staying connected while nurturing an infant: a challenge of new motherhood

Staying Connected WhileNurturing an Infant: A Challenge

of New Motherhood*Ruth Paris** Nicole Dubus

Abstract: Fifteen at-risk new mothers participating in a volunteer home-visiting program were inter-viewed about their experiences with these home-visitors and their relationships with close family andfriends after their babies were born. Results of the qualitative analysis, viewed through the lens of Rela-tional Cultural Theory (RCT), detail the social isolation and personal disconnection that they experi-enced. Their narratives also provide insights about the volunteers� use of techniques—such as validation,affirmation, consistency, and emotional and instrumental aid—to enhance the mothers� self-confidencein caring for their babies, to reduce painful feelings, and to increase interpersonal connections. Recom-mendations are included for working with couples anticipating a new baby.

Key Words: home-visiting, infancy, motherhood, postpartum depression.

The postpartum period is charged with mixedemotions for most mothers (Blumfield, 1992;Epperson, 2002). Feelings can range from plea-sure and joy to anger, loneliness, and depression.In addition, mothers of newborns in many West-ern cultures report feeling isolated from otheradults (Cowan & Cowan, 2000; Graham, Lobel,& Stein Deluca, 2002; Nicolson, 1998). Theyare at increased risk of mood disorders such asdepression and anxiety. Thus, their infants arevulnerable to early developmental deficits becauseof compromised parenting (Lyons-Ruth, Con-nell, Grunebaum, & Botein, 1990; Weinberg &Tronick, 1998). However, few studies haveclosely examined the different ways in whichpostpartum women feel isolated and lonely.

Not surprisingly, reports show that mothersof newborns benefit from emotional support.(Gomby, Culross, & Behrman, 1999; Heinickeet al., 1999). Home-visiting interventions havebeen used as a means of support, education, andprevention to address the needs of women andinfants during the postpartum period (Gombyet al.; Heinicke et al., 1999; Taggart, Short, &Barclay, 2000), but studies are needed thatdetail the usefulness of the home-visitor/newmother relationship from the client’s perspec-tive. We examined at-risk postpartum womento understand their relational experiences withtheir babies and families, and the social contextwithin which their new mothering experiencesoccurred. We also sought information about

*The authors would like to gratefully acknowledge Maryann Amodeo for her comments on an earlier draft of this article. Special thanks to Peggy

Kaufman, Debbie Whitehill, and the staff of the Visiting Moms Program, Greater Boston Jewish Family and Children’s Services.

**Address correspondence to Dr. Ruth Paris, Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215 ([email protected]).

Family Relations, 54 (January 2005), 72–83. Blackwell Publishing. Printed in the USA.Copyright 2005 by the National Council on Family Relations.

their perceptions of their relational experienceswith their home-visiting volunteers.

Postpartum Experiences andRelational-Cultural Theory

Postpartum ‘‘blues’’ are estimated to occur in26%–85% of women from all socioeconomiclevels in the United States (O’Hara, 1994).Symptoms can include mild to moderate sad-ness, tearfulness, emotional ups and downs, anx-iety, and sleep problems. These feelings cancontribute to women’s sense of isolation or dis-connection. In addition, it is possible that beingisolated can add to the feelings that encompassthe ‘‘blues.’’ New mothers may feel particularlylonely in their new roles because of the difficultyof sharing these unpleasant feelings. They alsomay be fearful of and unable to care consistentlyfor their new baby and or lack the support of anadult experienced in parenting newborns whocan offer guidance and affirmation on the chal-lenging aspects of parenting an infant.

Relational-Cultural Theory (RCT; Jordan,Kaplan, Miller, Stiver, & Surrey, 1991) offeredone perspective on mothers� postpartum moods,positing that women develop and function opti-mally in relation to others. Understanding,being understood, experiencing empathy fromand toward another, and feeling interpersonalconnection are all central values in the develop-ment of women’s sense of self and the skills andvalues that women bring to relationships of allkinds (Jordan et al., 1991; Miller & Stiver,1998). In fact, a loss of connection with impor-tant relationships can cause feelings of sadness,anger, loneliness, and depression, and feelingsof being misunderstood. Subsequently, a womanmight experience her needs, feelings, andthoughts as separate from and incomprehensibleto other valued people (Kaplan, 1991; Miller &Stiver). It is possible that many women whonurture a newborn experience disconnectionfrom their primary forms of support (usuallytheir partner and or other family members)because of the intensity of the birth and perina-

tal experience, and the different rates by whichwomen and men reportedly transition to therole of parent (Cowan et al., 1985). These dis-connections during the postpartum period cancontribute to women’s reports of postpartumanger, sadness, and depression (Blumfield,1992; Graham et al., 2002; Nicolson, 1998).

Home-Visiting Interventions

Home-visiting interventions are used to providedirect services to new mothers, infants, and fam-ilies during the challenging postpartum period(Gomby et al., 1999). Such interventions areseen as effective in part because they bring theservice to the client, and they allow the workersto observe the environment in which the motherand infant reside (Gomby et al.; Olds et al.,1999). By meeting the client in her home, thehome-visitor is better able to assess the family’sneeds, strengths, and challenges and develop theintervention that is best suited. In addition, sheis able to build a trusting relationship that canserve as a bridge to enable an isolated mother tobranch out into the community for ongoingsupport.

