Journal of Pediatric Psychology Advance Access originally published online on March 3, 2005
Journal of Pediatric Psychology 2006 31(5):452-459; doi:10.1093/jpepsy/jsi080
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Maternal Confidence in China: Association with Infant Neurobehaviors but not Sociodemographic Variables
1 Department of Pediatrics, David Geffen School of Medicine at UCLA, 2 Department of Pediatrics, Sichuan Provincial People’s Hospital, and 3 Department of Obstetrics–Gynecology, Sichuan Provincial People’s Hospital
All correspondence concerning this article should be addressed to Kek Khee Loo, Developmental Studies Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza Suite 3300, Los Angeles, California 90095. E-mail: kloo{at}mednet.ucla.edu.
Received February 18, 2004; revisions received May 14, 2004 and November 3, 2004; accepted November 6, 2004
 |
Abstract |
|---|
 Top Abstract MethodsResultsConclusionsReferences |
|---|
Objective To examine the relations of sociodemographic factors and infant neurobehaviors to maternal confidence in China.Methods The Brazelton Neonatal Behavioral Assessment Scale, Family APGAR, and Maternal Confidence in Caring for the Newborn scales were administered to 40 healthy, full-term neonates. Results Range and regulation of state, autonomic stability, and reflex cluster scores were positively correlated; the autonomic stability cluster score was negatively correlated with maternal confidence in meeting the infant’s social and instrumental needs. Educational level, age, income, satisfaction with family conditions, and infant sex were not associated with maternal confidence. Range of state and autonomic stability cluster scores predicted maternal confidence. Conclusions The infant’s abilities to tolerate stimuli, and to be consoled, were associated with maternal confidence. Also, maternal confidence was related to the recognition of infant autonomic cues. Family and sociodemographic variables were not associated with maternal confidence. The sex of the newborn did not affect maternal confidence.
Key words: behavior; Brazelton NBAS; culture; infants; mothers; parenting.
The purpose of the study was to examine the relations of sociodemographic factors and infant neurobehaviors to maternal confidence in healthy, full-term Chinese neonates.
It was three decades ago that Seashore, Leifer, Barnett, and Leiderman (1973)
highlighted the negative impact of prolonged infant–mother separation on maternal confidence in providing for the infant’s social (calming and responding to the infant) and instrumental (feeding and bathing) needs. Further studies have revealed the role of maternal confidence in predicting sensitive mothering behaviors (Walker, Crain, & Thompson, 1986) and healthy adaptation to motherhood (Williams et al., 1987). Sensitive parenting behaviors and contingent parent–child interactions, in turn, predict later child development outcomes (Barnard, Bee, & Hammond, 1984; Beckwith, Cohen, & Hamilton, 1999).
In studies based on Western samples, the most consistent predictors of maternal confidence are sociodemographic variables, such as maternal education, age, and number of people in the household (Gross, Rocissano, & Roncoli, 1989; Ruchala & James, 1997; Walker et al., 1986). Family and social support are important correlates and predictors of maternal caregiving confidence (Pridham, Lin, & Brown, 2001; Sepa, Frodi, & Ludvigsson, 2004). In the Howard University Normative Study, lower–socioeconomic status (SES) and younger African American mothers were more likely than middle-SES and older mothers, respectively, to report others (e.g., pediatrician, nurse, baby’s grandmother) as being better at performing social (calming and responding to the infant) caregiving roles at 2 days, but not at 1 month (Rosser & Randolph, 1989). Froman and Owen’s (1990) study on mothers’ and nurses’ perceptions of infant care skills indicated that maternal age, number of children, and nurses’ ratings of mothers’ skills were the strongest predictors of self-efficacy for infant care. Parity and associated caregiving experience are related to maternal confidence (Mercer & Ferketich, 1995). However, although it has been shown that multiparous women may view themselves as being more competent in caregiving than primiparous women (Walker et al., 1986), constraints in resources to take care of several children may lower maternal self-efficacy and satisfaction in caregiving (Affonso, Mayberry, & Sheptak, 1988; Walz & Rich, 1983).
