PREPARATION FOR PARENTHOOD INTRODUCTION TRENDS AND THE EVOLUTION OF FAMILIES AND PARENTING CHILDBIRTH PREPARATION THE TRANSITION

TION TO PARENTHOOD PARENTING AND THE PROVISION OF CHILD CARE PARENTING IN UNIQUE CIRCUMSTANCES: SINGLE-PARENT FAMILIES GAY AND LESBIAN PARENTS WOMEN WITH PHYSICAL CHALLENGES FUTURE TRENDS REFERENCES INTRODUCTION The proce o! prep"r#$% !or p"re$&hoo' co$ # & o! " er#e o! &ep ( e"ch o! )h#ch pre e$& *$#+*e ch",,e$%e "$' '#,e--" . Th# ch"p&er e/p,ore &he &"%e o! prep"r"&#o$( 0e%#$$#$% )#&h &he 'ec# #o$ &o 0eco-e " p"re$&( "$' pro%re #$% &hro*%h cho#ce re%"r'#$% -o'e o! 0#r&h( &he #-p"c& o! $e) p"re$&hoo'( "$' ch#,' c"re # *e . F#$",,1( &he pro0,e- &h"& p"re$&hoo' pre e$& #$ e2er", ,e co--o$ c#rc*- &"$ce "re '# c* e'. TRENDS AND THE EVOLUTION OF FAMILIES AND PARENTING

Preparing for parenthood begins with the decision to become pregnant, or the discovery of pregnancy in an unplanned circumstance. Fifty years ago, unreliable or unavailable contraceptive methods resulted in parenthood for couples regardless of readiness. In addition, couples suffering from infertility or repeated miscarriages had few options and generally accepted their inability to become pregnant, ultimately seeking other parenting options, such as adoption. In recent decades, the availability of effective and reliable contraception and sterilization techniques has given many the opportunity to chose the timing of parenthood. Advanced reproductive technologies now enable many couples with infertility problems to achieve a desired pregnancy. For some couples, the decision to become pregnant is carefully weighed against the impact that pregnancy and birth will have on their careers, lifestyles, financial status, and marital relationship. thers consider the repercussions of pregnancy and parenthood only briefly, or not at all. !espite a recent decline in the rate of unintended pregnancy among adolescents, college graduates, and wealthy women, the number of unintended pregnancies increased among less educated, poor, and minority women." #tatistical reports of birth and fertility rates reveal interesting childbearing trends. $istorically the birth rate for teenagers increased at an annual rate of %&'(, peaking in "))*. #ince then, the birth rate for teenagers hasdeclined +,(, a trend attributed to consistent contraception use and delay in se-ual activity.., + $owever, in .**/ the birth rate in the 0nited #tates for teenagers age "%&") rose une-pectedly by +(., 1hildbearing among women +* years of age and older has also shown an increase 2Fig. ".3. 4he pursuit of advanced education, careers and the necessity for two5income families has been largely responsible for the dramatic phenomenon of delayed childbearing. In addition, all measures of unmarried childbearing has risen )&".( per year. 6irths to unmarried women constituted +'( of all 0# births in .**%. 4he recent increases in nonmarital birth rates have been especially notable among women age .% and older.
CHILDBIRTH PREPARATION