Many home-visiting interventions are per-formed by trained professionals—nurses, socialworkers, or counselors. In previous studies,home-visiting interventions were evaluated onnumerous outcomes, including effectiveness inenhancing parent knowledge, attitudes andbehavior regarding childrearing, prevention ofchild abuse and neglect, and enhancement ofthe life course for the mother, among others(Gomby et al., 1999; Olds et al., 1999). Mostof these interventions use curricula that educatethe mothers on nutrition, child development,and parenting skills, and provide referrals tolocal support services. The relationship with thehome-visitor is mentioned in this literature onlyas it relates to the implementation of these serv-ices (Gomby et al.).

Other researchers and clinicians assert thatthe quality of the relationship between thehome-visitor and the mother is an important

Staying Connected While Nurturing an Infant � Paris and Dubus 73

predictor of treatment outcome (Heinicke et al.,1999; Lieberman & Pawl, 1993; Slade, 2002).The home-visitor’s foci in the intervention areon emotional and social aspects of the parent,parent-child relationship, and or child function-ing. Through the care and attention paid to therelationship, the home-visitor reinforces themother’s ability to keep her own needs in mind,and also enables the mother to be open andresponsive to the multiple needs and experiencesof her baby (Slade). These relationship-basedinterventions are characterized by a sustained con-nection between the mother and home-visitorthat lasts anywhere from 3 months to 3 years,and involves regular visits throughout the ser-vice period (Heinicke & Ponce, 1999; Mayes,2002).

Volunteer Home-Visitors

Although most home-visiting programs employprofessionals, paraprofessionals and volunteersalso are involved in this type of intervention.Whereas the professionally trained worker isable to fulfill many valuable functions, the para-professional or lay worker adds elements thatthe professional may be less able to provide,such as role modeling, increased client empathyfrom having been a new mother herself, andshared experience from living in the local com-munity (Hiatt, Sampson, & Baird, 1997).

Researchers in Australia examined the impactof volunteers in a home-visiting project for mul-tistressed new mothers (Taggart et al., 2000).They concluded that through friendship and thecommonalities of motherhood, the home-visit-ing relationship did address the feelings of lone-liness and isolation that the new mothersreported. In addition, the mothers experiencedthe volunteers as equals, and therefore felt nofear of harmful consequences if they shared withthe volunteers their difficulties in coping.

Connection as Intervention

Numerous studies confirm that the postpartumperiod is a time of great adjustment and onein which the mother benefits from support

(Cowan & Cowan, 2000; Feinberg, 2002;Pancer, Pratt, Hunsberger, & Gallant, 2000;Paris & Helson, 2002). It is a time ripe forintervention. Even before the birth of a child,women often anticipate personal needs forincreased support in the face of parenting a new-born. A study of low-risk pregnant womenfound that when a woman anticipated supportfrom her husband after her baby was born, shewas more likely to be depressed if such supportwas not forthcoming (Logsdon, McBride, &Birkimer, 1994).

RCT provides an approach to working withvarious types of clients that includes a range oftherapeutic interventions. A central construct inthe theory is ‘‘relational empowerment’’ (Surrey,1991), a process of emotionally connecting withanother person through the ‘‘capacity to beresponsive and �moved� by the thoughts, per-ceptions, and feeling states of the other person’’(p. 167). Being ‘‘heard’’ empowers clients to feel‘‘. enlarged, able to �see� more clearly, andenergized to move into action’’ (p. 167–168).Applied to the intervention we studied, byshowing empathy for the new mother throughengagement and understanding, the home-visitor would enable her to feel empowered inthe parenting role.

The Study

In the study reported here, 15 women who wereparticipants in a home-visiting intervention fornew mothers at-risk because of depression, isola-tion, and=or lack of resources were asked todescribe their relational experiences with theirbaby and family members during the postpar-tum period. These primarily first-time mothersalso were asked to describe the relationship thatdeveloped with their home-visitor and itsimpact on their lives. We were interested in howthey characterized the various feelings they expe-rienced (e.g., loneliness, isolation, insecurity,resentment) during the postpartum year, andwhether they perceived that the support ofa home-visitor assisted them with those feelings.

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Responses were analyzed using the lens of RCT(Jordan et al., 1991; Miller & Stiver, 1997) andemployed thematic coding techniques for analy-sis of interview responses. This close examina-tion using qualitative methods to understandthe voices of these new mothers offers a rich andeffective way to identify the most salient aspectsof their experiences, and to explain how theyviewed home-visitors aiding them in a time ofcrisis and change.

Method

The first author, an academic researcher, pro-vided consultation to the staff of a community-based nonprofit agency for the design of thestudy. Located in a large metropolitan area, thisagency offers a range of services, including men-tal health, geriatrics, adoption, and counselingfor children and families. Over the past 10years, the agency has developed a number of pro-grams for families with newborns and infants,including home-visiting, support groups, andindividual counseling. At the time of theresearch consultation, the staff was interested inunderstanding more about their home-visitingintervention and evaluating its effectiveness.