Infant variables have been found to influence maternal confidence as well. Difficult infant temperament decreased perceived self-efficacy in the parenting role (Cutrona & Troutman, 1986). Also, infant gender plays a role in parental self-efficacy and parenting satisfaction. In Hudson, Elek, and Fleck’s (2001) study of first-time mothers’ and fathers’ transition to parenthood, fathers’ infant care self-efficacy was significantly related to parenting satisfaction at 12 and 16 weeks. In particular, fathers of male infants expressed higher parenting satisfaction than fathers of female infants. Gender differences in the neurobehavioral characteristics of healthy newborns may be detected using the Brazelton Neonatal Behavioral Assessment Scale (NBAS) (Lundqvist & Sabel, 2000). It is unknown whether the potential differences in neurobehavioral characteristics between male and female neonates are associated with parental confidence or parenting satisfaction.
In preterm or low–birth-weight infants, infant health variables, such as severity of intraventricular bleed and evidence of respiratory distress syndrome, were significant predictors of maternal confidence (Gross et al., 1989; Zahr, 1991). In Latina mothers with low–birth-weight infants, the strongest predictors of maternal confidence was parity, followed by infant health, which together accounted for 25% of the variance in confidence (Zahr, 1993). The associations between maternal confidence and sociodemographic variables (maternal age, education, and caregiving experience) persisted in toddlerhood (12–36 months of age) in a full-term group, although the health conditions of the child (presence of cerebral palsy and respiratory distress) were overriding factors in determining maternal confidence in the preterm group (Gross et al., 1989).
As far as the authors are aware, maternal confidence and use of the Brazelton NBAS in China have not been reported in the literature. Within the context of an urban Chinese population, the authors sought to examine the social, family, and infant characteristics that influence maternal confidence.
The following questions were posed:
- What are the family and sociodemographic predictors of maternal confidence in an urban sample of Chinese mothers?
- Which are the neurobehavioral characteristics of the infant that predict maternal confidence in this sample?
- Is the gender of the infant associated with maternal confidence of Chinese mothers?
|
Methods |
|---|
|
TopAbstractMethodsResultsConclusionsReferences |
|---|
Participants
Forty mothers with healthy, full-term infants were recruited from the maternity ward of Sichuan Provincial People’s Hospital. This is a large urban hospital in Chengdu with 1,300 beds. Its annual outpatient and inpatient volumes are 900,000 and 35,000, respectively. Breastfeeding was highly encouraged and successful in this hospital, which is designated as a baby-friendly hospital. One hundred percent of the mothers in this sample were breastfeeding their newborn. Inclusion criteria were (1) full-term infants requiring only routine postnatal care (sleeping in a bassinet beside the mother’s bed, breastfeeding well, and not receiving any medications, treatments, or undergoing procedures), (2) singleton birth, (3) residence in Chengdu, and (4) consent of parents to participate in the research. Eighty-seven percent of eligible mothers gave their consent to participate. This collaborative research was approved by the UCLA Human Subjects Protection Committee.
The demographic and background variables for parents and infant are summarized in Table I. Even though most mothers were primipara because of the one-child-per-family rule, most lived in households with relatives who might have children. Thus, the mean number of children in the household was close to 3. Most of the mothers worked outside the home. All mothers were married and living with the husband.
|
Most mothers (35/40 or 87.5%) had undergone caesarean section with continuous epidural anesthesia. There were seven cases (17.5%) of repeat caesarean section and four cases (10%) of cephalopelvic disproportion. The remaining 29 mothers (72.5%) underwent elective caesarean section. These were essentially healthy mothers (no diabetes, preeclampsia, or eclampsia) who would otherwise have undergone vaginal deliveries in many other countries. The caesarean section rate in China is on the rise, and the most common indications for elective caesarean section in the rural areas were sociocultural, nonmedical reasons, such as feeling less pain, or the belief that it would be protective for the brain (Lei, Wen, & Walker, 2003; Wu, 2000). Other reasons may be related to insurance coverage (Cai et al., 1998), parental and/or professional perception of caesarean section as a benign "high-tech" procedure, and the willingness of parents to commit to a one-time procedure because of the one-child policy. The infants were born healthy, with mean Apgar scores (SD) of 9.9 (0.56) and 10 (0.16) at 1 and 5 min, respectively.
