Abstracts and Posters Presented at the 27^th Annual Conference of the Society for Reproductive and Infant Psychology

Nurturing the mental health of mothers of hospitalised preterm babies

Christopher R. Barnes & Elvidina N. Adamson‐Macedo

Centre for Health and Social Care Improvement, University of Wolverhampton, UK

Preterm delivery is a stressful event to parents. Nurturing the mental health of mothers of hospitalised preterms is of concern to all involved with their care. Mental health is acknowledged as a state of psychological wellness characterised by the satisfactory fulfilment of basic human needs such as sense of mastery, self‐worth and quality of attachment. Studies have recognised that the sense of touch may play a vital role in relation to the development of the preterm baby. However, there is a lack of research investigating whether sensory interventions provided by the mother to the baby can have any effect in nurturing maternal mental health. This study investigated the role of tactile interventions as mediators of maternal parenting Self‐Efficacy, Self‐Esteem, and Attachment. Within the quasi‐experimental design, a Randomised Cluster Control Trial (RCCT) was used to recruit 60 mothers and their hospitalised preterm neonates equally allocated to one of 3 groups (G 1–3): G1 touch therapy (known as TAC‐TIC), G2 toy, and G3 placebo/control (spontaneous touch). The study lasted for 10 days and mothers completed a questionnaire at the beginning and end of the study. Babies were filmed daily for 9 minutes and touched by their mother in the middle 3. The results indicated that (1) mothers in G1 reported significantly higher self‐efficacy, self‐esteem and attachment scores, and (2) their babies spent longer periods in an alert awake state and gained more weight over the 10 days than the other 2 groups. It is suggested that touching their babies has beneficial effects to both mothers and their babies.

A cross‐cultural comparison between the USA and the Netherlands among planned lesbian families

H. M. W. Bos; N. Gartrell N.; Th. G. M. Sandfort; F. Van Balen & H. Peyser H.

University of Amsterdam, Netherlands

Background. Western countries show varying degrees of acceptance of planned lesbian families, with some countries more tolerant of same‐sex parenting than others. The present study reports on a cross‐cultural comparison of homophobic experiences, disclosure to peers of having a lesbian mother, and psychological adjustment, of children in planned lesbian families in a less and a more tolerant country towards same‐sex parenting: the USA versus the Netherlands, respectively. Method. Data were analyzed from the “National Longitudinal Lesbian Family Study” (USA; 78 children, all 10 years old), and an ongoing Dutch study entitled “Parenting in Planned Lesbian Families” (74 children, mean age 10.84). The data were collected by interviewing children themselves (experienced homophobia and disclosure) and by parental report (psychological adjustment; CBCL). Results. Findings show that children in the USA sample experienced more homophobia, reported lower levels of disclosure, and more problem behaviour than children in the Dutch sample. It was also found that children with more experiences of homophobia also showed higher levels of problem behaviour. No significant associations were found between disclosure and problem behaviour. Additionally, it was found that homophobia is a significant mediator on psychological adjustment. Conclusion. The results indicate that cross‐national differences in the acceptance of homosexuality have consequence for the well‐being of children growing up in lesbian families, with acceptance leading to more openness and less experiences with homophobia.

Psychological, Social and Biological Factors Related to Maternal Antenatal Attachment

Johan C. H. van Bussel

Institute of Family and Sexuality Sciences, Department of Public Health, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium

Bernard Spitz

Department of Gynaecology and Obstetrics, University Hospital Gasthuisberg, Belgium

Koen Demyttenaere

Department of Neurosciences and Psychiatry, University Hospital Gasthuisberg, Belgium

Background: Following Bowlby's pioneering work on infant‐mother attachment, attachment from the mother's point of perspective has been explored extensively for the past decades. However, inconsistent results have been found when psychological, social and biological variables were investigated in relation to the bond between a mother and her unborn child. Methods: 268 women were assessed in the first, second and third trimester of their pregnancy with self‐rating scales measuring maternal antenatal attachment, psychological, social and biological variables. Results: Maternal antenatal attachment increased from the first over the second to the third trimester for both the global scale (F = 145.76, df = 523, p<0.0001), and its subscales ‘quality of attachment’ (F = 81.47, df = 523, p<0.0001) and ‘time in attachment mode’ (F = 104.35, df = 523, p<0.0001). For the first trimester, a significant association (R² = 0.16, F = 14.57, p = 0.0002) between quality of attachment and dyadic satisfaction and maternal age was found. Time in attachment mode was associated with concerns about the own mood, dyadic cohesion and maternal age (R² = 0.20, F = 16.03, p<0.0001). For the third antenatal trimester, a significant association between quality of attachment and dyadic consensus, fear for changes and maternal age (R² = 0.24, F = 16.89, p<0.0001) was found. Also, time in attachment mode was associated with dyadic cohesion, the extend of physical complaints and maternal age (R² = 0.24, F = 14.31, p = 0.0002). Conclusion: Temporal and relational variables were found to be consistently associated with maternal antenatal attachment. These findings underline the developmental and systemic nature of maternal attachment.

‘Balance is in the eye of the beholder’: information about disability in the prenatal testing context

Louise Bryant; Shenaz Ahmed & Jenny Hewison

Institute of Health Sciences, University of Leeds, UK

The provision of non‐directive, balanced information is considered essential to support informed prenatal testing decisions. Until recently, good quality information about the conditions for which prenatal tests are available has been lacking in educational materials given to pregnant women and their partners. This situation is beginning to be remedied as new information resources are developed, but the question of how to design and present balanced information about disabling conditions remains. This paper will bring together findings from two studies that have taken different methodological approaches to evaluating balance in information about tested‐for conditions. It will consider the difficulties of defining and designing ‘balanced information’ and look at how perceptions of bias are affected by the use of visual images in prenatal testing information.

Irregularities in item responsiveness in the Edinburgh Postnatal Depression Scale in case‐positive Chinese women

Sally Chan

Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, Peoples Republic of China

Colin R. Martin

Faculty of Health, Leeds Metropolitan University, Leeds, UK

Background: Widely translated and easily administered in both clinical and research settings, the Edinburgh Postnatal Depression Scale (EPDS) is generally accepted as a ‘gold standard’ screening tool for PND. Little research has been conducted at the individual item level of the EPDS in terms of clinically relevant distributional analysis in those women classified as case positive. The current study sought to investigate the individual item distributional characteristics of the EPDS on high scoring case positive postnatal women. Methods: 35 women were recruited from a PND clinic in a regional hospital in Hong Kong. Only data from those women both EPDS screen positive and formally diagnosed with PND by a psychiatrist was used in the current study. The distributional characteristics of all individual EPDS items were examined to determine any evidence of significant skew and kurtosis within the context of item responsiveness deficits. Results: EPDS scores ranged from 13–21 with a mean score of 18.89 (SD = 2.25). Individual item analysis revealed EPDS items 6 and 7 to be potentially problematic with very low variance. EPDS item 6 demonstrated both significant skew, 3.99 (SE = 0.40), and significant kurtosis, 14.75 (SE = 0.78). EPDS item 7 revealed significant kurtosis, 10.04 (SE = 0.78). Conclusion: Individual item response analysis of the EPDS in case positive women formally diagnosed with PND revealed that two EPDS items, 6 and 7, performed poorly. These items lack discriminability characteristics which is an undesirable finding for a screening measure. Further research in this area is required.

Transition to parenthood: the needs of parents in pregnancy and early parenthood

Toity Deave

University of the West of England, UK

Debbie Johnson

University of Bristol, UK

Rachel Fielding, Midwifery Manager

Southmead Hospital, UK

Linda Hicken, Supervisor of Midwives

Shirehampton Health Centre, UK

Introduction. Pregnancy and the transition to parenthood is a major developmental period within a family. Antenatal provision is offered to prospective parents to influence their coping skills in parenthood and improve parental and child health, behaviour and well‐being. However, previous research suggests that antenatal care is not based on parents' needs. The aim of this study was to find out how first‐time mothers and their partners think they could be better supported during the antenatal period, particularly in relation to the transition to parenthood and parenting skills. Methods. Semi‐structured interviews were carried out using a topic guide. Purposive sampling was used to recruit primiparous women from two NHS trusts. Recruitment took place antenatally at around 28 weeks gestation. Interviews were undertaken in the home between 30–36 weeks gestation and between 3–4 months postpartum. A total of 24 women and if at all possible, their partners, were recruited and interviewed: 20 supported and 4 unsupported women. Results and discussion. The qualitative analysis of the transcripts is presented and discussed in relation to the care, support and information parents may wish for, or need, that could help to improve their preparation for their transition to parenthood and becoming a parent. The implications for antenatal provision will also be discussed.

