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¶ … long-term health outcomes, prevalent anxiety, trauma, depression in women experiencing preterm birth. Significantly higher stress levels have been found in mothers giving preterm birth compared to mothers giving birth at full term.

Premature birth is a serious concern as both mother and the child go through an emotional trauma post premature delivery. It almost seems like a lost battle for a mother who delivers a premature child as the infant faces various health complications post premature birth. Mothers health is affected both physically and mentally resulting in delayed recovery post pregnancy and early termination of breast-feeding. This also affects mothers' emotional and psychological concerns, inability to make decisions, and also causes social, cognitive, emotional and behavioral development disorders in infants (Arzani, Valizadeh, Zamanzadeh, & Mohammadi, 2015). Children's cognitive, emotional, social and physical development is largely dependant on Parental mental health.(Goodman et al., 2011)) Poorer cognitive and behavioral child performance always correspond to maternal postpartum or chronic depressive symptoms.(Lyons-Ruth et al., 2002; Beck, 1999).

Purpose:

The present study tries to explore long-term mental health outcomes in mothers who experience preterm birth before 33 weeks of pregnancy and identifies interactional, main effect variables and predictors.

Research Questions:

What are the interactional, main effect variables and predictors in mothers who experience preterm birth?

Variables:

The three key variables for this study are anxiety, depression and stress.

Literature Review

A study of 40 parents of babies in the NICU revealed that forty five percent of the mothers met full standard for stress while the fathers did not show any (Shaw, et al., 2006). Instructed bed rest all through pregnancy makes the mothers feel that their babies are at high risk (Maloni, Kane, Suen, & Wang, 2002). In a study of 63 women who were admitted to hospitals for dysphoria and antepartum bed rest, was related to obstetric risk.

A study by Janssen and colleagues (1996) compared 227 women whose babies died at birth and 213 who gave birth to live babies. After continued observation of 6 months, it was found that women whose babies had died showed greater somatization, depression, and anxiety than women who gave birth to live children. However, after a period of 1 year, the mental health symptoms had subsided and the women who lost babies became normal.

Hughes and colleagues (1999) contrasted women who had a previous stillbirth with a controlled group of 82. Women who had a stillbirth earlier showed more signs of depression and anxiety in their third trimesters of a subsequent pregnancy, and were even more depressed post-pregnancy. Depression during pregnancy was indicative of depression post- delivery and was strongest for women who were lately bereaved. About 8% of the control group and 19% women had been depressed after pregnancy's one year.

In a review of 17 studies, Badenhorst et al. (2006) studied the effect of child loss on fathers. It was found that fathers experienced depression, grief, anxiety, but less than the mothers and do not carry any guilt like mothers. They may also develop PTSD. The fathers may also be traumatized by stillbirth or neonatal death but should become resilient to support their partners.

A study of 12 mothers and 9 fathers who lost their babies shared their experience of ultrasound. They indicated that the current ultrasound reminded them of the traumatic death of their baby in the previous ultrasound and the ultrasound room shared mixed feelings of depression and future hope.

A German studied mothers' feelings of grief after a pregnancy was terminated for fetal anomalies (Kersting et al., 2005). This study compared the reactions of 83 women who had undergone a termination before 2 to 7 years, 60 mothers who had undergone a termination 14 days prior, and 65 women who had had full-term babies. There were no differences in traumatic stress symptoms in any of the groups that had termination.

Methods

Institutional Review Board (IRB)

This research was approved by the Office for Protection of Research Subjects at UCLA, the University of Southern California institutional review board, and by the California State Committee for the Protection of Human Subjects.

Informed Consent

All participants gave oral or written informed consent prior to completing the survey (Ghosh, Wilhelm, & Ritz, 2013).

