The Model Predict Acceptance and Rejection of Babies Among Postpartum Mothers

doi:10.21203/rs.3.rs-4643979/v1

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Research Article

The Model Predict Acceptance and Rejection of Babies Among Postpartum Mothers

https://doi.org/10.21203/rs.3.rs-4643979/v1

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Background

Infant abandonment throughout the world, especially in Southeast Asia, is relatively high. The stress of life changes a mother's behaviour negatively, resulting in the baby being abandoned.

Objective

This research aims to develop a model of postnatal care to predict the rejection and acceptance of the baby.

Method

Cross-sectional design. The sample was 205 respondents. Likert scale instrument with favourable and unfavourable items. Inclusion criteria are mothers who have babies aged 0–40 days. Analysis used IBM Statistics 22, Lisrel 8.80 software. Statistical analysis: univariate, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), validity, reliability, cut-of-point, and categorization.

Results

Results: The average age of women was 26.63 (SD = 3.9), with a range of 19–39 years. EFA results in a Bartlett's Sphericity value < .05 and the correlation between variables is quite large. The total variance explained is seven indicator variables out of 77.71 totalling 40 items. Analysis with CFA on 40 items and meeting the goodness of fit criteria resulted in 18 items or 4 indicator variables, consisting of Emotional Stability (4 items), Personality (Active & passive-aggressive) (4 items), and Responsiveness emotional (6 items), responsiveness/Neglect (4 items). Construct reliability of the four indicator variables is .9820 (> .70). Variance extracted .75 (> .5). 18 items were declared valid and reliable. The cut-of-point score with 3 categories, namely low score < 42 (baby acceptance), medium score 42 ≤ X < 66 (risk of baby rejection), and high score ≥ 66 (baby rejection).

Conclusion

Model of mother-infant parenting patterns during the postpartum period which describes the baby's acceptance and rejection was built with 18 items and 4 indicator variables. Strategies to strengthen the mother's ability to caring the baby from preconception until the postpartum period.

Parenting

Postpartum

acceptance

rejection

baby

The picture of child care in Indonesia shows that almost 50% (20,983) of households experience baby neglect (1). Based on records in several developed countries, the incidence of infanticide and neglect per 100,000 births ranges from 2.1 to 6.9. However, it is known that there are difficulties in identifying infanticide because some of it is not recorded (2). In several countries in Southeast Asia with middle to upper income levels, there are quite a lot of cases of neglected babies. In Malaysia, from 1999–2011, there were 1096 cases of baby neglect (3). Child violence in Indonesia is largely not well documented. The amount of life pressure experienced by women is a predictor of changes in women's behavior to become negative in carrying out their role as mothers (1, 4). Household conditions, emotional control and communication between parent as models in baby care that mothers apply to raise children (4–6).

Parenting is a description of the specific behavior, knowledge and skills used by parents to care for their children(5). The development of the mother-infant relationship takes place from pregnancy. Disruption of the mother-infant bonding relationship hinders the parenting process. These factors trigger deviations in the mother's care for the baby, for example a history of unexpected pregnancies, abuse of the baby, not being able to meet the baby's needs (7, 8).The parenting experience that children receive when being raised by their parents can be reflected in the child's emotional climate as an adult (6).

Parenting deviations such as deviations in baby care can be prevented through early detection. The main goal of early detection is to protect babies from abuse and neglect. The main benefit of detecting deviations in parenting behavior is to give the baby the opportunity to grow and develop optimally. Normal parenting dimensions are based on attachment dimensions but vary according to cross-cultural conditions in each region. The attachment referred to refers to bounding attachment, namely full of affection, attention, comfort, attention, care, support, or love for the child (9).