A longitudinal study of perceptions of self and others in first time pregnant couples

Sarita Dewan

Child Psychology Service, Doncaster and South Humber Healthcare NHS Trust, UK

Depression during pregnancy has been increasingly acknowledged in research and practice, with estimated prevalence rates of 13% in women and 5% in male partners of pregnant women (Evans et al., 2001). The study aimed to investigate the experiences of couples during pregnancy, where one member of the couple was experiencing distress (anxiety or depression). More specifically the study aimed to investigate how first‐time expectant mothers and fathers perceived different aspects of the self, their partners and their same sex parent. The study also aimed to investigate how these perceptions changed over time. Seven first‐time expectant couples (seven males and seven females) completed the repertory grid technique at 12 to 20 weeks gestation. It was then repeated at 30 to 34 weeks gestation by six of these couples (one woman had an emergency caesarean section and so did not complete time point two). Findings are presented on the changes in male and female perceptions of self and others between the two time points during pregnancy. Analysis of element distances showed a lack of significant change in perceptions of self and others over the course of pregnancy. However, individual participant data sets suggested change on an individual basis and descriptive results provided information regarding trends in the participants' perceptions of themselves and those important to them.

Exploring the influence of prior termination of pregnancy upon experiences of women presenting with difficulties attributed to the menopause

Kathryn Dykes

Barnsley NHS Primary Care Trust & Sheffield University, UK

Pauline Slade

Sheffield PCT & Sheffield University

Annette Haywood

Sheffield PCT

Objectives. Anecdotal clinical evidence illustrates a high level of distress in women presenting for menopausal difficulties with a history of termination of pregnancy (TOP). The study aimed to explore women's experiences of menopause, TOP occurring more than ten years ago, and whether or not women see an association between these factors. Methods. Women reported TOP occurring between 10 and 34 years (mean 24 years) previously and were aged between 35 and 63 years of age (mean 47 years). Transcripts of eight face to face interviews were analysed using Template Analysis, which allows inclusion of a priori themes. All transcripts were analysed by two individuals to promote reliability and validity of the resulting template. Results. Experiences of menopause revealed themes of Symptoms, Presumptions and expectations, Impact of menopause and Meaning made. Five themes emerged relating to TOP; Impression left, Judgement, Growth and development, Coming to terms and managing the effects and Contradiction. Consideration of menopause and TOP together revealed three themes; Changes to thinking, Menopause as a time of reflection and Linkages or separateness. The integrative theme Keeping quiet and getting on spanned the template. Conclusions. Menopause was viewed as a time of vulnerability to increased negative thoughts associated with TOP, especially if having more children had been curtailed by the menopause. Results contradict current research that views TOP as a benign procedure for the majority of women. These results indicate that TOP is continually reappraised in the context of women's lives and the study is unique in considering this, an average of 24 years post‐procedure. Clinical implications are outlined and possibilities for future research highlighted.

Decision support for women choosing mode of delivery after a previous caesarean section: a developmental study.

A. Farnworth; S. C. Robson; R. T. Thomson; D. Burges‐Watson & M. J. Murtagh

Newcastle University, UK

Background: Women who have had a caesarean birth face a decision about how to deliver their baby in a subsequent pregnancy. This qualitative study examined the experiences of women making this decision, with or without the aid of a decision support intervention. Participants: 18 women who were pregnant for the second time and who delivered their first baby by caesarean section. Seven women had received standard clinical care. Eleven women had additionally received the intervention (an informational DVD/video and a home visit from a specialist midwife). Methods: Semi structured interviews with participants in their homes at 37 weeks gestation. All women had recently attended a hospital based antenatal clinic appointment where mode of delivery had been discussed/decided. Analysis: Thematic analysis using the constant comparative method. Results: This was a complex decision making scenario and several diverse needs were identified. Four themes relating to decision support were identified in the data: informational support; emotional support; participation and involvement in decision making and using decision support. Conclusion: The results suggest that the decision support intervention examined in this study is acceptable to women and provides a useful and accessible source of support. Women who received the intervention described positive effects on several aspects of their experience of decision making, particularly in terms of emotional support and confidence to make a choice. The intervention uses resources and expertise already available within the NHS; its effectiveness should be investigated in a larger trial.

Mental health and wellbeing of men during the transition to parenthood

Catherine Francis

Department of Psychology, University of Hull, UK

The purpose of this study was to investigate mens' antenatal experiences by looking at distress and potential factors that are contributor. It aimed (1) to examine the prevalence of paternal depression in a sample of expectant fathers at two points in pregnancy, at 12 weeks gestation and 28–34 weeks gestation, (2) to identify the characteristics and predictors of paternal distress during pregnancy (3) to describe the relationship between risky behaviour and paternal distress, (4) to describe the relationship between attachment and paternal distress. One hundred and fifty three men were recruited through regional antenatal services and assessed at 12 weeks of their partner's pregnancy. Fathers and their partners were reassessed at 28–34 weeks. The results revealed there were a significant proportion of men who experienced pregnancy to be a distressing and challenging time. The prevalence of paternal distress for the sample was 45.9% for distress and 18.5% for depression. Maternal depression was identified as the strongest predictor of paternal depression during the antenatal period. A younger age, a previous psychiatric history and lower socio‐economic status were the main predictors of distress in expectant fathers. Risky behaviour was associated with distress in early pregnancy but this relationship decreased over the course of pregnancy. Lower levels of attachment to the fetus were found to be significantly related to higher distress levels at the latter stages of pregnancy. Implications of the research are presented with suggestions for future investigation.

The role of nurses and midwives in screening for and intervening with postpartum distress. A literature review.

Anna Isabela Górska; Hrafnhildur Björk Brynjarsdóttir & Marga Thome

University of Iceland, Faculty of Nursing, Reykjavík, Iceland

The aim of this comprehensive review was to compile information concerning postnatal distress and the role of nurses and midwives to screen for and intervene with postnatal distress; to scrutinize the literature and discover any gaps in knowledge that could be of international relevance. Methods: a search of the electronic databases was made using the keywords nurses, midwives, role of, screen for postpartum distress, interventions for postpartum distress and training programs. Reference items such as training programs online, pamphlets, oral references and formal presentations were also used. Results: Twenty‐four studies were identified and are summarized in tables and reviewed in detail. Conclusions: Nurses are in a key position to screen for and intervene with postpartum distress. Community nurses and midwives need to have satisfactory resources in order to successfully screen for and intervene with PPD without causing harm. Several screening tools exist for nurses and midwives to successfully and effectively screen women for PPD. Training to screen for PPD should be validated for each country in light of the level of education that nurses and midwives receive in their basic training. Effective training programs should be cost‐effective and interdisciplinary, and should focus on family care with prevention in mind. Each country needs to conduct research in order to relate culture and perinatal distress patterns. More studies are needed to show outcomes of nursing interventions. Furthermore, it is concluded that specific training is needed for nurses and midwives to screen for and intervene with postpartum distress.

The MyBB study : a pilot study to evaluate an intervention promoting mother and baby bonding in a socially deprived area

M. Gunning; M. Page; C. Mcleod & K. Napier

The Centre for Integrated Healthcare Research, Queen Margaret University, Edinburgh, UK

The experience of good quality mother‐infant communication is associated with better infant outcome across cognitive, behavioural and socio‐emotional domains. However, the nature of the mother‐infant relationship is significantly impacted upon by maternal mental health and by the experience of social deprivation. Social deprivation is also associated with dramatically lower breastfeeding rates. This presentation details the development of a pilot intervention aimed at promoting optimal mother‐infant interaction and facilitating breastfeeding in the early postnatal period. Good quality mother‐infant communication is dependent mothers ability to accurately perceive and sensitively respond to infants cues and infants capacities to communicate in turn. An intervention aimed at improving such communication should be based around a system that enhances mothers' natural tendencies to respond well to their infants and optimises infant behaviour. A recent Cochrane review of skin‐to‐skin care for healthy newborns surmised that it is beneficial for the initiation of breast feeding, for the thermo‐regulation of the newborn and for the development of mother‐infant bonding. The use of a baby sling in the early postnatal months continues this close contact and has been shown to increase the quality of maternal communication 3 months and this effect persists, increasing the rate of secure attachment at 13 months of age. A recent pilot study is outlined, based in Edinburgh where we are integrating the promotion of skin‐to‐skin care in the immediate period following birth with the continuation of close contact with the infant in the first 2 postpartum months for women and babies living in an area of social deprivation.

Family relationships and children's psychological adjustment

E. M. Hakvoort; F. van Balen; H. M. W. Bos; J. M. A. Hermanns

Department of Education, University of Amsterdam

Background. Most children grow up in families with two parents and one or more siblings. Within families several subsystems are distinguished, e.g. marital, parent‐child and sibling subsystem. In the present study we assess (1) correlations between family subsystems, and (2) associations between family subsystems and children's psychological adjustment. Method. Families were recruited via municipal registration systems, schools, and personal networks. Inclusion criteria were: Intact families with one child between 8 and 12 years old (target child) and a younger child of at least 4 years old. The data were collected by interviewing the target children (e.g., Sibling Relationship Inventory; Strengths and Difficulties Scale) and by maternal reports (e.g., Marital Satisfaction Scale). Analyses were done for the total group and for boys and girls separately. Results. (1) For the total group and for boys, all family subsystems were significantly correlated with each other. For girls, there were no associations between marital subsystem on the one hand and the mother‐child and sibling relationship on the other hand. (2) For the total group, all family subsystems were correlated with one or more aspects of psychological adjustment. Significant correlations between marital and parent‐child (father and mother) subsystems and psychological adjustment were found for boys; for girls there were only significant correlations between the father‐child relationship and psychological adjustment. Conclusion. Our findings support the idea that the three subsystems ‐ particularly the parent‐child subsystem ‐ are associated with each other, and with children's psychological adjustment. These associations are stronger for boys than for girls.