Written informed consent was obtained from all women participating in the study (Papadopoulou, et al., 2013)

Subjects

29 mothers of a total of 35 preterm babies that had been born prior to the 33rd pregnancy week had been queried for psychological responses at Oslo University Hospital, Norway and they were assessed from June 2015 to July 2015 as:

First

T0 - within 2 weeks of premature delivery, Median 11 days (4-30 days)

Second

T1 - within a fortnight of discharge by hospital, median time after birth 2.7 months (0.2-4.7 months)

Third

T2- when the preterm baby was 6 months old, median time after birth 8.5 months (7.6-10.4 months);

Fourth

T3 - when the baby was eighteen months old; median time after birth 20.6 months (19.2-23.4 months).

Non-native speaking Mothers and mothers of babies who were very ill are excluded from this study. The study group was homogeneous with high score on education, income, and housing standard.

Mothers of sick children that the staff approximated to have low survival chances as well as mother who happen to be non-native speakers had not been included. A semi-structured interview and Medical databases were used to collect data about the pregnancy, birth, mother's background along with socio-demographic information. Most of them were pregnant for the first time and belonged to the age group of early twenties to early thirties. They were all living with the child's father congenially and had seemingly cordial relations as a couple. The, planned Caesarean section, pregnancy infection acute breech birth and Caesarean section in the pregnancies and deliveries were observed at 8.6%, 42.9%, 8.6%, and 45.7% respectively.

The mothers within this study had been a group with enhanced scores on socio-demographic variables including education, income as well as housing.

Not more than 23% of the babies needed artificial ventilation for more than a day. About 6%, 17% and 11%of the babies had surgery, patent ductus arteriosus and infections after birth, in that order. The mothers were referred psychological treatment if faced with serious mental health and both parents were provided with psychological care during their stay in the hospital

Instruments

Assessments of maternal mental health problems

The stress factor in the study is preterm birth of a child. The standardized psychometric instruments like State/Trait Anxiety Inventory, Impact of Event Scale (IES), and General Health Questionnaire (GHQ), had been utilized to calculate Maternal mental health problems. The behavioural aspects of distress were assessed by the version of the Impact of Event Scale (Horowitz, 1979; Sundin, 2003) with two subscales with fifteen items, that measured intrusive psychological distress and behavior and cognition that seemed to be avoidant.. Minor responses were denoted by a score of 0-8, moderate responses by 9-19 and severe responses were denoted by ?20. IES has proved to be one of the most important psychometric assessment method (Horowitz, 1979; Sundin, 2003)

The existence of distress, psychopathology as well as general well-being, indicating both acceptable as well-established validity and reliability is precisely calculated by General Health Questionnaire. It contains 30 items answered on a 4 point scale and the answers are treated as Likert sum scores with a scale of 0-90 and weights (0-1-2-3) and weights (0-0-1-1) in the range of 0-30 (Goldberg, 1991; Malt, 1989)

The maternal anxiety is calculated by the "Spielberger State Trait Anxiety Inventory." STAI-X1 includes a 20-question as well as a 12-question version and calculates anxiety levels showing subjective emotions including "tension," "apprehension," "nervousness" and "worry." Both the versions comprise of items rated on a four-step scale (1-2-3-4) within the score range of 20-80 for the 20-item version and 12-48 for the 12-item version. More anxiety is indicated by higher scores. There is overlap of ten items from the 20-item version. The clinically significant state anxiety had been classified as a STAI score of less than 20 for the ten-item version, which is equivalent of at least 40 for the 20-item version.

Trait anxiety is calculated via STAI-X2 which measures individual anxiety proneness levels, i.e. the tendency of the concerned individual to see the world as disturbing, and even threat., and the frequency with which such experiences occur for the individual. It measures and displays 20 items having a scoring range of 20-60 and the bench mark for clinically important trait anxiety is defined as greater than 40.

Instrument validity

The STAI-X1 and X2 are reliable self-evaluation questionnaires generally used in several studies with similar populations (Spielberger, 1970).

Statistical Methods

The value of continuous variables is displayed as standard deviations (SD) and if skewed, as range or median. The proportions and percentages are given by categorical variables. A random intercept linear mixed model measures the fixed effects of follow-up time. Pearson or Spearman correlation coefficients assessed the correlations between continuous variables. Linear regression analysis identified the possible predictors of mental health and psychological distress for… [END OF PREVIEW]

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