Efforts to prevent child neglect in Indonesia have currently received serious attention from the government. The Indonesian government has passed a law that regulates sanctions related to cases of child neglect and dumping. The results of a previous study in Jakarta related to positive baby care models, influenced by personality factors, self-esteem, responsiveness, emotions, orientation towards the baby, sociocultural, and maternal coping in the postpartum period (4). A parenting model developed to predict acceptance and rejection of the baby starting from the postpartum period. The aim of this paper is to develop and validate a parenting model that predicts infant acceptance and rejection in the postpartum period. The parenting model is expected to become an instrument in primary public health services or Community Health Centers and be used in postpartum maternal services in predicting acceptance and rejection of newborn babies.

Research Design

This study was a quantitative approach with a cross-sectional descriptive method (10). The flow of the stages of developing a mother-infant parenting model for the postpartum period is presented in a flow diagram below.

[Figure 1 about here.]

Figure 1 showing the stages of developing a mother-baby parenting model which describes the acceptance and rejection of babies in the postpartum period (pre-eliminary study stage and current research stage)

An initial study was conducted to determine whether the question items related to parenting models lead to acceptance or rejection. The total number of questionnaire items was 76 items. The results of the CVR analysis showed that 50 items were accepted and 26 items were rejected. Next, in the EFA tapuanalysis of the 50 items, 10 items were excluded and 40 items were accepted. The final analysis was carried out with CFA on 40 items (indicator variables), resulting in 18 items being accepted and 28 items being excluded. The results of the analysis can be seen in the research results report.

Sample Size and Technique

The total sample involved in this study was 205 postpartum mothers who met the inclusion criteria. Inclusion criteria include: mothers who have babies aged 0–40 days, can speak Indonesian, and do not have mental disorders or comorbidities. Sample calculations for explanatory factor analysis and confirmatory factor analysis (EFA and CFA) can be calculated based on the sample to item ratio, namely 5:1 (11). Minimum recommendations for overall sample size (> 200–400) (12). The minimum sample size was determined on the grounds that the minimum sample analysis was able to produce factor loadings (standardized value > .60).

Sample recruitment was determined after respondents received informed consent and respondents gave their consent to be willing to be recruited as research samples. The research was carried out from April to September 2021. The research sites were carried out in Indonesia in the South Jakarta Community Health Center, Depok Regional Health Center, West Java, and Jeulingke Banda Aceh Community Health Center.

Collecting data and Statistical Analysis

The instrument contains statement items containing elements of mother-infant parenting and demographic data. The instrument was developed from personality variables (active & passive-aggressive), self-esteem, responsiveness/abandonment, emotional stability, emotional response, socio-cultural and coping in the form of a 50-item Likert scale. The statement item elements contain positive statements (favourable) which describe the mother's behavior in accepting the baby and negative statements (unfavourable) which describe the mother's behavior in rejecting the baby. Data collection was carried out using purposive sampling technique. The considerations for selecting this technique were limited research time and respondents.

The data collected was then analyzed to produce a mother-baby parenting model for the postpartum period. Analysis was carried out on latent variables, namely: personality (active & passive-aggressive), self-esteem, responsiveness/abandonment (abandonment), emotional stability, emotional response, socio-cultural, coping) and indicator variables (statement items). Parenting models are then categorized into three categories. A high parenting score represents baby rejection, a low parenting score represents baby acceptance, and a moderate parenting score represents a risk of baby rejection.

The software used for analysis is SPSS 22 and Lisrel 8.0 software. The analysis carried out was univariate analysis and modeling analysis, namely structural equation modeling (SEM). The decision resulting from the analysis in measuring the suitability of the baby care model is seen from the goodness of fit test based on the absolute suitability index value, validity test value and reliability test value.

Demographic characteristics.

Respondent characteristics are age, education, and occupation. Respondents were on average 26.63 years old (SD = 3.9) with a minimum age of 19 years, and a maximum age of 39 years. Education levels range from primary education to higher education with a distribution of tertiary education (37.6%), high school (53.2%), junior high school (6.3%), and elementary school (2.9%). Participants as housewives (58.1%), private and government employees (23.4%), and entrepreneurs (18.5%).