The experiences of fathers attending complicated childbirth and the resuscitation of their baby

Merryl Harvey

BLISS Neonatal Nurse Research Fellow, National Perinatal Epidemiology Unit, University of Oxford, and University of Central England, UK

Helen Pattison

School of Life and Health Sciences, Aston University, Birmingham, UK

Most fathers in the United Kingdom attend the birth of their baby and there is a growing body of evidence regarding fathers' experiences of childbirth when healthy babies are born at term. However, there is limited evidence regarding fathers' experiences of complicated childbirth particularly when the baby requires immediate resuscitation. Recent directives in the UK have identified the need to empower and engage fathers. Consequently there is drive for greater understanding of issues from the father's perspective. The aim of this study is to gain an understanding of the experiences of fathers attending complicated childbirth and the immediate care for their baby. For the first phase of the study semi‐structured interviews were undertaken with twenty first‐time fathers recruited from one neonatal unit in the United Kingdom. Fathers were asked about their experiences, support received, the impact of their experiences and suggestions about the ways in which fathers encountering similar situations might be helped in the future. Responses were analysed using qualitative methods. Themes emerging from the interviews were: communication, control of emotions, fear of the imminent death of the baby and their partner, trust in health care professionals and coping with the unexpected. Knowledge generated by this study will inform health care professional education and training and the development of policy and health education. Consequently the quality of care provision will be enhanced and the needs of fathers more fully addressed.

Issues occurring at the delivery of a baby when the father is present: an observational study

Merryl Harvey

BLISS Neonatal Nurse Research Fellow, National Perinatal Epidemiology Unit, University of Oxford, and University of Central England, UK

Helen Pattison

School of Life and Health Sciences, Aston University, Birmingham, UK

The aim of this study is to gain an understanding of the experiences of fathers attending complicated childbirth and the immediate care for their baby. For the second phase of a larger study direct observations of deliveries were made in one NHS trust in the United Kingdom. A sample of first‐time parents was recruited and informed consent was obtained from participants. Observation commenced at the start of the second stage of labour. Observation continued until either the decision had been made that the baby was healthy and could therefore remain with the parents, or in situations when a baby required resuscitation at birth and/or admission to the neonatal unit, until the father was no longer present. Term and preterm births were observed and modes of delivery included normal and instrumental vaginal deliveries and elective and emergency caesarean sections. The immediate care of the babies ranged from normal routine care to full resuscitation involving the administration of oxygen and suction. Both quantitative and qualitative data were collected regarding behaviours, activities and interventions. Outcome measures were the nature and extent of physical contact and communication between those being observed and their specific activity and behaviour. It is anticipated that the findings of this study will inform health care professional education and training and the development of policy and health education, and thereby enhancing the quality of care provided for both parents.

Memory and emotion in pregnancy – a case study

Liane Hayes

University of Chester, UK

DrEverard Thornton

University of Liverpool, UK

Memory performance during pregnancy was examined using techniques from the studies of Linton (1982) and Reason (1979). The case was a woman in the second trimester of her first pregnancy in her late twenties. During this period, two sets of data were recorded. The first focussed on memory for events, some of which were real and some imagined. Each event was rated on a Likert‐type scale for importance, emotionality and valence at the time of the event. After two months the events were recalled at random and were measured for correct recall, clarity, current importance, emotionality and valence. The second set of data recorded memory errors. All episodes where memory errors had occurred were categorized using Reason's action slip categories. Data were compared with those collected from the same woman, six to eight‐months post‐partum. Results showed a small, but non‐ significant increase in events incorrectly recalled in pregnancy. Correlations between importance, emotionality and valence at the time of the event and the time of recollection were significant in pregnancy and post‐partum. Clarity and importance were significant only in pregnancy, as was the case for clarity and emotion. Significance for clarity and valence was only found in the post‐partum. No relationship was found between status of event (real or imagined) and correct recall, nor in the clarity of the event and recall in pregnancy but the latter variables were significantly correlated during the post‐partum period. The status of the event was related to clarity of the event at both stages. Memory errors were found to be distributed in similar proportions to that predicted. However, storage failures, though greater than expected during pregnancy, were not significantly so.

The transition to motherhood: assessing women's subjective well‐being

P. J. Hoffenaar

Dept of Education, University of Amsterdam

Background: Becoming a mother is a major role transition involving cognitive, physical, and emotional changes. The study takes a multi‐method approach in examining possible mean level changes in mothers' subjective well‐being (SWB) from pre‐ to postpartum periods. Method: Twenty women (age range 24–39; M = 32) pregnant with their first child participated at approximately 4 weeks before their estimated delivery date and 4 weeks after birth. Women estimated the percentage of time generally spent in a good mood (single‐item), completed the Edinburgh Postnatal Depression Scale (EPDS), and rated their actual experiences during the preceding day with the Day Reconstruction Method (DRM). The first two measures are global retrospective reports capturing judgmental aspects of SWB, whereas the DRM is based on the (weighted) duration and intensity of experienced positive and negative affect. Results: Irrespective of which measure was used, no significant differences between prenatal and postnatal measures of SWB were found. Further analyses revealed profound discrepancies between the two global measures (single‐item and EPDS) and the DRM before birth (Spearman's r = −.31 and r = .24, n.s.) and significant and strong convergence between these measures after birth (r = −.58 and r = .86, p<.01). Conclusion: Women generally seem to cope well. Global reports of general anxiety and depression and experienced SWB converged only after birth, suggesting that in the postpartum the judgmental and affective aspects of SWB can be less clearly distinguished. The contribution of the newborn child to women's well‐being may so decisive that this ‘colors’ both global evaluations and episodic reports.

Caregivers' cultural background and childrearing behaviour

Sanne Huijbregts; Louis Tavecchio & Paul Leseman

University of Amsterdam, Netherlands

Introduction Childcare centers in Western countries are becoming increasingly culturally diverse, regarding both professional caregivers, and children and their parents. Little is known about the possible effects on caregivers or children. The aim of this study is to analyse cultural differences in caregiving behaviour. In the first part of this research‐project we found cultural differences in general collectivistic and individualistic childrearing beliefs between caregivers. However, no differences were found in caregivers' beliefs about day‐care specific items (Huijbregts, Leseman & Tavecchio, submitted). In this second part we investigated caregiving behaviour among caregivers with different cultural backgrounds. Method Fifty‐eight professional caregivers (20 Dutch, 18 Caribbean‐Dutch, 20 Mediterranean‐Dutch), working with two‐ to four‐year‐olds, participated. Interactions with the children were filmed. A construction task, a creative activity, and lunch time, were coded with the NCKO caregiver scales. Results Preliminary analyses of variance with data from 36 caregivers show no cultural differences on any of the caregiver scales among the cultural groups. Conclusion It is somewhat surprising not to find any differences in caregiving behaviour between the cultural groups. These results partly contradict our previous findings, where cultural differences in general childrearing beliefs were evident. However, the findings are in accordance with the fact that no differences in caregivers' day‐care specific beliefs were found. It seems that in this case there is no correspondence between attitudinal and behavioural entities (cf. Ajzen and Fishbein, 1977).

Predictors of postnatal depression: using an antenatal needs assessment discussion tool.

Jenny Ingram

Bristol Research & Development Support Unit, UK

Jenny Taylor

Health Visitor, Bristol Primary Care Trust, UK

Depression affects 13% of postnatal women and the long term repercussions affect women, children and families. Health visitors are being urged to increase antenatal support, including preparation for the impact of becoming a parent, and identification of vulnerable families. Methods. An antenatal tool incorporating validated measures was developed to facilitate discussion on childhood experiences, perceived physical and emotional social support and to screen for depression (using EPDS). Postnatal information was also collected. Health visitors in Bristol PCT used the tool when visiting primiparous women antenatally at home over two years. Results. 20 health visitors covering 7 GP practices in South Bristol completed 187 antenatal and 142 postnatal records. There was a significant correlation between the 118 antenatal and postnatal EPDS scores recorded. An antenatal 13+ EPDS cut off gave a positive predictive value (PPV) of 35% for a high postnatal EPDS score and the 15+ cut off gave a PPV of 67%; women with high antenatal EPDS scores were significantly more likely to have postnatal depression symptomatology. Computed ‘At risk’ scores, combining high antenatal EPDS, poor antenatal emotional support and a high proportion of negative childhood adjectives were compared with postnatal EPDS scores. This score had a PPV of 86% using the antenatal EPDS 15+ score and a very high odds ratio for the likelihood of screening high postnatally. Conclusions. The high predictive value of the ‘at risk’ tool in identifying primiparous women who are likely to develop postnatal depression indicates that it is important to start these discussions in the antenatal period.

