Brenda Baker, PhD, RNC, CNS Jacqueline McGrath, PhD, RN, FNAP, FAAN Rita Pickler, PhD, RN, PNP-BC, FAAN Nancy Jallo, PhD, RNC, FNP-BC, WHNP-BC, CNS Stephen Cohen, MD, MHA Acknowledgment: Supported by National Institute of Health, Ruth L. Kerschstein National Research Service Award Individual Fellowship F31NRo

Examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mother of full term infants

 Infants born between 34 and 36 6/7 weeks gestation  Account for:  75% of preterm births (Dong, 2011)  9% of all births  Have limited compensatory resources that increase the risk of:  Temperature instability  Hypoglycemia  Respiratory instability  Sepsis  Feeding difficulties

 Longitudinal study 767 LPIs delays in reading and math were significant through 5 th grade (Chyi, 2008)  Systematic review of 10 studies examining early childhood outcomes of LPIs through age 7 identified: more neurodevelopmental disabilities delayed educational ability greater need for early-intervention more medical disabilities delayed physical growth (McGowan, 2011)

Defined as maternal intelligence that influences infant development and includes elements of sensitivity, responsiveness, and synchrony. Maternal competence continually changes as the infant grows and is based on verbal and non-verbal feedback from the infant. Maternal competence is influenced by: infant behavior support from others and maternal well-being (Teti, 1991, Tarkka, 2003)

 No difference in development of maternal competence based on: infant gender (Flagler, 1988) pregnancy risk status (Mercer, 1994) experienced versus first time mothers (Mercer, 1995) marital status, married versus single (Copeland, 2004)

The mothers ability to be warm and soothing with her infant, leading to a synchronous relationship where the mother reads her infant’s cues, is responsive to the infant’s needs, sees her infant respond with positive behaviors and over time influences development of the relationship and ultimately growth and development of the infant.

 Influenced by:  Satisfaction with life  Self-esteem  Number of children  Support from others (Drake, 2007, Amankwaa, 2007)

 Mothers typically are the primary caregiver  Maternal competence and responsiveness is based on a mother’s perception of her infant  Form a dynamic relationship that facilitates growth and development of the infant  Trust  Attachment  Language skills

 Infants respond to their mothers with verbal cues and behaviors that indicate their needs for nutrition, sleep, stimulation and safety are met  Infant cues, behaviors, weight gain and achievement of developmental milestones are positive reinforcements to a mother that she knows her infant and is meeting their needs  Leading to development of maternal competence

 Non-experimental cross-sectional, repeated measures design  Two data collection points Postpartum prior to discharge from the hospital 6 weeks postpartum

Postpartum mothers delivering at VCUHS /7 weeks gestation or weeks gestation First time and experienced mothers Maternal age > 18 years Read and speak English Singleton birth, birth weight appropriate for age No known congenital anomalies No perinatal complications that interfere with postpartum transition

 Number recruited & enrolled – 116  Completed Time One Survey – 109  Term – 77  Late Preterm Infant – 32  Completed Time Two Survey – 71  Term – 52  LPI - 19

Gestation Term and LPIComplications Term and LPI

 No statistical significance  Between term or late preterm mothers  Measurement points

 No statistical significance  Between term or late preterm mothers  Measurement points

 No statistical significance  Between term or late preterm mothers  Measurement points

 No statistical significance  Between term or late preterm mothers  Measurement points

 Factors most predictive of maternal competence at Postpartum: LPI -Postpartum support Term - Satisfaction with life  Factors most predictive of maternal responsiveness at postpartum: LPI - Infant temperament - Self-esteem - Stress Term - Self-esteem

 Survey instruments - socially desirable answers versus true feelings  Reading level  Participant burden – 176 items  Sample size - attrition  Hospital environment VCUHS late preterm population - approximately 5% of all births compared to the national average of 8% Change in care – decreased LPI births  6-weeks second survey time Mothers returning to work LPI’s adjusted age  English language only 1/5 of the available population were non-English speaking