Factor Analysis in Building a Baby Parenting Model

The baby parenting model was developed using structural equation modeling (SEM) analysis, namely explanatory factor analysis (EFA) and confirmatory factor analysis (CFA).

Explanatory Factor Analysis (EFA)

The results obtained include the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO MSA) which is .917 and Sig. Bartlett's of Sphericity < .05. The total variance of the latent variables explained from the initial eigenvalues shows that the factors formed have a value of more than one, as many as seven factors. The total variation of these seven factors is 77.706. Based on component analysis, the correlation of the seven factors is sorted from highest to smallest, namely 0.845–0.546. The results of the analysis obtained 40 items. Then, to see the pattern of relationships between one variable and other variables, analysis was continued using the CFA method.

Confirmatory Factor Analysis

Confirmatory factor analysis (CFA) used Lisrel 8.0 software to see the linear structural relationship of variables (personality, active & passive-aggressive), self-esteem, responsiveness/ignorance, emotional stability, emotional response, social culture and coping) and 40 statement items. Analysis is grouped based on: 1) goodness of fit evaluation, 2) validity and reliability of linear structural relationships.

[Figure 2 about here.]

The results of the match of the predicted model with other observed values meet the requirements. The Fig. 2 shows result of Normed Fit Index (NFI) = .94; Non-Normed Fit Index (NNFI) = .95; Parsimony Normed Fit Index (PNFI) = .81; Comparative Fit Index (CFI) = .96; Incremental Fit Index (IFI) = .96; Goodness of Fit Index (GFI) = .83 which can show that sample diversity can be said to represent the diversity that exists in the population.

The results of the CFA analysis of items and indicator variables obtained were F3: Emotional stability with 4 indicator variables, F4: personality (active & passive-aggressive) with 4 items, F5: emotional responsiveness with 6 items, F6: responsiveness/abandonment as many as 4 items. So that in the final development of the mother-baby parenting model for the postpartum period, the total acceptable latent variables were 4 and the indicator variables (statement items) were 18 items.

Variable Validity and Reliability Analysis

The item value for each indicator variable in Table 1 is said to be reliable if the correlation value rcount > rtable (.138). The validity test results of all calculated r-values for each indicator variable item are greater than the r-table, so it can be stated that all indicator variables constructed from the four indicator variables are valid. Validity and reliability testing of the model suitability indicator variables was carried out using Construct Reliability (CR) and Extracted Variance (VE). Based on the analysis of variance extraction and construct reliability, the calculation results show that the construct reliability of the four factors is .9820 (> .70) and the variance extracted is .75 (> .5)

Table 1

Measurement of statement items indicator variables of postpartum period mother-infant parenting model (n = 205).
Latent variable	Indicator Variables (Statement Items)	Standard Loading Factor (SLF)	Measure ment Error (ME)	T Value	Costruct Reliability (CR) \(\:CR=\frac{{(\sum\:SL)}^{2}}{{(\sum\:SL)}^{2}+\:(\sum\:ME)}\)	variance extracted (VE) ≥ .50 \(\:VE=\frac{{\sum\:SL}^{2}}{{\sum\:SL}^{2}+\:\sum\:ME}\)	Alpha Cronbha
Factor 3 (Emotional stability)	A13 (Calm in dealing with baby's behavior)	.60	.64	-	.78	0,55	.76
	A14 (control emotions when baby is fussy)	.87	.24	7.88
	A15 (Introducing baby to others)	.70	.50	7.57
	A11 (knowing the baby is hungry)	.56	.68	6.48
Factor 4 (personality[active and passive aggressive]	R3 (scolding baby when crying)	.85	.28	18.02	.95	.82	.95
	R6 (Refusing to breastfeed the baby)	.91	.17	19.63
	R7 (Leaving the baby alone)	.95	.09	17.94
	R8 (unresponsive to baby)	.91	.17	-
Factor 5 (responsive emotional)	R11 (leave the baby to someone else)	.84	.29	20.44	.97	.85	.97
	R13 (my baby is worthless)	.96	.07	20.97
	R14 (My baby plunged me)	.97	.06	18.13
	R15 (feeling pressured to have a baby)	.91	.17	19.69
	R16 (Regret giving birth to my baby)	.96	.10	17.55
	R17 (accompanied by anger in caring for the baby)	.90	.20	-
Factor 6 (daya tanggap/Abandonment)	R12 (Breastfeed baby only when reminded.)	.91	.14	10.94	.94	.80	.92
	R23 (Blaming the baby for my condition)	.93	.60	11.36
	R24 (does not meet the baby's needs)	.98	.04	11.14
	R25 (Not comfortable with baby)	.96	.10	-