Reflections on measurement anomalies of item 10 of the Edinburgh Postnatal Depression Scale

Wan Yim Ip

Faculty of Medicine, Chinese University of Hong Kong, ShatinHong, Kong, Peoples Republic of China

Colin R. Martin

Faculty of Health, Leeds Metropolitan University, UK

Background: The Edinburgh Postnatal Depression Scale (EPDS) is the instrument of choice for postnatal depression (PND) screening. Given that the majority of women will score zero on item 10, the validity and reliability of the item as part of a validated scale is questionable. The current study sought to determine if in a representative sample of postnatal women the distributional characteristics of this item represent any significant and enduring issues as part of the total scale. Methods: 120 women recruited to a larger study provided complete EPDS data at the six weeks postnatal period. The participants were Hong Kong Chinese and completed the Chinese version of the EPDS. The relative distributional characteristics of item 10 compared to the remaining nine items were investigated to determine any evidence of differential skew and kurtosis. Results: EPDS scores ranged from 0–24 with a mean score of 8.16 (SD = 5.11). Item 10 was observed to be highly skewed, 3.52 (SE = 0.22) and kurtotic, 11.95 (SE = 0.44) and revealed much lower variance than all the other EPDS items. Conclusion: The suggestion that item 10 is characteristically different from all other EPDS items in a representative sample is supported. The role of item 10 could be more usefully defined as an individual screening question rather than as part of a scale. However, this option would have to be based on a sound rationale that item 10 impacts negatively not only on the psychometric qualities of the measure, but also with regard to its screening accuracy.

Disengagement from clinical research during pregnancy: Is self‐esteem a factor?

Julie Jomeen

Department of Health Studies, University of Hull, UK

Colin R. Martin

Faculty of Health, Leeds Metropolitan University, UK

Background: Participant drop out can lead to weakening of the generalisability of research findings. Identification of characteristics associated with study disengagement could be of fundamental interest to the identification of those women who may be at risk of disengaging from routine clinical care during the course of their pregnancy. The current study sought to identify pertinent psychological domains that may influence disengagement. Methods: The investigation used a longitudinal design with participants (N = 148) recruited to the study during first trimester booking appointment (14 weeks) and followed up by post at 31 weeks. Baseline measures included reaction to pregnancy, anxiety (HADS‐A), depression (EPDS), self‐esteem (Culture‐Free Self‐Esteem Inventory: CFSEI‐2) and worry (Cambridge Worry Scale: CWS). The relationship of these key domains to disengagement was determined by conducting between‐subjects t‐tests on HADS‐A, EPDS, CWS, CFSEI‐2 and reaction to pregnancy scores assessed at the first observation point with the independent variable being the disengagement status of participants (responder/non‐responder) at follow‐up. Results: There were 31 (21%) non‐responders from the second observation resulting in an operational classification of disengagement from the study. A significant difference was observed between groups on CFSEI‐2, t ₍₁₄₆₎ = 2.47, p = 0.01, with disengaged participants having lower self‐esteem scores. Conclusion: The current study reveals that self‐esteem is also an important individual differences variable associated with engagement within a clinical research programme in pregnancy. A clinical implication is that women experiencing low self‐esteem during pregnancy may be at risk of disengaging from clinical services. Determining the role of self‐esteem in engagement within a clinical research programme parallels that of routine clinical care has a number of important clinical ramifications.

Does intensity and type of early postnatal support impact on self‐esteem?

Julie Jomeen

Department of Health Studies, University of Hull, UK

Colin R. Martin

Faculty of Health, Leeds Metropolitan University, UK

Background: A key psychological variable that has received little attention both in pregnancy and following the birth of a baby is the concept of self‐esteem. Self‐esteem has been negatively linked in a number of studies to depression and may be a critical resource for women in the postnatal period and during their early transition to motherhood. Models of maternity care which offer increased support might well be assumed to improve self‐esteem. Method: 148 women in a prospective cohort study were assessed to determine the impact of differing models of maternity care on self‐esteem. The study comprised of 3 self‐selecting groups to differing models of maternity care. The Culture Free Self‐Esteem Inventory (CFSEI) was administered at 12 and 32 weeks pregnant and at 14 days and 6 months postnatal, to assess the domains of social, general and personal self esteem. A mixed design ANCOVA was utilised to determine differences in self‐esteem between and within the groups. Findings: An interaction effect of time and group was demonstrated for both the social and general self‐esteem subscales at 14 days postnatal. Further post hoc analysis, revealed that the women who received Birth Centre care had significantly higher levels of social and general self‐esteem than those women who delivered under midwifery led care in the main maternity unit. Conclusion: The findings suggest that whilst options for care do not impact on self‐esteem overall, something specific to birth centre women's experiences at this early postnatal point impacted on their feelings of self‐worth. It seems possible that type or intensity of support in the early postnatal period is positively related to high self‐esteem.

Interpreting and illuminating control in childbirth through a mixed methodological approach

Julie Jomeen

Department of Health Studies, University of Hull, UK

Colin R. Martin

Faculty of Health, Leeds Metropolitan University, UK

Background: Evidence seems to suggest that women's perceptions of feeling in control during childbirth, is related to positive psychological outcomes, satisfaction and perceptions of a positive birth experience. A recent study suggests, however, that is the manner in which control is handed over to women that is more important. This paper explores the findings from a mixed methodological study assessing and interpreting women's experiences of personal control across their childbirth experiences. Method: The childbirth narratives of 10 women were analysed using a unique narrative/semiotic framework and then utilised to explore and interpret findings attained from 101 women who completed the Multi‐dimensional Health Locus of Control Scale (MHLC) in early and late pregnancy and following birth. Findings: The pattern of MHLC scores demonstrates high levels of control by ‘powerful others’ across pregnancy and into the early postnatal period. Two powerful and enduring narratives, which feature across women's maternity experience, enable an illuminating interpretation of the MHLC ‘powerful others' subscale findings. These include the role of ‘experts and expertise’, alongside women's aspirations to be ‘good mothers’. Conclusion: The quantitative findings suggest that in pregnancy and the early postnatal period, women believe that ‘powerful others’, which includes the midwife, have control over events governing their health. Initial interpretation of those findings, might have led to an essentially negative depiction of ‘personal control’ in childbirth. However, the integration of the qualitative findings provided an illuminating and unique insight, supporting the notion that this may not have the detrimental effect in psychological terms that has previously been suggested.

Fathers in the Neonatal Unit

Margaret Killen

Kings College PCT, UK

Joanna Hawthorne

Centre for Family Research, University of Cambridge, UK

Foretelling Futures, Dilemmas in Neonatal Neurology was a social science research project conducted in four neonatal units in southern England. The aim was to observe, examine and understand information sharing between medical staff and parents' experiences through interviews with both groups. Interviews took place with parents of 65 babies in the NICU, and 40 of these families on follow‐up, along with 16 parents of children aged 4‐6 years old who had been in the NICU. Interviews were open‐ended and covered the parent's experiences about information they received, how they felt and whether they wanted more or less information at the time and in retrospect. Within this sample, 16 fathers were interviewed. Fathers were found to feel deeply about their experiences and had similar feelings to the mothers. They talked about their fear of their baby and sometimes their partner dying. They acted as the mediator between the mother and the staff, but sometimes felt they could not show their real feelings to their partner or the staff. We found that fathers felt barriers to involvement with their baby through social expectations, but also through practical aspects in the NICU, such as space and chairs near the incubator. Many hidden influences served to reduce the father's involvement and perhaps fulfill the male stereotype of absence in neonatal units. Suggestions for enabling father's involvement in the neonatal unit are presented.

A Polish version of postpartum depression screening scale – a pilot study

Karolina Kossakowska‐Petrycka

Department of Psychopathology and Clinical Psychology, Institute of Psychology University of Lodz, Poland

The purpose of the study was to develop and psychometrically evaluate the Polish version of the Postpartum Depression Screening Scale (PDSS). The Postpartum Depression Screening Scale (PDSS) is a self‐reported, 35‐item Likert scale, which aims to screen for mood disorder (Beck & Gable, 2003). It assesses seven different dimensions, which are: Sleeping/Eating Disturbances; Anxiety/Insecurity; Emotional Lability; Mental Confusion; Loss of Self; Guilt/Shame; Suicidal Thoughts. The PDSS has a good psychometric properties: alfa reliability for the total PDSS is .97 and for the Short Version .87. The Polish version of Postpartum Depression Screening Scale (PDSS) was developed with the use of back translation on a prospective study group of 194 Polish women(mean age – 27,9; SD = 4,01) at 3–12 weeks postpartum. For the total Polish sample of women, the alfa reliability for the total PDSS was .97, for the Short Version of PDSS was .81, and for each of the seven dimensions it was .82, .74, .89, .89, .91, .90, .92, respectively.Construct validity was evaluated by comparison with two other depression measures – the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI). The PDSS's correlation with EPDS (r = 799; p = 0) and BDI (r = 0,779; p = 0) was significant. When the Polish version was compared to the original English PDSS, the reliability and validity psychometric were slightly lower, but within the acceptable range. In summary, the psychometric properties of the Polish version of PDSS were evaluated and the indications are that the Polish‐language version of the scale will be a useful instrument for screening symptoms of postpartum depression.

