Abstract

• One of the important tasks for new parents, especially mothers, is to establish warm, mutually affirming interpersonal relationships with the new baby in the family, with the purpose of promoting the healthy development of the child and the wellbeing of the whole family. Nurses assess the quality of the behavioral characteristics of the maternal-infant interaction. This study examined the relationships between primiparas perceptions of their delivery experience and their maternal infant interaction. It compared to delivery experience of mothers having a normal vaginal delivery with those having a cesarean section. The purpose was to explore the relationships between the mother's perceptions of her delivery experience with her maternal infant interaction. The aim was to contribute to the development of theoretical understanding in which to vase care toward promoting the quality of maternal-infant interaction. Data were collected directly by the investigator and a trained associate from Dec. 1, 1987 to March 8, 1988. Subjects were a random sample of 62 mothers, 32 who had a normal vaginal delivery and 30 who had a non-elective cesarean section(but without other perinatal complications) at three general hospitals in Seoul. Instruments used were the Stainton Parent-infant Interaction Scale(1981). The first observations were made in the delivery room(for vaginally delivered mothers only), followed by day 1, day 2, day 3 and 2 weeks, 4 weeks, 6 weeks and 8 weeks after birth, for a total of 7-8 contacts(Cesarean section mothers were observed on days 4 and 5 but the data not used for analysis). Observations in the hospital were made during the hour prior to scheduled feedings. The infant was placed beside the mother. Later contacts were made at home. Data analysis was done by computer using as SPSS program and indulged X2 test, paired t-test, t-test, and Pearson Correlation coefficient ; the results were as follows. 1. Mothers who had a normal vaginal delivery tended to perceive the delivery experience more positively than cesarean section mothers(p=0.002). the finding supported the hypothesis I that perception of delivery would vary according to the method of delivery. Mothers' perceptions of birth were classified into three dimensions, labor, delivery and the baby. There was a significantly different and positive perception by the vaginally delivered mothers to the delivery experience(p=0.000) but no differences for labor or the baby according to the delivery method(p=0.096, p=0.389). 2. Mothers who had a normal vaginal delivery had higher average maternal-infant interaction scores(p=0.029) than mothers who had a cesarean section. There were similar higher scores for the 1st day(p=0.042), 2nd day(p=0.009), and the 3rd day(p=0.006) after delivery but not for later times. The findings supported the hypothesis II that there would be differences in maternal-infant interaction for mothers having vaginal and cesarean section deliveries. However these differences decreased section deliveries. However these differences decreased over time ; by eight weeks the scores for vaginal delivery mothers averaged 8.1 and for cesarean section mothers, 7.9. 3. The more highly positive the perception of the delivery experience, the higher the maternal-infant interaction score for all subjects(F=0.3206, P=0.006). The findings supported the hypothesis III that there would be correlations between perceptions of delivery and maternal-infant interaction. The maternal infant interaction was highest when the perception of the baby and delivery was positive(r=0.4363, p=0.000, r=0.2881, p=0.012). No correlations between perception of labor and maternal-infant interaction were found(p=0.062). 4. The daily maternal-infant interaction score for the initial contact after birth to 8 weeks postpartum had the lowest average score 5.20 and the highest 7.98(in a range of 0-10). This subjects group of mothers needed nursing intervention to promote their maternal-infant interaction. The daily scores for the maternal-infant over the period of eight weeks. However, there were significantly different increases in maternal-infant interaction only from the first to second day(p=0.000) and from the fourth to sixth weeks after birth(p=0.000). 5. When the eight items of maternal-infant interaction were evaluated separately, "Expresses feelings about her role as mother" had the highest average score, 1.64(in a range of 0-3) and "Speaks to baby" the lowest, 0.9. All items, with the possible exception of "Expresses feelings about her role as mother", suggested the subjects' need of nursing intervention to promote maternal-infant interaction. 6. There were positive correlations between certain general characteristics, namely, both a higher economic status(p=0.002) and breast feeding(p=0.202) and maternal-infant interaction. There were positive correlations between a mother's confidence in her role as a mother and the perception of the birth experience(p=0.004). For mothers who had a cesarean section, a positive perception of the birth experience was related to the duration of her marriage(p=0.010), a wanted pregnancy(p=0.030) and her confidence in her role as a mother(p=0.000). Perceptions of birth for mothers who had a normal vaginal delivery were positive than those for mothers who had a cesarean section. The level of maternal-infant interaction for mothers delivered vaginally was higher than for cesarean section mother. The relationship between perception of birth and maternal-infant interaction was confirmed. Cesarean section has an impact on the mother's perceived experience of birth which, in turn, is positively related to maternal-infant in turn, is positively related to maternal-infant interaction. Nursing intervention to enhance maternal-infant interaction should begin in prenatal classes with an exploration of the potential impact of cesarean section on the perceptions of the birth experience and continue throughout the perinatal and post-natal periods to promote the mother's ability to control with this crisis experience and to mobilize social support. Nursing should help transform a relatively negatively perceived experiences into accepted, positively perceived and self affirming experience which enhances the maternal-infant interaction.

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