[Table 1 about here.]

So, the four indicator variable factors, namely emotional stability, personality (active and passive-aggressive), emotional responsiveness, and responsiveness/Abandonment, are reliable and valid in the postpartum period parenting model which predicts baby acceptance and rejection.

Postpartum Period Mother-Infant Parenting Model Score

The parenting model built to describe the baby's acceptance and rejection during the postpartum period consists of four positive statements (favourable) and 14 negative statements (unfavourable) shown on Table 2. The cut-of-point score of the Model is categorized into three categories: low score < 42 (baby acceptance), medium score 42 ≤ X < 66 (risk of baby rejection), and high score ≥ 66 (baby rejection).

Table 2

Parenting Model Categories that describe the acceptance and rejection of infants in the postpartum period (item = 18).
Variable	Likert scale	Max Score	Min Score	Cut of point (Mean/M): Max Score + Min Score /2	Range (score Maks- Min)	Standard deviasi (Range/6)	Category Score
							Low	moderate	high
							X < M – 1SD	M – 1SD ≤ X < M + 1SD	M + 1SD ≤ X
Mother-Baby Parenting Model	1–5	90	18	54	72	12	X < 42	42 ≤ X < 66	X ≥ 66

[Table 2 about here.]

This research has developed and validated a mother-infant parenting model for the postpartum period which predicts the baby's acceptance and rejection using four factors, namely emotional stability, personality (active and passive aggressive), emotional responsiveness, responsiveness/Abandonment and 18 statement items. These factors can be a stimulus in producing parenting behavior. The differences in parenting behavior shown by each mother depend on how the mother responds to internal and external stimuli such as situations in the family, economy and culture (13). Thus, the description of these four factors shows the baby's expression of acceptance and rejection. Expressions of mother-baby parenting behavior in the postpartum period which describe the mother's rejection of the baby in the form of the mother being acts uncaring, indifferent, hostile and unresponsive to the baby's needs (14). The description of parenting behavior is expressed as behavior that expresses the baby's rejection. This study shows that the mother-baby parenting model in the postpartum period can predict the risk of rejection/neglect of the baby from birth.

Based on the factors that build the mother-baby parenting model in the postpartum period, one of them is the dimension of emotional stability. The state of emotional stability when faced with the role of mother has different levels of stress (15). One of the predictors that influences changes in maternal behavior is emotional stability (16, 17). Factors that contribute to maternal emotional stability include social, economic factors and maternal experiences of stress so that mothers tend to experience greater stress and changes in behavior (6, 18, 19).

Personality (active and passive aggressive) is one of the psychological dimensions that can influence relationships, communication dynamics and behavior (14, 17, 20). Personality is valid and reliable for measuring someone's passive-aggressive behavior or personality (21). The role of the mother's personality in developing parenting behavior has been confirmed through the analysis stages in the current research. Passive and aggressive personality elements can be a factor in detecting mother-baby interpersonal relationships in clinics and in the community (21). Another factor that can measure mother-infant parenting behavior is emotional responsiveness. The first mother-baby relationship to be formed is an emotional bond. The emotional mother-infant bond appears after birth starting from early initiation of breastfeeding (22).