Gender associated traits and expectations of parenting in emerging adulthood

Karen L. Lawson & Sarah K. Yaremko

Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada

Parenthood is one of the major life choices facing young people as they transition to adulthood, however, there has been relatively little research examining the factors which may influence young adults' motivation to parent. The present study, informed by social role theory, examined parental role salience, expectations and intentions, and the extent to which the internalization of gender associated traits may be related to these parenting variables within emerging adults. Childless undergraduates at a western Canadian university (N=236; 119 women) completed a self-report questionnaire containing measures of parenting expectations, internalization of gender traits, subjective importance of the parenting role and intentions to parent in the future. As predicted, role salience and expectations were positively correlated with intentions. Further, for both women and men, the internalization of traits traditionally associated with nurturing and care-giving (i.e., feminine or expressive traits) was also positively correlated with these parenting variables, while the internalization of traits traditionally associated with power and career roles (i.e., masculine or instrumental traits) was not. However, gender moderated the relation between femininity and the expectations regarding the parental role among emerging adults. Although femininity was unrelated to the parenting expectations of women, men possessing more expressive traits held more positive views of parenting (more personal reward and less costs) than their less expressive male counterparts, or women regardless of their level of femininity. The implications of these findings are discussed in terms of the parental roles anticipated by young women and men.

Acceptance of infertility diagnosis, marital satisfaction and infertility‐related stress before and after In Vitro Fertilization

F. Maillard; E. Abbet & J. Darwiche

C/L Psychiatry DP‐CHUV, Lausanne, Switzerland

N. Favez N.

UR‐CEF DP‐CHUV, Prilly

M. Germond & P. Guex

CPMA, Lausanne, Switzerland

Introduction: The aim of this longitudinal study is to assess how infertile couples accept their diagnosis of infertility when they become parents after In Vitro Fertilization (IVF). The relationship between the acceptance of the infertility diagnosis, the marital satisfaction and the perceived infertility‐related stress is analyzed. Material and methods: Research sessions: 1) before IVF 2) at the 5th month of pregnancy or one year after the first research session when there was no pregnancy. Coding of infertility diagnosis's acceptance allows us to classify individuals as Resolved or Unresolved (adaptation of Marvin's Interview, 1993). Marital satisfaction was measured with the Dyadic Adjustment Scale (Spanier, 1976) and infertility‐related stress with the Fertility Problem Inventory (Newton, 1999). Results: Before IVF: marital satisfaction was higher and infertility‐related stress was lower for Resolved women compared to Unresolved women. After IVF: pregnant women were more satisfied and non pregnant women perceived less infertility‐related stress. The acceptance of the infertility diagnosis was higher after IVF for men and women of both groups. Conclusion: This study allows the identification of risk factors, such as lack of marital satisfaction and/or infertility‐related stress, which could impede the acceptance of the infertility diagnosis. Positive changes were observed between the two research sessions: IVF failure did not seem to impede non pregnant couples to better accept their infertility diagnosis. Men appear less sensitive to the changes observed as the results were more pronounced for women. The next step will be to analyse the postnatal data to follow the evolution of these variables.

Effect of psychological interventions on depressive symptoms in postnatal women ‐ a cluster randomised trial in primary care

C. Jane Morrell

University of Nottingham, UK

Pauline Slade

Clinical psych Unit University of Sheffield, UK

Stephen Walters

SHARR University of Sheffield, UK

Terry Brugha

Department of Psychiatry, University of Leicester, UK

Background: There are problems in the detection of postnatal depressive symptoms and in the short term PND has been found to be amenable to treatment, but not prevention. Psychological interventions may help recovery from PND but it is not known whether psychological interventions also benefit those at lower risk of developing PND, or what the impact might be on the women's infants. Method: A cluster‐randomised trial with 4084 women, in 100 GP practices (clusters). The aim was to estimate differences in outcomes for mother or infant for either of two distinct psychological interventions, delivered by health visitors in primary care. The intervention group health visitors were trained in the use of the Edinburgh Postnatal Depression Scale (EPDS) and in the clinical assessment of postnatal women. The control group health visitors offered usual care. Results: Among at‐risk women, 45.6% in the CG vs. 33.9% in the IG scored ⩾12 on the EPDS. Among all women, 16.4% in the CG vs. vs. 11.7% in the IG scored ⩾12 on the EPDS. Of 2241 ‘lower risk women’, 10.8% in the CG vs. 7.7% in the IG scored ⩾12 on the EPDS. There was some indication of a difference in infant outcomes among at‐risk women and among all women. Conclusion: The package of training of HVs in the systematic assessment of postnatal women and offering structured psychological interventions was effective in reducing the proportion of women experiencing depressive symptoms. There was some indication of a positive effect on infant outcomes according to the women's reports.

Correspondence and stability of measures of locus of control across the menstrual cycle

Colin R. Martin

Faculty of Health, Leeds Metropolitan University, UK

Background: Locus of Control (LOC) represents an enduring and relatively stable psychological dimension that has been applied extensively in health settings, including those pertinent to reproductive health. LOC measures should not only be stable over time but should also correlate to a relatively high degree with other measures of LOC. The current study sought to determine if the theoretical assumptions of LOC concordance and stability held in women across the menstrual cycle. Methods: 30 female participants, mean age 29.74 (sd = 6.27), with normal menstrual cycles were recruited to the study. The independent variable was cycle phase, these being the follicular (day 9), luteal (day 20) and pre‐menstrual (day 26). The dependent variables were Locus of Control of Behaviour (LCB) scale and Internal‐External Locus of control (LOC) scale scores. Results: One‐way repeated measures analysis of variance (ANOVA) revealed no significant effect of menstrual cycle phase on LOC scale scores, F(2,58) = 0.34, p = n/s or LCB scale scores, F(2,58) = 0.92, p = n/s. Examination of control orientation at the cyclical level revealed no significant correlations between LOC and LCB scale scores. At the individual scale level, correlations across the cycle were all highly significant. Conclusion: The finding that there were no significant correlations between the LOC and LCB scales at any phase of the menstrual cycle raises important questions as to the theoretical validity of LC measures. The scales appear to measure psychological phenomena which are conceptually distant and distinct. Consequently, caution is suggested when making theoretical assertions based on derivative LOC measures in reproductive health.

‘What can we say to the family we are supposed to support?’: Japanese health professionals' views and evaluation of their communication with bereaved families.

Masahiro Masuda

Faculty of Humanities and Economics, Kochi University, Japan

The present study is designed to analyse reproductive health professionals' view of their communication with families who lost their babies by miscarriage or perinatal loss. Communication between bereaved families and health professionals has been recognized as a crucial factor that may significantly affect the families' post‐loss adaptation. Therefore, health professionals in Japan have recently been paying more attention to how to improve their communicative interactions with bereaved families. Although some bereaved families recognize health professionals as their enemies whose imprudent communication hurt them, a psychological viewpoint focusing on “disenfranchised grief” (Doka, 1989, 2002) suggests that health professionals should also be regarded as members of “the party concerned,” and that their grief and their coping with loss should not be under‐acknowledged. A questionnaire survey was performed to investigate how health professionals cope with loss and how their communication skills actually worked and should be improved. Two hundred and ten health professionals including obstetricians, pediatricians, midwives and registered nurses participated in this research. The questionnaire consisted of Likert‐type measurements of respondents' attitudes towards their experiences, and also open‐ended questions directly asking to describe their experiences. Analytic induction of qualitative data illustrates what Japanese health professionals recognize as “good” and “bad” communication in their provision of perinatal care.