In their intervention called ‘‘Visiting Moms,’’community volunteers who were experiencedmothers were trained by the agency in activelistening techniques, problem-solving strategies,the postpartum experience, and stress in newfamilies. They provided free weekly supportivevisits over a period of up to 1 year for newmothers deemed at-risk by social service ormedical providers because of social isolation,a history of depression or anxiety, or lack ofresources. The relationship-based interventionoffered concrete assistance (e.g., holding a babywhile a mother takes a shower), educationalinformation (e.g., parameters of a normalinfant’s growth and development), and emo-tional support (e.g., listening to a mother’s fearsand doubts about her ability to care for her babyin the best way possible). Given the limitedamount of systematic data that the agency had

collected on this program and the nature of theinsights that the staff sought on the mothers�lives, we suggested that the agency employa qualitative methodology using in-depth inter-views to understand more thoroughly the partic-ipants� experiences as new mothers and theirperceptions of the impact of the home-visitorrelationship.

Sample

Purposive sampling was used to recruit a groupof 15 women from a variety of backgrounds whowere clients in this home-visiting intervention.Recruited women represented the range of pro-gram participants (e.g., partnered and single;urban and suburban; middle class, working class,and poor). Additionally, recruited women werethose thought to have had diverse experiences(positive, neutral, and negative) with the services.

Participating women had received 6–8 monthsof the year-long weekly intervention, approxi-mately 26–35 home-visits per woman. Themajority of the mothers were in their mid-30sand early 40s, with a mean age of 38 years (SD ¼4.7). Most were Caucasian from the UnitedStates, with two recent immigrants from Africaand Western Europe. Eleven out of the 15 weremarried, and 53% were of moderate income(yearly earnings between $30,000 and $60,000,blue- and white-collar jobs) by the agency’s inter-nal assessment scale. One respondent was livingbelow the poverty line. All but two had graduatedfrom high school, with 56% having had somecollege. Most women were first-time mothers,but two had older children living at home or else-where. Two of the women had given birth totwins. All women were referred to the programbecause of one or more of the following circum-stances: history of depression, current anxiety,few or no supports from family or friends, lack ofknowledge about mothering, tension in the mari-tal relationship, status as a single parent, and=orhaving a premature baby.

Respondents were all willing to share theirpostpartum experiences and their thoughtsabout their home-visiting volunteer.


Data Collection

An agency worker contacted the respondents andsecured their agreement to participate in oneinterview about their experiences with theirhome-visitor. The interviewer was a staff memberof the agency who had no previous contact withthe study respondents. Specific areas of inquiryin the semistructured interview with the motherincluded expectations of the home-visiting pro-cess (e.g., ‘‘What were you expecting from having aVisiting Mom?’’); description of the home-visitorrelationship and services offered (e.g., ‘‘How isyour relationship with your Visiting Mom differ-ent from your relationship with other people?’’and ‘‘What kinds of things do you do with yourVisiting Mom?’’); description of the mother’spostpartum period (e.g., ‘‘What was happeningfor you after the baby was born and you decidedto get a Visiting Mom?’’); and description of herrelationships with family and friends (e.g., ‘‘Werethere changes in your relationship with your hus-band/partner after the baby was born?’’).

Respondents were informed by the inter-viewer that the information provided wouldremain confidential. The interviews took place inthe respondents� homes to maximize convenienceand allow them ease in caring for their babies.Interviews lasted approximately 1 hour, and wereaudiotaped and later transcribed verbatim.

Analysis

Our analysis followed the guidelines recomm-ended by Leiblich, Tuval-Mashiach, and Zilber(1998) for analyzing qualitative interview datausing a categorical-content approach. In thismethod, coders focus most closely on the sec-tions of the interviews that best addressed thequestions at hand. These sections detailed therelational experiences of the mothers postpar-tum, and the subsequent interventions withtheir home-visitors. Using this method, otherparts of the interview were used to validate orcontextualize the findings where appropriate.

Initially, both authors each read four inter-views from the lens of RCT to identify contentcategories. To preserve the emotional quality of

the interviews, we used low inference descriptorsthat employ the participants� own words todefine the content areas (Kirk & Miller, 1986).If text was assigned the same code in three ormore interviews, it was considered significant.Transcripts were analyzed using multiple codes,so individual respondents could have describedall of the experiences noted in the results (e.g.,one mother could have had the experiences ofisolation, loneliness, and disconnection). Wethen conferred and considered alternative pos-sibilities until we believed that we had a clearidea of how to develop initial coding categories.Subsequently, the second author read the re-maining interviews and continued to code usingthe decided upon schema. We conferred everyfour interviews to ensure that the schema re-mained relevant and accurate given our researchquestions. Where necessary, we changed andcondensed coding categories. This process ofline-by-line coding (Charmaz, 2002) generatedseveral larger thematic categories. The softwareprogram ATLAS.ti (Version 4.2) was used fordata management and analysis.

Results

We identified seven general themes regardingthe women’s relational experiences in earlymotherhood and their perceptions of relation-ships with their home-visitors. Specifically, thesethemes were respondents� feelings of (a) isola-tion, (b) loneliness, and (c) disconnection fromother adults around them in the postpartumperiod, as well as experiences with home-visitorsthat were described as (d) providing a constantpresence in a time of change, (e) offering valida-tion of feelings, (f) affirming of their compe-tence as mothers, and (g) allowing them to feelconnected and taken care of.

Relational Experiences of New Mothers

In the context of describing relationships withtheir babies, families, and friends, the new moth-ers all spoke of the isolation and loneliness that


often led to disconnection. Regardless of whethera woman was responding to a question about herlife situation at the time of the referral, her expe-riences with her home-visitor, or her thoughtsregarding the program, she described in detailthe changes that ensued after the birth of herbaby and how those changes contributed to hervaried feelings about motherhood.

