant.

8. What do we know about Maternal Responsiveness? • Influenced by: • Satisfaction with life • Self-esteem • Number of children • Support from others (Drake, 2007, Amankwaa, 2007)

9. Why Does Maternal Competence and Responsiveness Matter? • Mothers typically are the primary caregiver • Maternal competence and responsiveness is based on a mother’s perception of her infant • Form a dynamic relationship that facilitates growth and development of the infant • Trust • Attachment • Language skills

10. How does Maternal Competence Develop? • Infants respond to their mothers with verbal cues and behaviors that indicate their needs for nutrition, sleep, stimulation and safety are met • Infant cues, behaviors, weight gain and achievement of developmental milestones are positive reinforcements to a mother that she knows her infant and is meeting their needs • Leading to development of maternal competence

11. Study Design • Non-experimental cross-sectional, repeated measures design • Two data collection points • Postpartum prior to discharge from the hospital • 6 weeks postpartum

12. Study ParticipantsInclusion/Exclusion Criteria • Postpartum mothers delivering at VCUHS • 34-36 6/7 weeks gestation or 37-41 weeks gestation • First time and experienced mothers • Maternal age > 18 years • Read and speak English • Singleton birth, birth weight appropriate for age • No known congenital anomalies • No perinatal complications that interfere with postpartum transition

13. Recruitment • Number recruited & enrolled – 116 • Completed Time One Survey – 109 • Term – 77 • Late Preterm Infant – 32 • Completed Time Two Survey – 71 • Term – 52 • LPI - 19

14. Maternal Experience

15. Ethnicity of the Sample

16. Marital Status of the Sample

17. Infant Characteristics Gestation Term and LPI Complications Term and LPI

18. Maternal Competence – ANOVA Repeated Measures Demonstrated • No statistical significance • Between term or late preterm mothers • Measurement points

19. Maternal Responsiveness – ANOVA Repeated Measures Demonstrated • No statistical significance • Between term or late preterm mothers • Measurement points

20. Maternal Factors Influencing Development of Maternal Competence and Responsiveness • No statistical significance • Between term or late preterm mothers • Measurement points

21. Infant Factors Influencing Development of Maternal Competence and Responsiveness • No statistical significance • Between term or late preterm mothers • Measurement points

22. Factors Predictive of Competence & Responsiveness – Regression Analysis • Factors most predictive of maternal competence at Postpartum: • LPI -Postpartum support • Term - Satisfaction with life • Factors most predictive of maternal responsiveness at postpartum: • LPI - Infant temperament - Self-esteem - Stress • Term - Self-esteem

23. Limitations • Survey instruments - socially desirable answers versus true feelings • Reading level • Participant burden – 176 items • Sample size - attrition • Hospital environment • VCUHS late preterm population - approximately 5% of all births compared to the national average of 8% • Change in care – decreased LPI births • 6-weeks second survey time • Mothers returning to work • LPI’s adjusted age • English language only • 1/5 of the available population were non-English speaking