Procedure
Consecutive mothers were recruited by the head nurse of the maternity ward, between the second and fifth day after delivery. The purpose of the study, and the procedures, including the conduct of the NBAS examination, were explained to them. They were told that the arousal of the infant from sleep, crying, and stimulation from light, sound, and mild pinpricks could be expected as part of the examination. Six mothers chose not to participate because they perceived that the risks of waking up the infant, and having the infant cry, outweighed the potential benefits (theoretical knowledge gains) from the research. Information on the six mothers were thus not collected. For mothers who agreed to participate, the head nurse collected data on parents and infant, including sociodemographic variables, and requested mothers to complete the Maternal Confidence in Caring for the Newborn instrument and the Family APGAR scale. Upon the completion of the questionnaires, the mothers were administered the NBAS by one of two certified examiners (authors K.K.L. and H.Z.), who were blinded to the maternal confidence and sociodemographic data. The NBAS was administered between late morning and early afternoon, midway between feeds, when the infants were asleep. If the examiners missed the window of opportunity to begin the examination with the infant in the sleep state, the examination was postponed to the following day. The mothers were usually resting in bed while observing the examination. The neurobehavioral characteristics of the infant were discussed with the mother at the end of the examination.
Measures
Maternal Confidence in Caring for the Newborn
This is a rating scale to assess the overall parenting confidence, parental confidence in recognizing the infant’s behaviors, calming the baby when the baby is crying, soothing the baby to sleep, showing affection to the baby, and attending to the baby’s feeding needs. Items are based on the social and instrumental tasks on Seashore’s Maternal Self-Confidence Scale (Seashore et al., 1973) and adapted for use with newborns, with the deletion of the "bathing" and "diapering" items and insertion of "sleeping" and "overall confidence in care" items. A team of three developmental pediatricians and two pediatric nurse practitioners with clinical and research experience reviewed the items for applicability to newborns. They consulted a group of one pediatrician, one obstetrician–gynecologist, and three nurses in China, on the applicability of the instrument to the Chinese sample. It was considered that many mothers may not have first-hand experience in giving the newborn a bath in the first few days of life. "Putting the baby to sleep" was felt to be more relevant than "diapering" as an instrumental task. The notion of "overall confidence in care" was considered to be relevant and useful. Seashore’s scale required mothers to compare themselves in relation to others (father, baby’s grandmother, pediatrician, nurse, and experienced mother), in their ability to take care of the instrumental and social needs of the infant. The authors chose a more direct format of asking questions, beginning with "How confident are you..." for ease and feasibility of use in other cultures. Each of the six items is based on a Likert scale of 1–5. Items on the scale correlated with subscale scores on mother–child interaction-based Nursing Child Assessment Teaching Scale (Barnard, 1994) in a full-term American sample at 1 month (Zurabyan, Loo, Lim, Azarraga, & Howard, 2004). Cronbach alpha’s for Chinese and American full-term and American preterm samples were .83, .85, and .86, respectively.
Family APGAR Scale
The Family APGAR was designed to be a utilitarian instrument to measure a subject’s satisfaction with five components of family function. It is a self-appraisal questionnaire consisting of five questions on a five-point Likert-like scale. The five components are the abilities to (1) turn to family for help, (2) talk over and share problems, (3) receive support for new activities or directions, (4) receive affection and emotional support, and (5) share time together. It has been used on college students, medical center outpatients, psychiatry clinic outpatients, and, cross-culturally, in a Taiwanese sample (Chau, Hsiao, Huang, & Liu, 1991; Mengel, 1988; Smilkstein, Ashworth, & Montano, 1982). Cronbach’s alpha was .86, with a test–retest reliability of .83. Construct validity (r = 0.80) was established with the Pless–Satterwhite Family Function Index (DelVecchio Good, Smilkstein, Good, Shaffer, & Arons, 1979; Pless & Satterwhite, 1973).
