Background: Breastfeeding is well established as the optimal method for ensuring healthy infant nutrition. However, many adolescents remain unaware of the role of breastfeeding. Adolescent mothers continue to have the lowest rate of breastfeeding in many countries including Thailand, with only 17% of Thai adolescent mothers continuing to breastfed at 6 months postpartum. Objective: Examine factors influencing breastfeeding behaviors in adolescent mothers, particularly those in Thailand. Methods: This dissertation project involved two research studies focusing on breastfeeding influencing factors in adolescent mothers. The first study was an integrative review of 22 articles published in 2000-2012. The findings revealed that personal factors appear to be the most important to the decision to initiate and maintain breastfeeding for adolescent mothers. Perceptions of cultural expectations also influence breastfeeding decisions and behaviors. Additionally, infant factors seem to be considerations in breastfeeding duration for the adolescent mother. The second study used a prospective cohort design to explore personal, social, cultural, and infant factors that explain and predict breastfeeding initiation and maintenance at 4 weeks postpartum in Thai adolescent mothers. The sample of 96 adolescent mothers was recruited at two prenatal clinics in Thailand. There were three time points for data collection; the initial visit was completed in the prenatal period, the second visit was within 48 hours postpartum, and the third was at 4 weeks postpartum. Instruments were the Iowa Infant feeding Attitude Scale (IIFAS), Breastfeeding Influencing Factor Assessment (BIFA), Hughes Breast-Feeding Support Scale (HBSS), Pictorial Assessment of Temperament (PAT), Vulnerable Baby Scale (VBS), and Parenting Sense of Competence Scale (PSOC), all of which were translated into the Thai language. Results: Personal, social, and cultural factors were significantly correlated with breastfeeding initiation and were significant positive predictors of exclusive breastfeeding duration. Infant temperament was a significant negative predictor of exclusive breastfeeding duration. Maternal competence was also positively correlated with duration of exclusive breastfeeding. Conclusion: Facilitating the support mothers receive from their personal support systems is important to breastfeeding duration and maternal competence in the postpartum period. Enhancing exclusive breastfeeding and maternal competence provides a supportive environment for new adolescent mothers to develop their maternal role.

During the postpartum period, new mothers may experience physical changes, mental disturbances, and adaptation to the maternal role. However, relationships between these three concepts have not been explored as a whole and their influencing factors are not fully studied. Especially for Chinese mothers, social support may be viewed negatively when it comes from parents-in-law. Therefore, the purpose of this study was to understand health and its influencing factors among Chinese mothers. This study involved a cross-sectional and correlational design. The conceptual framework guiding this study integrated a health model and the theory of stress. Well established instruments were used to measure perceived global stress, personal stress and support, importance of support and support received, general physical health, health conditions, depressive symptoms, and maternal competence. The effects of stress and social support on health outcomes were tested. A total of 150 Chinese mothers who were in their first year postpartum completed the survey. Results showed that mothers did not rate their health as good and they experienced an average of 5.03 and 3.91 kinds of health conditions within and after 2 months postpartum, respectively. Mothers did not have high maternal confidence and about 23.5% of mothers had a potential of being depressed. Mothers did not experience high level of stress and did not receive much social support. Mothers living with Chinese in-laws or not did not differ in level of stress and health measures. Mothers’ general physical health, health conditions, depressive symptoms, and maternal competence were correlated with each other. Perceived global stress had effects on all health measures. Support received had effects on general physical health and depressive symptoms, while importance of support had effects on depressive symptoms and maternal competence. Social support had moderating effects on stress and depression, and on stress and general physical health. The results suggested that culturally relevant postpartum care, which includes assessments of maternal health, maternal stress, and social support, should be provided to Chinese mothers. Future studies can focus on interventional studies in promoting maternal health with mothers of ethnic minorities and model testing on the conceptual framework used in this study. / text

The experience of becoming a mother is a personal and social experience influenced by individual characteristics, friends and family, and the infant. The journey to become a mother encompasses concepts of maternal competence and responsiveness. The purpose of this study was to examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mothers of full term infants. The conceptual model for this work was based on the work of Reva Rubin describing maternal identity and role development. Maternal competence and responsiveness are components of maternal role and are influenced by social support, maternal self-esteem, well-being, stress and mood. In addition, infant temperament and perception of infant vulnerability influence development of maternal competence and responsiveness. A non-experimental repeated measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers. One group consisted of mothers of late preterm infants 34-36, 6/7 weeks gestation. The second group consisted of mothers of term infants, >/=37 weeks gestation. Both primiparas and multiparas were included in the study. Data was collected in the initial postpartum period prior to discharge from the hospital and again at six-weeks postpartum. No statistically significant differences in development of maternal competence or responsiveness between mothers of LPIs and term infants were identified. This study adds to our knowledge concerning outcomes of mothers of late preterm infants and development of competence and responsiveness.

abstract: This qualitative study investigated the postpartum experiences of mothers who used hypnosis to birth. This research project was based on a constructivist version of Grounded Theory. Qualitative inquiry and analysis were conducted on 15 semi-structured interviews; two pilot interviews were also conducted. Phone and in-person interviews were completed with Caucasian, Hispanic, and multiracial mothers who were between one month and 15 months postpartum. The following 12 major themes emerged: bonded with child, development of self-efficacy, breastfeeding success, family criticism, online support, impact on family, practice effect, amazement to misevaluation, induction overwhelm, holistic benefits, minimal post partum depression, and birth stories. Mothers of two or more children appreciated birth more, reported an increased sense of calm and closeness within their nuclear and extended family, believed that the benefits of hypnosis for birthing assisted in the areas of bonding with their newborn, self-efficacy, breastfeeding and overall postpartum success. First-time mothers appreciated the physical aspect of recovery after delivery. They emphasized the birth narrative despite cultural differences in sharing their stories. Although they attributed much success to the use of hypnosis for birthing, they tended to make more indirect attributions to the bond with their child, self-efficacy, breastfeeding, and overall postpartum success. Mothers who required a c-section, epidural, or induction during birth experienced feelings of guilt and viewed hypnosis as an isolated tool for birth and a tool to reduce guilt and stress postpartum. Mothers who birthed naturally used hypnosis postpartum in more ways. Hispanic mothers expressed greater difficulty with balancing their roles as a career woman and mother. They had different expectations around the participation of their partner during birth preparation and postpartum. Breastfeeding was most important to this group and reflected communal values. Hypnosis for birthing was described as being helpful for mothers who had a psychological history with depression, anxiety, or trauma. Participants reported overall effectiveness of hypnosis for birthing methods despite mixed reactions from birthing professionals, family, and friends. The importance of these findings for counseling psychology is discussed. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2015