Mental health affects parents' sensitivity and responsiveness, as well as reduced mother-infant bonding (23). So maternal responsiveness is a mediator between postnatal mental health (depression, anxiety and stress) and mother-infant bonding (4, 23). The selection of the responsiveness/abandonment factor in developing a mother-baby parenting model for the postpartum period is appropriate in predicting whether a mother will accept or be at risk of rejecting the baby.

The development of a postnatal care model is relevant to the early childhood care model which has high validity and reliability for describing child acceptance and rejection (24, 25). The mother-infant parenting model for the postpartum, early childhood and school age periods is built on the relationship between emotional, social, economic and psychological factors. The indicators in the current mother-baby parenting model are aimed at 0–1 month postpartum mothers who are assessed based on mother-baby parenting behavior (1, 26). Management of parenting behavior applied by mothers to newborn babies plays an important role in the development of the child's psychological condition in the future. Several underlying things from the current research and supported by previous information illustrate that detection of changes in mother-baby parenting behavior in the postpartum period can be based on emotional stability, personality (active and passive aggressive), emotional responsiveness, responsiveness/Abandonment factors. These four factors can trigger changes in the sensitivity of the mother's parenting behavior and can be influenced by the situation or pressure the mother is experiencing at that time (27).

Other factors that can influence parenting behavior are the mother's experience while being cared for as a child, and the parents' parenting patterns (9). These factors are components that need to be explored when parents provide care for babies from an early age. This information is the basis for knowing the parenting model provided by the mother.

Based on factor analysis of mother-baby parenting modeling for the postpartum period, four factors were produced, namely emotional stability, personality (active and passive aggressive), emotional responsiveness, responsiveness/Abandonment, with 18 statement items (indicator variables). In predicting maternal parenting behavior, the mother-baby parenting model for the postpartum period is classified into three categories, namely low score (no risk), medium score (risk of rejection), and high score (baby rejection occurs). Based on the stages of analysis that have been carried out, including factor analysis, it can be stated that the mother-infant parenting model for the postpartum period can be declared as a fit and appropriate model to be applied in predicting baby acceptance and rejection. These four factors can be said to describe the mother's behavior in accepting or rejecting the baby.

To reduce incidents of neglect and violence, including neglect of babies and children, requires serious efforts from various parties. Efforts to prepare prospective parents from preconception to postpartum are very important and urgent. The preparation of human resources in the health sector and public knowledge about regulating the number of children is effective in increasing awareness about the negative impacts of unplanning pregnancy.

Acknowledgment

This research was supported by a grant from the Jakarta Health Polytechnic 1, and the research has no conflict of interest.

Introduction to Methods

I hereby confirm that all methods employed in this research were conducted in strict accordance with the relevant guidelines and regulations. Informed consent was obtained from all subject prior to their participation in the study.

Ethics Consideration

This research has been approved by the Ethical Clearance Committee of the Jakarta Ministry of Health Polytechnic 1 with No. 168/KEPK/VIII/2021. Before data is collected. This research has paid attention to research ethics where there is informed consent for participants.

Data Availability Statement

The experimental data and the simulation results that support the findings of this study are available in Figshare with the identifier https://doi.org/10.6084/m9.figshare.26195669.

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The Model Predict Acceptance and Rejection of Babies Among Postpartum Mothers

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Abstract

Background

Objective

Method

Results

Conclusion

Figures

Introduction

Methods

Research Design

Sample Size and Technique

Collecting data and Statistical Analysis

Result and Discussion

Factor Analysis in Building a Baby Parenting Model

Explanatory Factor Analysis (EFA)

Confirmatory Factor Analysis

Variable Validity and Reliability Analysis

Postpartum Period Mother-Infant Parenting Model Score

Discussion

Conclusion

Declarations

References

Additional Declarations

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