Brazelton NBAS
The NBAS is a highly versatile instrument in which the examiners are called upon to elicit the optimal performance of the neonates, on the basis of their behavioral cues, thresholds for response, tolerance of stimuli, and regulatory capacities. The instrument consists of 28 behavioral, 18 reflex, and 6 supplementary items. The behavioral and supplementary items are scored on nine-point scales, whereas the reflex items are scored on four-point scales. The developers of the NBAS preferred not to give a total score for the infant’s performance, in consideration of the possibility that such a score may be misinterpreted or misused. On individual items, a higher score may not necessarily imply optimal function. Reliability of the instrument is difficult to determine because of the construct of the instrument. Test–retest reliability is low to moderate. Because the newborn period is one of rapid change in all systems, a high degree of test–retest correlation may in fact not be desirable (Brazelton & Nugent, 1995). Factor analysis is generally used to establish validity in grouping the NBAS items. The most commonly used factor analysis scheme reduces the NBAS scores to seven clusters: (1) habituation (response decrement to light, bell, and tactile stimulation), (2) orientation (animate and inanimate visual and auditory items and alertness), (3) motor performance (includes tonus, motor maturity, pull to sit, defensive items, and level of activity), (4) range of state (includes peak of excitement, rapidity of build-up, irritability, and lability of states), (5) state regulation (includes cuddliness, consolability, self-quieting activities, and hand-to-mouth self-consoling), (6) autonomic stability (includes tremors, startles, and changes in skin color), and (7) reflexes (such as Moro, Babinski’s, plantar and palmar grasps, ankle clonus, and stepping) (Lester, Als, & Brazelton, 1982). Instructions for recoding and calculation of cluster scores can be found in the reference, Lester Als, & Brazelton (1982). Higher NBAS cluster scores indicated a better behavioral response, except in the reflex cluster, where higher scores indicated more abnormal responses. The two examiners achieved inter-rater reliability above 95% before and during the study.
Data Analysis
Descriptive statistics, Spearman correlations, and regression analysis were used. p-values less than .05 (two-tailed tests) were regarded as statistically significant. All statistical analyses were performed using SPSS (Chicago, IL) for Windows (version 11.0) software.
|
Results |
|---|
|
TopAbstractMethodsResultsConclusionsReferences |
|---|
Most mothers reported being highly confident in attending to the social and instrumental needs of the infant. Mean confidence (SD) in recognizing the behaviors of the infant, calming, showing affection, feeding, putting the infant to sleep, and overall caring for the infant were 4.08 (0.75), 3.54 (0.82), 3.85 (0.84), 3.63 (0.88), 3.33 (0.74), and 3.95 (0.91), respectively. There were no statistically significant correlations between maternal confidence and age, educational level, husband’s age and education, income, gestational age, number of previous pregnancies, parity, number of children in the household, employment, infant’s weight, and infant’s sex. Family APGAR scores were not associated with maternal confidence.
The mean cluster scores (SD) for the NBAS are as follows: 6.37 (2.18), habituation; 6.25 (1.66), orientation; 5.62 (0.83), motor; 4.00 (0.57), range of state; 5.14 (1.66), regulation of state; 6.50 (1.05), autonomic stability; and 0.45 (0.64), reflexes. Range of state cluster scores (irritability and excitability to stimuli items) were positively correlated with maternal confidence in calming (r = 0.34, p = .04), recognizing the behaviors (r = 0.38, p = .02), showing affection (r = 0.42, p = .01), as well as putting the infant to sleep (r = 0.34, p = .32). Regulation of state cluster score was correlated with maternal confidence in showing affection to the infant (r = 0.32, p = .05). Autonomic stability cluster score was negatively correlated with maternal confidence in recognizing the infant’s behaviors (r = –0.33, p = .05). Abnormal reflexes cluster score was negatively correlated with maternal confidence in putting the infant to sleep (r = –0.39, p = .02). Habituation, orientation, and motor system cluster scores were not related to maternal confidence scores (Table II).
|
Gender differences in NBAS profiles were analyzed by applying the Wilcoxon–Mann–Whitney test. There were no statistically significant differences in the behavioral items and cluster scores between boys and girls, although girls had more hand-to-mouth movements, with a median (interquartile range) of 4.5 (3.0–6.0) compared to boys’ 3.0 (1.0–6.0), approaching statistical significance (p = .055). This may be a spurious finding in our sample, but female fetuses have been seen to have more mouth movements on ultrasound scans at 16, 18, and 20 weeks’ gestation (Hepper, Shannon, & Dornan, 1997).