Isolation. All study participants experiencedsome feelings of isolation or separateness. Theyhad given birth during the winter months ina metropolitan area of the northeastern UnitedStates. For some, the isolation came from feel-ing homebound. Dressing an infant and navi-gating the cold and ice were daunting enough tokeep the women from venturing outside forsupport and interactions with others. Onewoman described her experiences of isolation inthis way: ‘‘I didn’t leave my bed for two weeks,and didn’t leave the house for a month, and Iwas going out of my mind.’’

Some felt isolated because they were immi-grants who had come to this country when theywere pregnant and had subsequently given birth;their family, social network, and familiar culturewere often an ocean away. Three women spokepointedly to this experience of isolation fromfamily and loved ones. The first said, ‘‘I wasexpecting my baby, and I was kind of depressedand lonely �cause I had no relative around me.’’The second said, ‘‘Because you really are inAmerica all by yourself.’’ The third said, ‘‘Whenyou came here, you don’t have a family; youdon’t have a family to help you.’’

Those women who were not immigrants alsofelt isolated because they experienced their fami-lies as unavailable. This lack of availability wassometimes due to geographic separations, lifecircumstances, or emotional distance. Onewoman described the reality for many newmothers: ‘‘When I came from the hospital mysister was working and all my friends were busy.I was all alone. I was here (at home), stranded.’’

Loneliness. For the majority of respondents(73%), becoming more aware of their isolationinevitably led to a feeling of loneliness or desola-tion. In addition to the isolation described

above, they spoke of other circumstances thatled to their feeling lonely. Chief among themwere the physical and emotional demands ofnurturing an infant 24 hours a day, 7 daysa week. One woman described the trapped feel-ing of pain and loneliness in a physical way, say-ing, ‘‘Sometimes I’m ready to tear my hairout . At the beginning, I was just sitting herebreast feeding and staring at the walls, and justso terribly uncomfortable in my entire body, Iwas just . really unhappy . ’’

Another type of loneliness was attributed tonot having their own mothers around. Themajority of the women (80%) had mothers whowere far away, not available emotionally, ordeceased. They wished for a senior mother whowould provide them with guidance, assistance,companionship, empathy, and a mutual under-standing of their new experiences. Threerespondents spoke specifically of their mothers�unavailability—1 mother was deceased and 2mothers were ill. The first said, ‘‘We’ve onlybeen up here about three and a half years orsomething . and my mom was living in Wash-ington, and she was relatively young and died,just suddenly, right after . [the birth].’’ Thesecond respondent said, ‘‘My mother is . sick,in a nursing home, so it’s not like she can .you know, she doesn’t even know who I am, shehas Alzheimer’s, so . there wasn’t anybody.’’The third respondent reported, ‘‘My mother hasan illness, so she’s not really able to be here thatoften. I was a little bit nervous as to how I wasgonna be able to handle the first baby.’’

The third form of loneliness came from thefrustrated attempts to share the new motherexperience with others who would understand.One respondent described her situation in try-ing to connect with friends: ‘‘My friends havebeen kind of . real busy. There’s one friend Ihave . she’s never really had any experiencewith babies.’’ For those women who were mar-ried, frustration was directed toward theirspouse as well. They felt that no matter howsupportive their husbands tried to be, nonecould understand the physical and emotionalchanges they experienced. In these quotes, two


women shared their thoughts about the limita-tions of their husbands� helpfulness and adjust-ment to parenting: ‘‘My husband sometimes isthe stressful part’’ and ‘‘In the beginning, hedidn’t exactly get it. He didn’t even know whatit was about . so I went through it for twomonths and he would, he would think it wasjust me being a wreck.’’

An additional element to the women’s expe-rience was the fact that most were unpreparedfor the intense feeling of loneliness and theinability to share it with anyone who wouldunderstand. They were surprised at how alonethey felt in mothering an infant. All respondentsplanned for the birth of their babies. A strategyfor financial support during the postpartumperiod often was developed such that they reliedon a husband’s income or support from govern-mental assistance or savings, or they developedother plans that necessitated returning to workwithin a few months postpartum. All strategiesrequired much emotional, economic, and logis-tical maneuvering. Given the difficulty of secur-ing support for this period, that one woman wascontemplating modifying her plan is notewor-thy and perhaps indicative of the magnitudeand challenge of these unexpected feelings ofloneliness. She said, ‘‘I find it very lonely! I findit quite lonely. So I don’t know . I thought Iwould be a stay-at-home mom for at least 2years. I might have to tweak that.’’

Disconnection. The feeling of disconnectionor detachment from other adults around themwas a prevalent response to new parenting. Forsome new mothers (n ¼ 9), this was sharply feltin relation to those from whom they once foundsupport and understanding, such as husbands.This disconnection might have been due to thechange in schedules that the couples had madeto provide care for their infants. Commentssuch as ‘‘We never see each other now’’ werecommon. For others, the disconnection camefrom feeling emotionally distant because eachfilled dissimilar roles in caring for the newborn;for example, the husband served as financialprovider and the wife served as daily caregiver.These changes were particularly notable for our

respondents in their mid-30s to early 40s, whohad been working for many years. Two newmothers described these challenges.