Hyperemesis in pregnancy study

C. McParlin & D. Carrick‐Sen

Royal Victoria Infirmary, Newcastle upon Tyne

S. C. Robson

Newcastle University

Background: Nausea and vomiting in pregnancy (NVP), is a frequently occurring, often debilitating condition. There are potential substantial implications for women's quality of life (QoL) and in terms of health care resources. The more severe form, Hyperemesis Gravidarum, (HG), affects 0.3–2% pregnant women and is associated with fluid and electrolyte disturbances, weight loss and nutritional deficiency. The aetiology of HG is unknown and management inconsistent and often unsympathetic with little psychological support or education. Hypothesis: Successful out patient management is likely to reduce patient and health care costs and may improve women's psychological and physical wellbeing. Aim: To investigate if midwifery‐led out‐patient management for NVP involving rapid rehydration plus ongoing support reduces in‐patient costs and improves women's QoL. Participants: 53 pregnant women attending hospital with severe NVP were randomly allocated to a control (n = 26), or intervention group, (n = 27). Methods: Women were approached from within the maternity assessment unit. Women allocated to the control group received conventional “standard” inpatient management. Women allocated to the intervention Group received rapid intravenous rehydration and antiemetic treatment on an outpatient basis and were discharged home with ongoing advice and support from a specialist midwife. Outcome measures: Self completion questionnaires were completed on Day 0 and 7 and length of hospital admission and pregnancy outcome were recorded. Results: Data are presented on physical symptoms, quality of life, social support, impact on daily living, use of complimentary therapy and satisfaction with care.

Mothers' experiences of interacting with their premature infants

Marina Nicholaou

University of Nottingham

Positive mother‐infant interactions are important for child development, particularly for premature infants who are at greater risk of developmental delay. Research suggests that maternal interactions with premature infants may be compromised but there has been little research into mothers' perceptions of interacting with infants following discharge from neonatal care. This qualitative study examined the experiences of mothers of interacting with their premature infants and explored their perceived support and information needs. Semi structured telephone interviews were conducted with twenty mothers which were audio taped and transcribed verbatim. Median gestational age of infants at birth was 27 weeks (23–34). Transcripts were thematically analysed and nine themes emerged from the qualitative data. Mothers reported feeling unsure and anxious about interacting with their infants in the early periods after discharge as they felt unprepared to take their infants home from the hospital. Babies were perceived as sleepy and also unresponsive. Many participants recalled that information about taking infants home had focused on physical care with little guidance about interactions and play. There was a strong feeling that such information would have been helpful. Participants had felt supported in the neonatal unit but health professionals in the community were perceived as lacking expertise in the care of premature infants and unable to deal with parental concerns. The study identified difficulties associated with the transition from neonatal unit to home. There is a clear need for informational support for parents at discharge which focuses on helping them promote their premature infants' social and cognitive development.

On boys and sex

Mark Offord & Olga van den Akker

Psychology School of Life & Health Sciences, Aston University, Birmingham, UK

Britain has the highest teenage pregnancy rate in Europe and politicians, researchers, and health and social care professionals appear to be baffled by these non–abating trends. It has been suggested that teenage pregnancy is not necessarily bad for the mother or the child, although set against this there is a significant trend in documentation that suggests future problems for both parties can have severe effects on the health and social care systems and society at large. An additional factor which has not received much attention is the fact that the biological father/partner is unlikely to be involved in raising the child. This review investigated the ways in which adolescent males have been receiving effective sex education. The sex education that was examined included all major channels of information for the adolescent of today, such as the education system, parents, peers, and the media. The main aim was to understand if more can be done to reduce adolescent pregnancy rates through emphasizing the financial and emotional costs of parenthood to adolescent males while educating them in the area of sexual behaviour. The literature searched for this review came from electronic databases and books, using a number of keywords ‐yielding over 844 results. A number of prominent themes were apparent. The most startling was the lack of knowledge about all aspects of sex and the behaviours associated with it, among adolescents, their parents, their colleagues, and unfortunately most of their teachers. Recommendation for further research includes identifying why such ignorance is rife in the UK.

Women's reasons for parenthood

Satvinder Purewal & Olga van den Akker

Aston University, Birmingham UK

Objectives: The aims of this study were to determine which factors influence women's reasons for parenthood, in order to elucidate differing needs in post modern (Assisted Reproductive Technology era) populations. The study supplements earlier qualitative work demonstrating individual differences in British populations. Method: The Reasons for Parenthood scale was completed by 252 women online. Data was analysed using SPSS. A number of sociodemographic variables characterised endorsements of different reasons for parenthood. Results: Ages ranged between16 to 68, and most were White. Women who reported a fertility problem (n = 35) were significantly more likely to rate fulfilment, wanting to please their partner and make a family as relevant reasons for parenthood compared to women who did not report or were not aware of a fertility problem (n = 185). Younger women were significantly more likely to report wanting a child that is part them and their partner, to give a child a good home, carry on the family name, want a genetically related child and to confirm their femininity as relevant reasons for parenthood and fear that a child would interfere with their career as relevant reasons against parenthood. Women who believed genetic ties between child and parent were important were significantly less likely to report other reasons for parenthood as relevant in their reproductive decision making compared to women who did not report the importance of genetic ties. Implications: This study will assist counselors in tailoring specific needs within different populations including the prospect that parenting a genetically related child may be challenged.

Development and preliminary validation of the Attitudes to Twin IVF Pregnancies Scale.

V. Rai & C. Glazebrook C.

School of Community Health Sciences, University of Nottingham, UK

Aim: To produce a short, valid and reliable measure of attitudes to twin IVF births for use with health professionals and couples undergoing IVF treatment. Method: Nineteen UNESCO delegates, 141 health professionals and 243 pre‐clinical and clinical medical students completed the Attitudes to Twin IVF Pregnancies scale (ATIPS). Participants rated 44 items on a 7 point Likert scale from strongly agree to strongly disagree. Results: The responses were analysed using item analysis to remove items with poor discriminatory power and low item‐total correlations. Two sub‐scales emerged with readability <12 years. Twelve questions formed the risk sub‐scale which assessed attitudes to the risks and benefits of a twin birth. The scale had good internal consistency (Chronbach's alpha = 0.7). Scores ranged from 17 to 69 (mean = 40.3, SD = 8.74). Two‐way ANOVA found a significant effect of group (p<0.001) but not gender. The medical students had less positive attitudes to a twin birth than the health professional group (p<0.001) and the conference delegates (p = 0.004). Eight questions formed the SET scale assessing attitudes to single embryo transfer. The scale had satisfactory internal consistency (Chronbach's alpha = 0.53). Scores ranged from 19 to 56 (mean = 34, SD = 5.3). Two‐way ANOVA found a significant effect of group (p<0.001) but not gender, with medical students having a less positive attitudes to single embryo transfer than health professionals (p<0.001) and conference delegates (p = 0.02). Conclusion: The ATIPS appears to be an acceptable and reliable tool to assess health professionals' attitudes to twin births and multiple embryo transfer.

Women's perspectives on caesarean section birth

M. Redshaw & C. Hockley

National Perinatal Epidemiology Unit, University of Oxford

Views of women who had recently undergone caesarean section birth were examined in a large scale study of women's experience of maternity care. A random sample of women aged 16 years or more were selected from birth registrations in England and sent a questionnaire three months after the birth. They were asked about pregnancy, labour, birth, postnatal care and recovery using structured formats and a small number of open‐ended questions. A response rate of 63% was achieved and of these 23% (672) had a caesarean section birth. Approximately half of the sub‐sample (54%) had a caesarean birth due to unforeseen problems in labour, most commonly for failure to progress or fetal distress. The characteristics of women who experienced CS birth are compared with those who gave birth vaginally: they were no different in terms of ethnicity, being born in the UK, or being a single parent, though they were more likely to be older mothers, to be primiparous, and to live in less deprived areas. Text responses to open ended questions about care during labour and birth, the postnatal period in hospital and anything else a woman wished to say about their care were analysed using qualitative methods. A total of 66% of women having CS responded to one or more of these questions. Predominant themes related to the need for information and explanation, the pain and discomfort experienced and how care for themselves and their babies was provided. The language used reflected feelings of helplessness, isolation and recognition of the need to recover from the surgical procedure itself.

A window on repeat termination: staff perceptions

T. Regis

Newcastle Reproductive Health Research Group, University of Newcastle, UK

Background: The total number of terminations of pregnancy (TOP) in women resident in England and Wales in 2005 was 186,400, of these 32% were to women who had had a previous TOP. Evidence suggests that repeat TOP for ‘social reasons’ is problematic for women and staff when women access the TOP service more than once. Aims: to explore the phenomenon of repeat TOP through the perceptions of staff working within a termination service within North East England. Objectives: to explore (a) feelings about repeat termination of pregnancy; (b) the circumstances surrounding women's situations that lead women to request repeated terminations; and (c) explore staff experiences when caring for women who access the termination service. Methodology: a qualitative phenomenological study. Methods: in‐depth face to face interview with 17 staff, digitally recorded, transcribed and analysed using Interpretive Phenomenological Analysis. Results: Four of several common themes were explored more deeply: normality and risk‐taking were associated with the complex issues that shaped health professionals perception of women's decision making; emotional labour was associated with health professionals emotional response when caring for women undergoing TOP; dirty work was associated with responses to staff undertaking work in the TOP service. Conclusions: Staff harbour negative feelings about women's need to request repeated terminations; some feelings can be rationalised somewhat by a deeper understanding of the social and particularly the psychological complexities that shape women's decisions. Staff experience much emotional labour which can be further burdened by the disdain of others.