A step-wise regression analysis tested the relative contribution of range of state, autonomic stability scores maternal education, and family income to variance in mean maternal confidence score. Initial exploratory modeling had indicated that the regulation of state and other cluster scores, except for the range of state and autonomic stability scores, were statistically redundant in the regression analysis. Maternal education and family income were selected based on theoretical relevance to maternal confidence. The autonomic stability and range of state cluster scores were the only predictors of maternal confidence. The autonomic stability cluster score accounted for 18% of the variance (R2 = 0.18, ß = –.42, p = .01) and the range of state cluster score accounted for an additional 10% (R2 = .10, ß = .32, p = .04).
|
Conclusions |
|---|
|
TopAbstractMethodsResultsConclusionsReferences |
|---|
The salience of sociodemographic variables versus the infant’s behavioral cues to maternal confidence has not been studied in the mainland Chinese population. Data on the use of the Brazelton NBAS in China have also not been reported. This study revealed that maternal confidence in this urban Chinese sample was more closely related to the neurobehaviors of the infant, than sociodemographic variables.
There is no lack of range in the sociodemographic variables in this sample. For example, the educational level of mothers varied from primary school to postgraduate education, the age ranged from 21 to 39 years, and the income levels were distributed in the range of <4,800 to >180,000 Rmb per annum. Despite the variation in demographics, the Chinese mothers’ mindset in perceived abilities to meet the social and instrumental needs of the infant appears to be largely based on cues from the infant’s behaviors and responses. A lower level of perturbability of the infants was associated with higher confidence of mothers in calming, showing affection, putting the baby to sleep, and interpreting the baby’s behaviors. Because mothers usually transferred the infants to the bassinet while the infants were in drowsy or sleep states after breastfeeds, it was not uncommon to evoke reflex responses during these movements. Also, the babies were loosely covered, and the blankets were prone to unravel with these changes of position. Thus, asymmetric reflexes, if present, were more likely to be seen during these events associated with sleep. This may possibly account for the association between the reflex cluster score and maternal confidence in putting the baby to sleep. Mothers who observed changes in the infant’s skin coloration, startles, and tremulousness (autonomic stability cluster) appeared to feel more confident in recognizing the infant’s behaviors. That is, seeing is believing, and noticing these changes may relate to the mothers’ perceptions of being able to recognize the infant’s behaviors, even if these changes were indicative of autonomic instability.
In a society that traditionally favors boys, the sex of the newborn was not associated with maternal confidence. Although this preference is expected to be more tangible in rural areas where boys and men help in farming, the economic success of women in migrating to urban areas for nonagricultural and higher-paying jobs and the one-child policy may have started to shift outlooks on gender equality (Doherty, Norton, & Veney, 2001; Robey, 1985). An epidemiologic study in economically disadvantaged, rural minority areas of Yunnan Province, China, indicated that maternal child-rearing behaviors (such as maternal disciplining and playing behaviors, attitudes toward breastfeeding, swaddling, and child health practices) were not associated with children’s gender (Li et al., 2000). Gender preference is a notion that may change with pregnancy and birth (Marleau & Saucier, 2002; Marleau, Saucier, Borgeat, Bernazzani, & David, 1997). This study did not replicate the findings on gender-based differences in NBAS profiles (Lundqvist & Sabel, 2000), which might be expected, because the background variables, such as the ethnic composition and rate of caesarean section, were substantially different. The small sample size in this study could have limited finding a possible association between gender of the newborn and maternal confidence.
In the clinical context, maternal confidence of Chinese mothers can potentially be very malleable to teaching interventions, because recognition of the infant’s capacities can be more easily achieved than uplifting the sociodemographic factors. Demonstration of the Brazelton NBAS has proved to be beneficial as a teaching intervention (Das Eiden & Reifman, 1996), and this may be an effective teaching tool for Chinese mothers. Because the range of state and autonomic regulation clusters affect maternal confidence significantly, swaddling may be useful for conferring a sense of maternal confidence in this population.
A limitation of this study is the small sample size. However, the correlations between sociodemographic variables and maternal confidence have been found on similar-sized samples (Seashore et al., 1973; Zahr, 1993). The sample size was sufficient to allow the detection of the neurobehavioral assessment scores that were predictive of maternal confidence. Thus, the relative strength of association between neurobehavioral scores and maternal confidence, as opposed to sociodemographic variables, remained a salient finding. The lack of statistically significant associations between family and social demographic variables with maternal confidence in this sample, however, does not imply that these findings may not be found in a larger sample.