We have less time for each other, you know.He goes to work and it’s been financially diffi-cult for us, losing my paycheck. His schedule isso crazy. He’s mostly at work. So you know,it’s usually me and the kids.

Respondents evidenced an element of sur-prise at how disconnected they felt from friends,family, and partners. Some even felt discon-nected when they were in support groups fornew mothers. They reported that they could notrelate to the discussions of the other womenwho might have been younger or had moreabundant resources available to them. Onewoman related her experience in this way:

The first mom’s group I went to was horrible.I went to one, and I didn’t have anything incommon with any of the moms and they . allhave more money than we do, they all owntheir own homes, none of their husbands workseven days a week . people were looking atme like, ‘‘You don’t have a nanny?’’ or youknow, ‘‘The baby doesn’t have his own room?’’I mean, I felt like . not only do I have a babywho screams all the time, but he doesn’t havehis own nursery . I was a wreck.

Relationships with Home-Visitors

The relationships with home-visitors were over-whelmingly positive for these new mothers, yetfew understood what they were signing up forwhen they were referred by a social worker,nurse, or friend. One woman stated, ‘‘I didn’treally KNOW what to expect, actually. I justkind of jumped in . I just thought it wasa GREAT concept, the little that I knew’’[emphasis in original]. Other women clearlydescribed having hopes and expectations, butthey did not know whether those hopes andexpectations would be realized. A respondentshared, ‘‘I prayed to God to give me a nice


person to have [as] a friend, you know.’’Another said, ‘‘I was looking . anything tomake me feel less isolated and less lonely in thisnew task.’’ A third reflected, ‘‘I think it’s advice,I felt so incompetent at the time as a parent,somebody who could give advice as necessary.’’One woman emphasized the special difficultiesof being a foreigner in a strange culture withoutthe support of family and the subsequent help-fulness of a home-visitor. She said, ‘‘It’s veryuseful, especially for a foreigner, when you camehere you don’t have a family . you don’t havea family to help you.’’

We heard the importance of the home-visi-tors� support and empathic stance in therespondents� descriptions of the intervention.The connection with the home-visitor wasextremely important to all of the new mothersand formed the basis for the intervention’svalue. Respondents described different helpfulaspects of the relationship. Some were morearticulate in their descriptions of what specifi-cally was beneficial to them. We coded thesetranscript excerpts in the following ways: theVisiting Mom’s (a) being a constant presence,(b) providing validation, (c) offering affirmationof the mother’s competence, and (d) allowingfeelings of connectedness and being taken careof. All study respondents described some ofthese positive benefits from this home-visitingintervention.

Constant presence in a time of change. Manyof the mothers (n ¼ 9) felt isolated and over-whelmed caring for their infants and would nothave been able to make weekly appointmentsoutside the home. They discussed the impor-tance of their home-visitor initiating the weeklyappointment. The home-visitor called themother, asked when the best time was for a visit,and appeared consistently every week. That thehome-visitor began the process and reliably fol-lowed through weekly enabled the women tofeel connected with someone who was thinkingabout them and ultimately left them feeling lessisolated. Three respondents described theirexperiences: ‘‘It was useful just to have some-body there, someone coming in . or to know I

wasn’t gonna be alone with him’’; ‘‘She’s justkind of been a constant outside person whilethere’ve been all these changes going on’’; and‘‘I think it’s been . something really useful .having sort of a continuity of having . hercoming by every week, or almost every week .over a period of time.’’

Providing validation. We found that thehome-visitor used her listening skills to developa nonjudgmental and supportive relationship. Anumber of women (n ¼ 10) expressed relief innot being told how to parent. In some situa-tions, this feeling of validation or affirmationstemmed from the home-visitor demonstratingan acceptance of the mother’s mixed emotions.One woman described how she felt comfortableand affirmed in sharing both negative and posi-tive aspects of her mothering: ‘‘.just even mak-ing me feel that things are normal.that othermoms go through similar things, and she wentthrough similar things.’’ Another womandescribed the particular way she felt helped byher Visiting Mom saying, ‘‘It’s more just anaffirmation of �its all right that you’re feelingthis way right now� which has been very help-ful.’’ Similarly, a third woman described feelingvalidated by being able to share her authenticmixed feelings, something she was unable to dowith anyone else.

I just wanted there to be somebody else that Icould talk to about what was going on. I mean,�cause most people are just so . upbeat. ‘‘Oh,you’ve got a baby! That’s so WONDERFUL.Isn’t it so GREAT! Don’t you love your babyand everything!’’ And I was just in absolutepain and not in a good space. [emphasis inoriginal]

This woman went on to describe that she wasable to share with her Visiting Mom how badshe felt about these painful feelings, and howthis process eased her feelings of isolation.

Offering affirmation of mother’s competence.We saw that the home-visitors� affirmation ofthe new mothers was highly valued by themothers, because the home-visitors themselves


had experience in mothering. The home-visitors�affirmation of the new mother’s competence inthe form of reflecting on her already-obtainedskills in reading her baby’s cues was highly valuedby the mothers. By identifying and pointing outwhat the new mother was doing well and joiningwith her in the joy of her infant, the home-visitoraffirmed the new mother’s competence in thetasks of caring for her child. One new motherreflected on her home-visitor and said,

She’s let me know I’m doin� a good job. And Ithink sometimes I’m doing a good job, andsometimes . I don’t know. I mean, the babygets the attention and the love, and he’s suchagood kid. He’s happy, so, if he’s happy I knowI’m doin� somethin� right. You know? But . Idon’t know . she says that I’m doing good.And she seems to understand things I gothrough.