Mealtime interactions in weight faltering compared to normally grown infants assessed using the Mellow Parenting Scale: a population based nested case control study

Joanne Robertson

Psychological Medicine, University of Glasgow, UK

Charlotte Wright

PEACH Unit Division of Developmental Medicine, University of Glasgow, UK

Christine Puckering

Department of Child and Family Psychiatry, University of Glasgow, UK

Background: Infant weight faltering is common in infancy and an association with between parent‐child interaction has been suggested. However, there are few reliable and valid feeding assessment measures and those available do not take into account the influence of parent‐child interaction in the feeding process. The current study is an exploratory study of the properties of a parent‐child scale (Mellow Parenting) and an evaluation of its usefulness in the assessment of feeding and eating in children with mild‐moderate weight faltering. Methodology: A simplified version of the Mellow Parenting scale was devised during a pilot study and its psychometric properties examined in a sample from the Gateshead Millennium study¹ of 30 mother‐infant dyads with weight faltering and 29 healthy controls. The analysis utilised an experimental design and was conducted blind to caseness. Inter‐rater reliability was also completed blind to infant health status. Mean domain scores were compared between cases and controls using the Mann‐Whitney test. Results: The simplified version of the Mellow Parenting scale had excellent inter‐rater reliability (0.82) and coherent inter‐relationships between coding domains. Low levels of negative behaviours were observed in both cases and controls. Healthy mother‐infant dyads displayed significantly higher levels of positive reciprocity than case mother‐infant dyads across nearly all domains. Conclusions: The coding scheme revealed consistent differences in maternal interaction with weight faltering compared to normally grown controls.

Women's worries about labour and birth: social and ethnic differences

R. Rowe; C. Hockley & M. Redshaw

National Perinatal Epidemiology Unit, University of Oxford

Women's worries and concerns about labour and birth and the relationship between their worries and socio‐demographic factors were explored using data from a national survey of women's experience of maternity care.4800 women in England were sent a postal questionnaire in June 2006, three months after they had given birth. Women were selected at random from all women giving birth during one week using birth registrations. 2960 women returned a completed questionnaire, giving a response rate of 63%. For ten different aspects of labour and birth, women were asked to indicate how worried they were before labour using a four point scale. The areas of concern can be categorised loosely as: uncertainty, pain and medical intervention. Overall, around 55–65% of women indicated that they were very worried or quite worried about pain during labour, having a long labour or needing a caesarean, forceps or ventouse delivery. Women having a second or subsequent baby were less worried than women having their first baby. Concerns of women from Black and Minority Ethnic (BME) groups were similar to the overall sample, but on each dimension their responses indicated they were more worried than White women. For example, 79% of BME women reported feeling very worried or quite worried about pain during labour compared with 64% of White women. Similar, although smaller, differences were found between women living in areas of high deprivation compared to women living in other areas. These findings have implications for health professionals' communication with women during the antenatal period.

Psychological predictors of miscarriage among young Australian women

Ingrid Rowlands & Christina Lee

University of Queensland, Australia

Introduction: In understanding the psychological sequelae of miscarriage, longitudinal research which assesses women prior to miscarriage is vital. Method: This study uses the Australian Longitudinal Study on Women's Health to examine the psychological health of women before and after miscarriage. The first analysis involved 7,790 young women who responded to Survey 2 in 2000 (aged 22–27). Women were categorised into 3 groups: No Miscarriage, Previous Miscarriage and Future Miscarriage (these women would go on to have their first miscarriage before the next survey). The second analysis used 7, 261 women who responded to Survey 3 (aged 25–31), categorised into two groups: No Miscarriage and Recent Miscarriage. Results: At Survey 2, both the Previous and Future Miscarriage groups were more likely to report feeling that life was not worth living, and to have a previous diagnosis of depression or anxiety, than women in the No Miscarriage group. At Survey 3, however, there were no psychological differences between women who went on to have a miscarriage (Recent Miscarriage group, formerly Future Miscarriage group) and the No Miscarriage group when pre‐existing differences were taken into account. Conclusion: While women who experience miscarriage may experience psychological distress, the longitudinal analysis suggests that the distress is evident before the miscarriage occurs. We suggest that some women find the entire process of preparing for pregnancy and motherhood distressing, and it is this pre‐existing emotional vulnerability, rather than the pregnancy loss, that explains elevated levels of distress in other research.

Midwives' ability to estimate women's vulnerability to postnatal emotional difficulties in the first three postnatal months

Catherine Scullion

University Of Birmingham, UK

Geraldine Scott‐Heyes

Royal Hospitals Trust, Belfast

Arie Nouwen & Ruth Howard

University of Birmingham

There is a need to improve identification of mothers at risk of postnatal emotional difficulties. This study aimed to assess if postnatal ward midwives could identify mothers on postnatal wards at risk of experiencing emotional difficulties, specifically depressive symptoms and post traumatic stress symptoms at 10–12 postnatal weeks. The study also aimed to determine if midwives' estimates of risk for mothers could add to the predictive value of the Edinburgh Postnatal Depression scale (EPDS; Cox, Holden & Sagovsky, 1987). Using a prospective longitudinal survey design, 121 mothers on postnatal wards in a maternity hospital were recruited within 72 hours after delivery when they completed standardised measures assessing depressive symptoms (EPDS), post traumatic stress symptoms (IES‐R), infant temperament (ICQ‐6) and parenting confidence (PSOC). Midwives completed a Likert style questionnaire giving their views on these variables and on whether mothers were at risk of experiencing emotional difficulties at 10–12 postnatal weeks. Mothers were followed up by post at 10–12 weeks when 92 women completed the same questionnaires again. The main results indicated that midwives' estimates of risk were significantly correlated with outcome for mothers in terms of depressive symptoms at 10–12 postnatal weeks (as measured by EPDS). In addition, midwives' estimates of risk significantly added to the variance explained by EPDS time one scores on EPDS time two scores. The results suggest that postnatal ward midwives can in the early postnatal days enhance the predictive value of the EPDS.

Promoting normality in labour, satisfaction and fulfilment with birth – a comparative study in north east England

Debbie Carrick‐Sen; Lesley Gilchrist & Andrew Loughney

Newcastle upon Tyne Hospitals, NHS Foundation Trust

Gill Smith

Northumbria University

Background: There is low level evidence to support time restrictions during second stage of labour. Aims and Objectives: A pre and post study to examine a midwife training and support programme. Methodology: All primipara women with uncomplicated labour participated in a three month pre and post study. Women completed a questionnaire ∼24 hours after birth. The midwife completed a clinical outcome form. The intervention included revised evidence based clinical guidelines and mandatory training for all midwives to promote normality and unrestricted time limits. The primary research question was maternal satisfaction. Secondary outcomes included fulfilment, sense of control, emotional experience, carer attitude and clinical outcome. Results: 1981 (824 pre and 1130 post) clinical outcome forms and 734 (349 pre and 385 post) maternal questionnaires were returned. There was no different in maternal satisfaction. The post group reported feeling; more fulfilled (p<0.05), less overwhelmed (p<0.01), less out of control (p<0.05), less powerless (p<0.05), less detached (p<0.05) and less pain (p<0.001). Carer attitude was reported as less; sensitive (p<0.001), considerate (p<0.001), supportive (p<0.05) and warm (p<0.001). More midwives in the post period were caring for more than one labouring woman (10% vs 21%; p<0.001). In terms of clinical outcome, there was no difference in assisted vaginal delivery [AVD]. However, annual background data has observed a reduction (p<0.05). Conclusion: The study reported an improvement in maternal emotional experience but a deterioration in carer attitude. There are concerns regarding the increased birth rate in Newcastle and its impact on the woman's experience of labour.

An exploratory study of treatment choices following early miscarriage and couple's psychological outcomes

C. Sheard; C. Glazebrook & R. Homer

Division of Psychiatry, Queen's Medical Centre, Nottingham University, UK

S. Cox

Institute of Work, Health and Organisations, University of Nottingham, UK

J. Moore

Early Pregnancy Assessment Unit, Nottingham City Hospital Trust, UK

Background: This study aims to explore factors influencing treatment choices following missed miscarriage and couple's psychological outcomes. Method: Twenty‐three women attending an Early Pregnancy Assessment Unit for treatment for a missed miscarriage and their partners (n = 12) were recruited to a prospective survey. Participants were offered a choice of treatment and 70% chose surgical treatment and 30% chose medical management. The General Health Questionnaire (GHQ‐12) was completed after 7 days and at 6 weeks. Women rated 12 factors which might have influenced their choice of treatment from ‘1’ – a major factor to ‘4’ – not a factor. Free comments were invited. Results: Women who chose medical treatment were significantly more likely to rate wanting to avoid staying in hospital, avoid having an operation, avoid having an anaesthetic and wanting to choose the most natural treatment as a strong factor. Women choosing surgical treatment rated desire for a less painful treatment as a strong factor. Theme analysis of the open comments revealed 7 themes including the influence of past experience and the need for closure. Women's GHQ scores did not differ between treatment choices. Men whose partners chose surgery had higher scores on the GHQ‐12 at 6 weeks follow‐up indicating more distress (Z = −2.72, p = 0.006). Nearly 42% of men scored as a GHQ case of psychological disorder, all of them being in the medical treatment group. Conclusion: The majority of women chose surgical treatment, influenced by a range of factors. Surgical management of miscarriage may be associated with more psychological distress in men.

