Method of Infant Feeding as a Predictor of Maternal Responsiveness

METHOD OF INFANT FEEDING AS A PREDICTOR OF MATERNAL RESPONSIVENESS By Emily Eiwen Drake R.N. , Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2005 Major Director: Sharron S. Humenick, R.N. , Ph.D. Professor, Department of Maternal Child Nursing, School of Nursing Infants need to develop effective, secure attachment to their primary caregivers in the first year of life. Researchers have not been able to identify all the factors that may influence the development of infant attachment. Most of the studies in this area have been done without regard to infant feeding as a potential factor. Maternal responsiveness appears to be key in the child’s development of secure attachment behaviors, yet even after decades of research on infant attachment and maternal responsiveness, there is little evidence available to assist with early identification of families at risk and few interventions known to be effective in promoting maternal responsiveness. The research questions for this study were: 1) Do mothers who exclusively breastfed their infants for at least 6 weeks report more maternal responsiveness behaviors 2-4 months after delivery compared to mothers who exclusively formula feed their infants? 2) How well does breastfeeding duration predict self-reported maternal responsiveness at 2-4 months once socio-demographics and maternal characteristics (i.e., self-esteem, satisfaction with life) are statistically controlled? A cross-sectional survey design was used to assess the variables of maternal responsiveness, feeding patterns, and maternal characteristics in a convenience sample of 200 mothers in the first 2-4 months after delivery. The 60-item instrument included scales to measure maternal responsiveness (MIRI: Amankwaa et al., 2002), self-esteem (RSE: Rosenberg, 1965), and satisfaction with life (SWLS: Diener et al., 1985) as well as infant feeding and socio-demographic questions. A mixed mode data collection strategy was used combining Internet data collection with traditional paper-and-pencil survey methods. Somewhat surprisingly, mothers who exclusively breastfed for at least 6 weeks did not report any more maternal responsiveness behaviors compared to mothers who formula fed their infants. Hierarchical multiple regression analysis revealed that satisfaction with life, self-esteem, and parity, but not breastfeeding, explained a significant portion of the variance in self-reported maternal responsiveness scores. Further research in this area is needed. It should be noted that this is one of few studies of maternal responsiveness using a self-report instrument and may also be the first study of maternal responsiveness using Internet data collection. 1 CHAPTER 1: INTRODUCTION The purpose of this study was to compare self-reported maternal responsiveness in breastfeeding versus formula feeding mothers in the first 2-4 months after delivery. Infant feeding practices were evaluated as a potential predictor of maternal responsiveness. In chapter one, the problem statement, background, significance, research questions, and purpose of the study will be discussed. This chapter includes a summary of the theoretical framework and a discussion of the need for further research on maternal responsiveness. Maternal responsiveness has been labeled as a critical factor in the cognitive and emotional development of children (Ainsworth, Blehar, Waters, & Wall, 1978; Raval et al., 2001). Derived from classic attachment theory (Ainsworth & Wittig, 1969; Bowlby, 1969), maternal responsiveness is a construct that describes sensitive interactions between mother and child. The early maternal-child relationship is critically important because it serves as the basis for the development of secure infant attachment and promotes healthy child development; thus, it was the focus for this study. It was hypothesized that the breastfeeding experience, along with other factors, may directly affect the mother’s responsiveness to her infant’s cues. Ultimately it was anticipated that