Maternal Expectations

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Maternal Expectations Perceptions of Infant
Vulnerability

• Marilyn Stern, Ph.D.
• Departments of Psychology Pediatrics
• Virginia Commonwealth University
• Acknowledge Colleagues
• Katherine Karraker West Virginia University
• and a number of former students from University
  at Albany, including Bonnie McIntosh Sara
  Moritzen Michelle Olexa Jennifer Zak-Place and
• Current students from Virginia Commonwealth
  University Monica Durrette Becky Foster Cassie
  Brode Melissa Joiner Jerlym Porter and many
  others

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Programmatic Group of Studies

• Identified a possible negative influence on the
  caregiving environment of premature infants
• Studies suggest that adults hold a set of Biased
  Beliefs about infants who are Identified as
  having been born prematurely
• Set of Beliefs ?A Prematurity Stereotype

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• Explored how this prematurity stereotype may
  negatively influence adults perceptions of,
  expectations for, and behavior toward premature
  infants
• Expectancy Confirmation Process Model
• Given certain expectations about the way an
  Interaction might be ?
• Individuals Tend to Act in Ways as to Produce in
  Reality What they Expect to Find

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PREMATURITY STEREOTYPING

• Represents a potential threat to the Optimal
  Development of these infants
• Inaccurate expectations elicited by the label of
  Vulnerability may subsequently impact the childs
  social and cognitive development negatively

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Facts about Prematurity
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• Survival rates of preterm and low birthweight
  infants has increased dramatically in the past 20
  years

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• With increased survival rates has come a dramatic
  increase in length of stay in the hospital for
  these high risk infants
• Admission to a Neonatal Intensive Care Unit
  (NICU) highly stressful for parents and infants

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• Early stressful experiences can subsequently
  affect parental attitudes, behaviors and care
  giving relationship
• All infants born prematurely may experience
  Delayed Development in the physical, cognitive,
  social-emotional behavioral areas
• Despite Initial Delays, BY about 9-months,
  healthy preemies show ? FEW Overt Signs of
  Vulnerability

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Basis for this Line of Research

• Vulnerable Child Syndrome (Green Solnit)
• Observations that parents reactions to and
  treatment of a child perceived as Vulnerable can
  more Accurately be Attributed to the Label of
  Vulnerability and the Expectations Engendered by
  that Label Rather than the Actual Cues Emitted by
  the Child

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TRUE VULNERABILITY

• HIGH
• ParentalPerception ofVulnerability
• LOW

• HIGH LOW
• CHRONIC (TYPE II
• DISEASE error)
• Vulnerable Child Syndrome
• (TYPE II error) Normal Child
• CHILD NEGLECT

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Potential for Long-term Consequences

• Suggested by studies that find a Persistent
  Relationship between behaviors observed in early
  mother-infant interactions and later infant and
  child competence
• To Summarize early maternal-infant interactions
  are important and predictive of later child
  outcomes

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UNDERLYING PREMISE PREMATURITY STEREOTYPING

• Presenting the same or randomly selected infants
  to subjects in both labeling conditions allows
  exploration of the extent to which perceptions
  and behaviors are influenced by beliefs about
  prematurity, independent of the characteristics
  or behaviors of the infants

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SUMMARY OF OUR FINDINGS

• CONSISTENTLY FIND COGNITIVE AND BEHAVIORAL
  EVIDENCE FOR A STEREOTYPE ?
• Mothers of Full-term infants, Mothers of
  ill-Full-term infants, Mothers of Premature
  infants and Nurses and Health Care Providers ?
• Rate Infants Labeled Premature (PL) more
  Negatively than Infants Labeled full-term (FTL)

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Behavioral Implications of the Stereotype

• When given an Opportunity to Interact with an
  unfamiliar full-term or preterm infant labeled
  either full-term or premature
• Mothers Treat Infants labeled Preterm more
  Negatively than those Labeled Full-term
• AND the Infants Respond to mothers in a
  NON-Synchronous fashion

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LONGITUDINAL ASSESSMENT of the PREMATURITY
STEREOTYPE

• We also examined the effects of Prematurity
  Stereotyping in Mothers own interactions with
  their infants from 5 to 12 months

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Relationship between Maternal Stereotyping
Interactive Behaviors

• In general, Mothers of Premature infants who
  rated PL infants more positively and Mothers of
  Full-term infants who rated FTL infants more
  positively ?showed more positive interactions
  with their own infants.
• Greater Levels of Prematurity Stereotyping ?
  Significantly Related to more Negative Indices of
  Maternal Interactive Behavior and Infant
  Responses at all age points

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IMPLICATIONS

• Evidence for the Prematurity Stereotype found on
  both a Cognitive and Behavioral Level
• Support for the Utility of the Stereotyping
  Assessment Paradigm for Identifying Mothers
  AT-RISK for Developing a Negative Stereotype
  Associated with their Infants Prematurity
• Findings Suggest that Premature Birth Status and
  Expectations for Vulnerability Impact Caregiving
  over time, possibly affecting Later Developmental
  Outcomes

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LONGER-TERM FOLLOW-UP SHOWED

• Significant Relationships Between early
  indices of Perceived Vulnerability, including
  Prematurity Stereotyping, AND Later Bayley Scores
  AND Parenting Behaviors

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SAMPLE FINDINGS

• Greater Levels of Prematurity Stereotyping at 5
  months ? children with lower Bayley scores at 3
  years
• Greater Levels of Prematurity Stereotyping ?
  Poorer Parenting Self-Efficacy Less Parental
  Perceived Control and Less Optimism at 3 years

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CURRENT MOD SUPPORTED PROJECT

• How Early Maternal Perceptions Expectations
  Relate to Later Adaptation and Mother-Infant
  Interactions
• Phase 1 NICU and one month follow-up
• Interview mothers coping optimism social
  support depression Stereotyping Assessment
  Task Perceived infant Vulnerability
• Phase 2 Three months follow-up
• Mother-Infant Interactions coping social
  support depression childcare stress maternal
  efficacyperceptions of infant vulnerability

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PRELIMINARY RESULTS

• NICU rated as a highly stressful experience
• During NICU hospitalization mothers showed
  prematurity stereotyping ?
• Surprisingly, Stereotyping was not related to
  gestational age, infant birth weight, or number
  of days infants were hospitalized

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RESULTS Contd

• Mothers who viewed PL infants more negatively,
  perceived their own infants to be more vulnerable
  at one-month follow-up
• Mothers showing more stereotyping during NICU
  hospitalization
• reported using more avoidance and more
  distancing coping strategies
• and reported poorer eating habits one month after
  their infants discharge

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RESULTS contd

• Mothers who reported their infants as doing
  better compared to other infants in the NICU,
  were more likely to report at one-month
  post-discharge follow-up that it was easier for
  them to bond with their baby

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IMPLICATIONS OF PRELIMINARY FINDINGS

• Prematurity stereotyping ?can be identified
  during NICU hospitalization
• Identifying mothers most likely to show
  stereotyping during NICU hospitalization is
  important in prevention efforts and in promoting
  healthy mother-infant outcomes
• Further data collection and more complex analyses
  of these data ?should help identify the factors
  most critical to target in designing effective
  interventions with mothers of prematurely born
  infants hospitalized in the NICU