Support and reassurance in antenatal care

V. J. Snaith & S. C. Robson

Newcastle University, UK

J. Hewison

University of Leeds, UK

Background: In concordance with the recommendations of the guidelines ‘Antenatal care: Routine care for the healthy pregnant woman’ (National Collaborating Centre For Women's and Children's Health, 2003). the number of planned antenatal visits that low risk primiparous women receive has been reduced. Concerns have been raised that this change may reduce women's satisfaction with care and result in poorer psychosocial outcomes. Aims: To evaluate the effects of two packages of care that may provide women with greater support and reassurance during pregnancy without increasing the number of face to face visits they receive. Methods: The project was a randomised controlled trial involving 840 low risk primiparous women. Participants were randomised into one of the following groups: Group 1: Control, standard antenatal care; Group 2: telephone intervention. Participants were contacted by a study midwife at 29, 33 and 37 weeks gestation to provide them with an opportunity to discuss concerns and ask questions; Group 3: telephone support + uterine artery Doppler screening group. Telephone intervention as detailed above and uterine artery Doppler screening was undertaken during the 20 week anomaly scan. This type of screening provides information on a woman's risk of developing significant pre eclampsia and/or fetal growth restriction. Outcome measures: The primary outcome measure is the number of scheduled and unscheduled antenatal visits and admissions. Secondary outcomes are anxiety, social support and major clinical outcomes.

Training health visitors and community nurses and midwives across the North Atlantic in assessment of carer‐infant interaction during the first year of life using the NCAST feeding scale.

Marga Thome

Faculty of Nursing, University of Iceland, Reykjavík, Iceland

Lisa Mincke

South Leeds NHS, Primary Care Trust, Leeds, UK

Hallriður K. Jónsdóttir & Karen Sigurjónsdóttir

Faculty of Nursing, University of Iceland, Reykjavík, Iceland

Training of primary health care professionals in assessing Infant‐Carer Interaction by the NCAST Avenue Satelite Program (Feeding and Teaching Scales) has taken place for over three decades in the USA, the UK and other Anglo‐Saxon countries. The scales have to date not been translated into other European languages except Icelandic. Trainer training is provided by the NCAST Institute of the University of Washington and a world‐wide network of trainers has been established over time. A UK trainer has been training the first group of Icelandic community nurses and midwives during the spring term 2007 in use of the feeding scale. It took place in English and 20 participants concluded it successfully and were certified for use of the scale in practice. The NCAST feeding scale has been translated into Icelandic and the back‐translation has been approved by the NCAST Institute. The Icelandic version will be used in practice and reference is made to the English manual. Initial piloting of the translated version has been carried out with a mother and her premature infant who suffers from heart disease. Results are presented in this poster. In future, the scale is intended for assessment of interaction with groups of parents and infants that are likely to present with problems postnatally, such a. prematurity, parental depression, child neglect, parental substance abuse, or other problems.

Training health professionals cross‐culturally in promoting infant‐ and parent mental health by the Solihull Approach

Marga Thome

Faculty of Nursing, University of Iceland, Reykjavík, Iceland

Hazel Douglas

Solihull NHS Primary Care Trust, UK

Tatiana Morozova & Svyatoslav Dovbnya

Early Intervention Institute, St. Petersburg, Russia

Training primary health care professionals in the promotion of infant‐and parent mental health by the Solihull Approach started in the UK in 2001 and are attracting international attention. In the spring term of 2007 the first group of Icelandic students (n = 24) concluded the training. It was carried out by British trainers in Iceland and the English version of the Resource Pack was used and students presented their course work in English. The Resource Pack has been translated from English into Russian and training in Russia planned. The transfer of theoretical concepts (containment, reciprocity, behaviour management) into practice is supported by presentation of case studies. Case‐studies are considered a fundamental method of building knowledge in practice‐oriented disciplines. Throughout training by the Solihull Approach, students are encouraged to develop their own case studies and to analyze them by help of the theoretical knowledge. Successful transfer of knowledge into practice and the generation of knowledge in practice depend on cultural context. Three case studies from the UK, Iceland and Russia are presented. This will illustrate that case‐studies in infant/parent – and family mental health can be valid in building knowledge across cultures.

Early attachment security, subsequent maternal interactive behaviour and later child executive functioning: continuity and change

Hedwig, J. A. van Bakel

Tilburg University, The Netherlands

J. Marianne Riksen‐Walraven & Sanny Smeekens

Radboud University, Nijmegen, The Netherlands

A large body of evidence documents the dominant role of early attachment security in predicting children's subsequent development. Thompson (2000), nevertheless, argues that children vary significantly in whether early attachments have an enduring impact upon them. The present study's aim is to address the question how early attachment security (at 15 months) and subsequent maternal behaviour (at age 5) combine to predict children's executive or self‐regulatory functioning at age 7. The most behaviourally regulated 7‐year‐olds would be those with a history of secure attachment (at 15 months) who subsequently experienced relatively high quality parenting (at 5 years), that the least behaviourally regulated children at age 7 would be those with histories of insecure attachment who subsequently experienced low quality parenting and that children with discontinuous or inconsistent patterns will function in between these two groups. When the children were 15 months (M = 15.1, sd = .25), 129 families with healthy infants were enrolled in the study. At age 15 months and 5 and 7 years, the children and their primary caregiver were seen again in various settings. Results show main effects of the 15‐month attachment security on parent reported behaviour regulation at age 7 and main effects of maternal interactive behaviour at age 5 on executive functioning as measured by the BADS‐C (Emslie et al., 2003). Results are discussed in terms of differential effects of early experiences on various aspects of executive functioning.

Parental attitudes and son or daughter preference

Frank van Balen

Dept of Education, University of Amsterdam, The Netherlands

Background. It is assumed child‐rearing and sex‐role stereotyping is associated with preference for a son or daughter. Authoritarian child‐rearing style is supposed to be associated with a preference for any gender, as opposed to no preference. Sharp sex‐role stereotyping is supposed to be associated with a preference for boys among men and for girls among women. Methods. An internet questionnaire was carried out, directed at parents. Questions were asked about son preference, daughter preference and no preference. Authoritarian parenting was measured by 6 questions. Stereotypical ideas about child hobbies, characteristics, possible future professions, and assisting in household tasks, were measured by existing scales. Results.The sample consisted of 125 mothers and 43 fathers. 25% had a preference for girls; 16% for boys. Among males there appeared a significant relationship between authoritarian child‐rearing and preference for a specific gender. Men with a preference for boys had more stereotypical ideas about ‘girlish’ hobbies and ‘boyish’ professions. Men with a preference for girls showed less stereotyping about ‘girlish’ household tasks. Women with a preference for girls showed more stereotyping regarding ‘girlish’ household tasks. Conclusion. The relationship between authoritarian child‐rearing style and preference with any gender of the child could be an expression of a general attitude of control and domination. The relationship between strong sex‐stereotyping and preference for a son or daughter might be explained by with a general positive attitude and assessment towards the own gender.

Infertile Turkish migrant couples and their health care seeking behaviour and decision‐making

F. B. van Rooij; F. van Balen & J. M. A. Hermanns

University of Amsterdam, The Netherlands

Introduction. This paper presents an overview of the healthcare seeking behaviour of infertile Turkish migrants in The Netherlands. Additionally, their decision‐making regarding biomedical healthcare will be discussed according to four types of decision‐making: ‘setting limits’, ‘taking control’, ‘step by step’, ‘follow the doctor’. Methods. Participants were recruited within and outside biomedical care settings. 31 infertile Turkish migrants (11 couples and nine women) participated in a structured questionnaire study as well as in a qualitative study. The structured questionnaire contained questions regarding the possibilities they saw to overcome their infertility, their help seeking, doubts about seeking care, and agreement with partner. Additionally, they were interviewed in‐depth about their infertility. Results. When participants became aware of their infertility, 81% thought that there would be a good chance to overcome their infertility by biomedical solutions or a combination with other solutions. They all visited Dutch hospitals. 40% additionally visited hospitals in Turkey. A minority also used non‐biomedical solutions. None of the participants had adopted or fostered children. A childless life was only a strategy by necessity. Respondents reported little disagreement between partners. Regarding the way couples took decisions: one couple could be classified as ‘setting limits’ type, 12 couples as ‘taking control’ type, seven couples as ‘step by step’ type. None of the couples belonged to ‘follow the doctor’ type. Conclusion. Biomedical solutions are seen as the obvious way to overcome infertility. Few doubts and disagreement about treatment occur between partners. They often decide also to seek help in Turkey. Most couples show initiative regarding treatment.