The fact that all mothers were married and living with their husbands is also a limiting factor. The lack of a comparison group excluded the possibility of examining differences in maternal confidence between this sample and other groups, for example, Western, other Asian, or Chinese rural samples. Such comparison studies point to avenues for future research in the area of maternal confidence. It is also possible that self-esteem, stressful life events, mental health, social support, and other factors not measured in this study may be related to maternal confidence. Longitudinal follow-up of the changes in maternal confidence, and the factors influencing confidence over time, may be examined in future research. Overall, this study calls for a more comprehensive study of Chinese infants, which should examine the cultural contextual variables, such as parental gender preference and social stresses, in more detail.
In summary, family and sociodemographic variables were not related to maternal confidence in this urban Chinese sample. Instead, the neurobehavioral characteristics of the newborns were found to be predictive of maternal confidence. In a culture that has a traditional preference for boys, the gender of the newborn did not affect maternal confidence.
|
References |
|---|
|
TopAbstractMethodsResultsConclusionsReferences |
|---|
Affonso, D. D., Mayberry, L. J., & Sheptak, S. (1988). Multiparity and stressful events. Journal of Perinatology, 8(4), 312–317.
Barnard, K. (1994). NCAST caregiver/parent–child interaction teaching manual. Seattle, WA: NCAST Publications, University of Washington, School of Nursing.
Barnard, K. E., Bee, H. L., & Hammond, M. (1984). Developmental changes in maternal interactions with term and preterm infants. Infant Behavior and Development, 7(1), 101–113.[CrossRef]
Beckwith, L., Cohen, S. E., & Hamilton, C. E. (1999). Maternal sensitivity during infancy and subsequent life events relate to attachment representation at early adulthood. Developmental Psychology, 35(3), 693–700.
Brazelton, T. B., & Nugent, J. K. (1995). Neonatal Behavioral Assessment Scale. Cambridge: MacKeith Press.
Cai, W. W., Marks, J. S., Chen, C. H., Zhuang, Y. X., Morris, L., & Harris, J. R. (1998). Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China. American Journal of Public Health, 88(5),777–780.
Chau, T. T., Hsiao, T. M., Huang, C. T., & Liu, H. W. (1991). A preliminary study of Family Apgar Index in the Chinese. Gaoxiong Yi Xue Ke Xue Za Zhi, 7(1),27–31.
Cutrona, C. E., & Troutman, B. R. (1986). Social support, infant temperament, and parenting self-efficacy: A mediational model of postpartum depression. Child Development, 57(6),1507–1518.
Das Eiden, R., & Reifman, A. (1996). Effects of Brazelton demonstrations on later parenting: A meta-analysis. Journal of Pediatric Psychology, 21(6), 857–868.
De, I., Vecchio Good, M., Smilkstein, G., Good, B. J., Shaffer, T., & Arons, T. (1979). The Family APGAR Index: A study of construct validity. Journal of Family Practice, 8(3), 577–582.
Doherty, J. P., Norton, E. C., & Veney, J. E. (2001). China’s one-child policy: The economic choices and consequences faced by pregnant women. Social Science & Medicine, 52(5), 745–761.
Froman, R. D., & Owen, S. V. (1990). Mothers’ and nurses’ perceptions of infant care skills. Research in Nursing & Health, 13(4), 247–253.
Gross, D., Rocissano, L., & Roncoli, M. (1989). Maternal confidence during toddlerhood: Comparing preterm and fullterm groups. Research in Nursing & Health, 12(1), 1–9.
Hepper, P. G., Shannon, E. A., & Dornan, J. C. (1997). Sex differences in fetal mouth movements. Lancet, 350(9094), 1820.
Hudson, D. B., Elek, S. M., & Fleck, C. M. (2001). First-time mothers’ and fathers’ transition to parenthood: Infant care self-efficacy, parenting satisfaction, and infant sex. Issues in Comprehensive Pediatric Nursing, 24(1), 31–43.
Lei, H., Wen, S. W., & Walker, M. (2003). Determinants of caesarean delivery among women hospitalized for childbirth in a remote population in China. Journal of Obstetrics and Gynaecology in Canada, 25(11), 937–943.