Another mother shared similar feelings: ‘‘Shehas been generally supportive in statements like�I’m a great mom . I’m doing the best I can�and she (baby) seems healthy so she’s given MEpositive comments that I really don’t hear fromother sources at this time.’’

Allowing feelings of connectedness and beingtaken care of. The new mothers described feel-ing better because they had someone withwhom to connect and share their troubling feel-ings. Their experience of being cared for by theirVisiting Mom in turn enabled them to feel lessalone. Three respondents described their experi-ence in this way.

I just felt connected and taken care of, and thatwas just a great resource to have. I felt like Icould bring up anything about new mother-hood and it wouldn’t phase her. I feel a lot bet-ter knowing there are people I can talkto . whether they don’t have a solution forme at least when you talk to someone that’sa relief.

Another woman detailed what she experiencedwith her Visiting Mom, saying,

So I really appreciate what I get out of it. I’dsay.the talking, having someone listen, some-one witnessing what goes on, was also impor-tant. Whether it’s with him (baby) or howdifficult he is or even relational stuff.

Discussion

This study describes the relational experiencesof 15 at-risk new mothers who were participantsin a home-visiting program. Broadly, the studyqueried them about their relationships withclose family and friends soon after their babieswere born, and their experiences with theirhome-visitor. Viewed through the lens of Rela-tional Cultural Theory, the results provide anin-depth understanding of the relationship chal-lenges and surprises that these women faced. Inaddition, the study describes how the partici-pants viewed their volunteer home-visitors asimportant sources of connection and support.From the mothers� descriptions, we were able totease out different types of loneliness and thediverse ways that they experienced help fromtheir home-visitors. Given the negative impactof isolation on women and infants, that thesenew mothers felt connected with someone whohad lived through similar life changes andunderstood the new mothers� experience is animportant finding.

Postpartum Relational Experiences

The women in our study reflect the millions ofmothers in the United States who experiencesome mild to moderate form of postpartum‘‘blues’’ (Epperson, 2002). The loneliness andisolation described by these participants is farmore common today than 50 years ago. Cur-rently, large numbers of women are living faraway from close family and often go throughtheir first parenting experience on their own.Even with advances in policy, such as the Familyand Medical Leave Act of 1993 (Public LawNo. 103-3), husbands or partners are back atwork within brief periods.


Few of the women in this study anticipatedthe social isolation that they later experienced.Most had partners whom they thought could bedepended on for support and connection. AsLogsdon et al. (1994) found, our participants�feelings of isolation and depression may beexacerbated by unmet expectations of husbands,family, or friends. Despite the increasing accu-mulation and dissemination of scientific knowl-edge to the public about postpartum mooddisorders (Cox, Murray, & Chapman, 1993;Epperson, 2002), most of the women studiedwere surprised by their feelings. Images of moth-erhood as glorious and fulfilling are promulgatedin the media, and thus are still the dominantexpectation of women having their first child. Inaddition, few expectant couples anticipate thedivergent psychological ways in which they mayenter parenthood, and hence they do not activelyanticipate the process or seek out the necessarysupports (Cowan et al., 1985). Although we onlyfocused on new mothers and not their partners,this theme emerged as a significant and painfularea of insight for them.

Relational Empowerment

RCT offered a useful framework for understand-ing mothers� lonely and depressed feelings, par-ticularly with regard to the isolation fromhusbands, family, and friends. Surrey (1991)described the difficulties when important con-nections cannot be sustained through a transition.‘‘When an important relational context cannotenlarge to allow for mutual experience and themovement of dialogue, women feel disempow-ered. If the connection feels severed there can bea sense of deadness . non-vitality’’ (p. 172).Our participants spent their postpartum daysand nights caring for their infants. Yet, like manyother women who desire meaningful connec-tions, they sought a ‘‘mutuality of understand-ing’’ with others around their new parentingexperience, and they were often disappointed.Although they may have experienced an intenseconnection with their babies, that was inade-quate. They needed to be able to share the expe-

rience with adults, such as husbands, partners, orother people to whom they were close. If thecontext of these relationships did not enlarge toallow room for the new mothering experience,the respondents felt alone and disconnected.

With their Visiting Moms, the new mothersfelt validated just knowing that they could sharehonestly the mixed emotions they experienced.The home-visitors did not expect them to feelor behave in any particular way, which enabledthe new mothers to voice real concerns aboutthemselves, their partners, and their babies. Ata time of increased isolation, the new mothersexperienced the home-visits as the high point oftheir week. This was an important constant intheir lives. For 1–2 hours the new motherscould share the feelings of being overwhelmed,ask questions that seemed ill-informed, or justhave someone else hold the baby. Sharing theseexperiences, even for a short time, enabled manyof the respondents to feel calmer, less alone, andsubsequently less disconnected from othersaround them. They experienced a kind of ‘‘rela-tional empowerment’’ (Surrey, 1991), wherefeeling ‘‘heard’’ enabled them to move into the‘‘action’’ of caring for babies and connectingwith others around them.

Volunteer Home-Visitors

Many mothers expressed feeling less isolatedand more able to care for their babies with thesupport of their volunteer home-visitor. Theresults were similar to those of Hiatt et al.(1997), who pointed out that paraprofessionalhome-visitors are important role models fornew mothers, particularly because they act as‘‘mentor-mothers’’ and not professionals. Inter-estingly, these findings could be viewed as con-trasting with the work of Olds et al. (1999),who question the efficacy of paraprofessionalhome-visitors. However, we think that our in-depth interviews and qualitative analysis meth-odology enable us to understand the mother’sperception of the intervention, and thereforeoffer another view of the use of paraprofession-als in home-visiting programs.


The meaning of the volunteer status of thehome-visitors and the importance placed on itby the new mothers was not thoroughlyexplored here. However, respondents reportedthat it was a significant element in the interven-tion, similar to findings in the Australian pro-gram (Taggart et al., 2000). Our participantsappreciated that the home-visitors took theirown time to help them. This may contribute tothe new mothers� perceptions of the authenticityof the relationships and the feeling that thehome-visitor was like a much-needed friend.

Importantly, the study is not without limita-tions. Participants were a small number ofmostly Caucasian women in their middle to late30s who were part of a specific agency-basedintervention in one region of the country. Thesample size and population limits its generaliz-ability to any larger group of women. The depthof qualitative information affords insight intothe processes at work in these types of home-visiting interventions, but it does not allow us tomake any causal connections.

Implications for Clinical Practiceand Program Development

This volunteer paraprofessional home-visitingintervention based on a relationship model canserve as a template for other community agen-cies. The usefulness of paraprofessionals hasbeen demonstrated (Hiatt et al., 1997; Taggartet al., 2000). Our findings take the field onestep further in highlighting the importance offocusing on the relationship between the at-riskmother and the home-visitor. A consistenthome-based weekly intervention that serves tovalidate the mixed emotions that can accom-pany new motherhood, affirms a mother’s com-petence in the ways that she cares for her baby,and offers support to break through a newmother’s isolation is likely to prove helpful witha low-to-moderate-risk population in reducingisolation and bolstering the parent-infant rela-tionship. Training volunteer paraprofessionals

who are experienced mothers uses the popularconcept of senior mentors for women who facea challenging life experience (Cowan & Cowan,2000). In addition, given the profound types ofisolation and loneliness described by study par-ticipants, any intervention aimed at improvingthe postpartum period and the mother-infantrelationship needs to screen for and address sub-clinical and clinical depression.

The new mothers� feelings of isolation andloneliness also could be addressed through cou-ples groups, such as those described by Cowanand Cowan (1995), that anticipate parenthoodand educate participants about the differentways that women and men adjust to the newparenting role. Our results suggest that thesesessions should discuss postpartum ‘‘blues’’ asone common aspect of becoming a parent, andthe need to maintain communication betweenpartners and with outside friends and family.Singles or couples should develop support plansfor the weeks and even months after their babyarrives. Mental health practitioners connectedwith labor and delivery clinics could routinelydiscuss the importance of open communicationin the couple’s relationship and the high level ofsupport needed during the postpartum period.

Given our findings and the fact that few stud-ies have evaluated volunteer home-visiting pro-grams, future research should use methods toassess objective outcomes over time, such asreduction in depression, isolation, and other riskfactors and increases in parenting efficacy.Results should be tested on larger and morediverse samples, such as younger women, Afri-can-American, Latina, Asian and other ethnic orracial minority women, and immigrants and ref-ugees who struggle with extreme disconnectionsin a new country. Often, these are the targetpopulations for current home-visiting interven-tions. In addition, future studies should usea broader perspective to include fathers andother close family members. A family perspectiveis emerging in many types of home-visiting pro-grams, but mothers still remain the primary ser-vice recipients. Studies over the past 20 yearsdelineate the importance of fathers and partners


in children’s growth and development and incomposing the supportive unit for mothers andinfants in the early postpartum period (Lamb,2002; Palkovitz, 2002; Paris & Helson, 2002).Finally, although this study did not focus on thevolunteers, it is important to increase our under-standing of these types of home-visitors becausesuch information is essential for determining howto best plan and supervise staff to retain them.

References

Atlas.ti v4.2. (2002). Visual qualitative data analysis, management and theorybuilding. Berlin, Germany: Scientific Software Development.

Blumfield, W. (1992). Life after birth: Every woman’s guide to the first year ofmotherhood. Rockport, MA: Element.

Charmaz, K. (2002). Qualitative interviewing and grounded theory analy-sis. In J. F. Gubrium & J. A. Holstein (Eds.), Handbook of interviewresearch (pp. 675–694). Thousand Oaks, CA: Sage.

Cowan, C. P., & Cowan, P. A. (1995). Interventions to ease the transitionto parenthood: Why they are needed and what they can do. FamilyRelations, 44, 412–423.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: Thebig life change for couples. Mahwah, NJ: Erlbaum.

Cowan, P. A., Cowan, C. P., Heming, G., Garrett, E. T., Coysh, W. S.,Curtis-Boles, H., & Boles, A. (1985). Transmissions to parenthood: His,hers, and theirs [Special issues]. Journal of Family Issues, 6, 451–481.

Cox, J. L., Murray, D., & Chapman, G. (1993). A controlled study of theonset, duration and prevalence of postnatal depression. British Journalof Psychiatry, 163, 27–31.