Lester, B. M., Als, H., & Brazelton, T. B. (1982). Regional obstetric anesthesia and newborn behavior: A reanalysis towards synergistic effects. Child Development, 53, 687–692.[CrossRef][ISI][Medline]
Li, Y., Liu, J., Liu, F., Guo, G., Anme, T., & Ushijima, H. (2000). Maternal child-rearing behaviors and correlates in rural minority areas of Yunnan, China. Journal of Developmental and Behavioral Pediatrics, 21(2), 114–122.
Lundqvist, C., & Sabel, K. G. (2000). Brief report: The Brazelton Neonatal Behavioral Assessment Scale detects differences among newborn infants of optimal health. Journal of Pediatric Psychology, 25(8), 577–582.
Marleau, J. D., & Saucier, J. F. (2002). Preference for a first-born boy in Western societies. Journal of Biosocial Science, 34(1), 13–27.
Marleau, J. D., Saucier, J. F., Borgeat, F., Bernazzani, O., & David, H. (1997). Mental representations concerning the sex of the baby of pregnant nulliparous women who wished a boy or a girl. Psychological Reports, 80(1), 273–274.
Mengel, M. B. (1988). The Family APGAR in a research setting. Family Medicine, 20(2), 96, 98,144.
Mercer, R. T., & Ferketich, S. L. (1995). Experienced and inexperienced mothers’ maternal competence during infancy. Research in Nursing & Health, 18(4), 333–343.
Pless, I. B., & Satterwhite, B. (1973). A measure of family functioning and its application. Social Science & Medicine, 7(8), 613–620.
Pridham, K., Lin, C. Y., & Brown, R. (2001). Mothers’ evaluation of their caregiving for premature and full-term infants through the first year: Contributing factors. Research in Nursing & Health, 24(3), 157–169.
Robey, B. (1985). Sons and daughters in China. Asian Pacific Census Forum, 12(2), 1–5.
Rosser, R. L., & Randolph, S. M. (1989). Black American infants: The Howard University Normative Study. In T. B. Brazelton (Ed.), The cultural context of infancy (Vol. 1, pp. 133–165). Norwood, NJ: Ablex Publishing Corporation.
Ruchala, P. L., & James, D. C. (1997). Social support, knowledge of infant development, and maternal confidence among adolescent and adult mothers. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 26(6), 685–689.
Seashore, M. J., Leifer, A. D., Barnett, C. R., & Leiderman, P. H. (1973). The effects of denial of early mother–infant interaction on maternal self-confidence. Journal of Personality and Social Psychology, 26(3), 369–378.
Sepa, A., Frodi, A., & Ludvigsson, J. (2004). Psychosocial correlates of parenting stress, lack of support and lack of confidence/security. Scandinavian Journal of Psychology, 45(2), 169–179.[CrossRef]
Smilkstein, G., Ashworth, C., & Montano, D. (1982). Validity and reliability of the family APGAR as a test of family function. Journal of Family Practice, 15(2), 303–311.
Walker, L. O., Crain, H., & Thompson, E. (1986). Mothering behavior and maternal role attainment during the postpartum period. Nursing Research, 35(6), 352–355.
Walz, B. L., & Rich, O. J. (1983). Maternal tasks of taking-on a second child in the postpartum period. Maternal Child Nursing Journal, 12(3), 185–216.
Williams, T., Joy, L., Travis, L., Gotowiec, A., Blum-Steele, M., Aiken, L., et al. (1987). Transition to motherhood: A longitudinal study. Infant Mental Health Journal, 8(3), 251–265.
Wu, W. L. (2000). Cesarean delivery in Shantou, China: A retrospective analysis of 1922 women. Birth, 27(2), 86–90.
Zahr, L. K. (1991). The relationship between maternal confidence and mother–infant behaviors in premature infants. Research in Nursing & Health, 14(4), 279–286.
Zahr, L. K. (1993). The confidence of Latina mothers in the care of their low birth weight infants. Research in Nursing & Health, 16(5), 335–342.
Zurabyan, A., Loo, K., Lim, A., Azarraga, M., & Howard, J. (May 2004). Maternal self-confidence, knowledge of infant development, and infant responsiveness to the mother in early infancy. Poster session presented at the Pediatric Academic Societies Meeting, San Francisco, CA.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||