Epperson, N. (2002). Postpartum mood changes: Are hormones to blame?Zero to Three, 22, 17–23.

Feinberg, M. E. (2002). Coparenting and the transition to parenthood: Aframework for prevention. Clinical Child and Family Psychology Review,5, 173–195.

Gomby, D. S., Culross, P. L., & Behrman, R. E. (1999). Home visiting:Recent program evaluations: Analysis and recommendations. TheFuture of Children, 9, 4–26.

Graham, J. E., Lobel, M., & Stein Deluca, R. (2002). Anger after child-birth: An overlooked reaction to postpartum stressors. Psychology ofWomen Quarterly, 26, 222–233.

Heinicke, C., & Ponce, V. (1999). Relation-based early family interven-tion. In D. Cicchetti, & T. Sherre (Eds.), Developmental approaches toprevention and intervention (pp. 153–191). New York: University ofRochester Press.

Heinicke, C. M., Ruth, G., Recchia, S. L., Guthrie, D., Rodning, C., &Fineman, N. R. (1999). Relationship-based intervention with at-riskmothers: Outcome in the first year of life. Infant Mental Health Journal,20, 349–374.

Hiatt, S. W., Sampson, D., & Baird, D. (1997). Paraprofessional homevisitation: Conceptual and pragmatic considerations. Journal of Com-munity Psychology, 25, 77–93.

Jordan, J. V., Kaplan, A. G., Miller, J. B., Stiver, I. P., & Surrey, J. L.(1991). Women’s growth in connection: Writings from the Stone Center.New York: Guilford Press.

Kaplan, A. G. (1991). The ‘‘self-in-relation’’: Implications for depressionin women. In J. V. Jordon, A. G. Kaplan, J. B. Miller, I. P. Stiver, &J. L. Surrey (Eds.), Women’s growth in connection (pp. 206–222). NewYork: Guilford Press.

Kirk, J., & Miller, M. (1986). Reliability, validity and qualitative research.Beverly Hills, CA: Sage.

Lamb, M. E. (2002). Infant-father attachments and their impact on childdevelopment. In C. S. Tamis-LeMonda, S. Catherine, & N. Cabrera(Eds.), Handbook of father involvement: Multidisciplinary perspectives(pp. 93–117). Mahwah, NJ: Erlbaum.

Lieberman, A. F., & Pawl, J. H. (1993). Infant-parent psychotherapy. InC. H. Zeanah, Jr. (Ed.), Handbook of infant mental health (pp. 427–442). New York: Guilford Press.

Lieblich, A., Tuval-Mashiach, R., & Zilber, T. (1998). Narrative research:Reading, analysis, and interpretation. Thousand Oaks, CA: Sage.

Logsdon, C. M., McBride, A. B., & Birkimer, J. C. (1994). Social supportand postpartum depression. Research in Nursing and Health, 17, 449–457.

Lyons-Ruth, K., Connell, D. B., Grunebaum, H. U., & Botein, S. (1990).Infants at social risk: Maternal depression and family support services asmediators of infant development and security of attachment. ChildDevelopment, 61, 85–98.

Mayes, L. (2002). Harris programs in perinatal mental health at the YaleChild Study Center. Zero to Three, 22(6), 24–25.

Miller, J. B., & Stiver, I. P. (1998). The healing connection: How womenform relationships in therapy and in life. New York: Guilford Press.

Nicolson, P. (1998). Post-natal depression. New York: Routledge.O’Hara, M. W. (1994). Postpartum depression: Causes and consequences.

New York: Springer-Verlag.Olds, D. L., Henderson, C. R., Kitzman, J. F., Eckenrode, J. J., Cole,

R. E., & Tatelbaum, R. C. (1999). Prenatal and infancy home visita-tion by nurses: Recent findings. The Future of Children, 9, 44–65.

Palkovitz, R. (2002). Involved fathering and child development: Advancingour understanding of good fathering. In C. S. Tamis-LeMonda,S. Catherine, & N. Cabrera (Eds.), Handbook of father involvement:Multidisciplinary perspectives (pp. 119–140). Mahwah, NJ: Erlbaum.

Pancer, M. S., Pratt, M., Hunsberger, B., & Gallant, M. (2000). Thinkingahead: Complexity of expectations and the transition to parenthood.Journal of Personality, 68, 253–280.

Paris, R., & Helson, R. (2002). Early mothering experience and personalitychange. Journal of Family Psychology, 16, 172–185.

Slade, A. (2002). Keeping the baby in mind: A critical factor in perinatalmental health. Zero to Three, 22, 10–16.

Surrey, J. (1991). Relationship and empowerment. In J. V. Jordon,A. G. Kaplan, J. B. Miller, I. R. Stiver, & J. L. Surrey (Eds.), Women’sgrowth in connection: Writings from the stone center (pp. 162–180). NewYork: Guilford Press.

Taggart, A. V., Short, S. D., & Barclay, L. (2000). ‘‘She has made me feelhuman again’’: An evaluation of a volunteer home-based visiting projectfor mother. Health and Social Care in the Community, 8, 1–8.

Weinberg, M. K., & Tronick, E. Z. (1998). Impact of maternal psychi-atric illness on infant development. Journal of Clinical Psychiatry, 59,53–61.


staying connected while nurturing an infant: a challenge of new motherhood

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