4he choices encountered by women and their partners for their childbirth e-perience have undergone remarkable changes throughout the twentieth century. ne hundred years ago in the early ")**s midwives attended most of the births in the 0nited #tates in the mother7s home. As the training of physicians began to include obstetrics, use of anesthesia, and other advancing technologies, the place of delivery moved from the home to the hospital. In ")+8 %*( of births were in the home, most births were conducted by physicians rather than midwives. 6y ")%% only "( of babies were born at home. 4hat number has not changed in .**'. As medicine became more specialized, obstetricians attended increasing numbers of births, while general practice and midwife numbers declined. 1ertified nurse5midwives have been attending increasing numbers of births in recent decades to appro-imately ""( of 0# vaginal deliveries. 4his rise can be attributed to rising consumer preferences for birth alternatives and a falling number of obstetricians and family practice physicians attending births due to rising malpractice costs. 4oday7s certified nurse5midwives are registered nurses with advanced obstetric and gynecologic training, typically at the master7s degree level, who practice most commonly in a hospital setting in collaboration with a physician. 1ertified Professional 9idwives 2formerly known as :lay: midwives3, who learn and attend births through apprenticeship and non university5 based programs, generally deliver babies in the home. ;icensure and regulation of 1P9s varies state to state. Physicians trained in the specialty of family practice and maternal5child health are emerging as providers of maternity care, having the unique and valuable ability to provide intergenerational continuity of care for mothers, infants, and their families. 6ecause obstetric care has become more diverse and specialized, women can choose their type of care according to their particular needs and risks. <omen can choose an obstetrician, family physician, or nurse5 midwife for their prenatal care and delivery. Although they often overlap, the traditional and alternative or =noninterventive> models of health5care delivery emerge as a directive in this choice. 4he routine or traditional management of the birth process, including the use of technologies such as continuous fetal monitoring, epidural anesthesia, intravenous infusion, and episiotomy, are issues that a woman may consider when choosing her provider. A noninterventive approach that facilitates the natural processes of labor and birth with minimal use of routine interventions or analgesics is preferred by some women, while at the same time other women are choosing elective primary cesarean sections. 4he preparation for pregnancy and parenthood is becoming more consumer5oriented, and women are selecting their provider based on their personal philosophy and desires for their birth e-perience. ;ess than "( of 0# births occur at home? the ma@ority of women in the 0nited #tates choose to give birth in a hospital. Free5standing birth centers have recently become available in some locations as an alternative birth site, with ./( of out5of5hospital births occurring in free5standing birth centers.) 4he safety of out5of5hospital births 2free5standing birth centers or home birth3 is an ongoing topic of dispute. 9any issues surface, including claim to ultimate responsibility and control of the birth, safety, economics, and the right of a woman to choose her place of birth. #tudies evaluating the relative safety of home, birth center, and hospital birth are difficult to analyze due to the difficulty in designing well5controlled, prospective, randomized trials. A-isting studies report that the overall intrapartum and neonatal mortality rates in birth centers and planned home births are comparable to that of low5risk hospital births,"*, "", ". asserting that they are a safe alternative to hospital birth. $owever the formal position of the American 1ollege of bstetricians and Bynecologists recommends the hospital or free5standing birth center as the safest place to give birth."+ 1hildbearing women and their partners are almost universally encouraged to participate in childbirth education classes. Although some women choose not to take advantage of these classes, the benefits that can be derived from them warrant careful consideration. 1ommunity5based prenatal classes, ;amaze, 6radley, $ypno6irthing and other methods differ in their philosophy and techniques. Carious other classes are also available, including ones that focus on breastfeeding, cesarean birth, prenatal e-ercise, newborn care, sibling preparation, child care, and more. 4he main emphasis of most childbirth preparation classes is upon the birth process per se, and unfortunately little attention is given to infant care skills or the impact a new baby will have on the marriage, careers, lifestyle, and financial state of the new parents. 4his aspect of preparation for parenthood is largely left to personal e-perience.

1losely associated with the choices of health5care provider, delivery locale, and childbirth education are the decisions involving the birth e-perience itself. In hospital birth settings, there is a choice of natural childbirth, narcotic analgesia, or epidural anesthesia for pain management. #ome women will devise a =birth plan> to facilitate discussion of alternative positions for labor and birth, use of interventions such as amniotomy, intravenous fluids, episiotomy, and labor stimulation. Further preferences must be considered for the postpartum periodD breast or bottle feeding, circumcision, return5to5work plans, child5care providers, and so on. 4he broad spectrum of choices available to childbearing women in the ."st century is far different from the traditional paradigm employed only a few decades ago.
THE TRANSITION TO PARENTHOOD

4he heath5care provider is generally in close communication with a woman throughout her pregnancy and immediate postpartum period. nce the event of birth has occurred, however, new parents are left to rely on intuition, family advice, past e-periences, child5care books, or telephone help lines. Few classes focus e-clusively on teaching parenting strategies, skills, and e-pectations. Advice is proffered from family, friends, health5care professionals, and complete strangers. 4his advice is often conflicting and confusing. Parenting approaches used by previous generations are considered by some to be outmoded and even harmful, and the =authorities> may offer contradictory advice. 4he numerous parenting5education strategies employ differing philosophies about what works. Although there are educational books that describe the application of these strategies in detail, few couples prepare for this aspect of parenthood before the birth of their child, and few new parents have time afterward. 4here has been a century of child development research and advice dedicated to helping parents to parent their children. Eew parents soon become overwhelmed with the amount of information and opinion. Five media e-perts have written and spoken e-tensivelyD 6en@amin #pock, 4. 6erry 6razelton, Fames !obson, Penelope ;each and Fohn Gosemond. 4heir advice is often contradictory and not always consistent with the scientific evidence. 4he vast amount of decades of research is daunting and therefore largely not accessible to the general public. Hey controversial issues such as child care, working mothers, discipline, and electronic media stand out as concerns of new parents that must be addressed soon after the baby is born.",, "%, "/ !ata suggests that parenting educational programs can make a significant contribution to the short5term psychosocial health of mothers. $owever, there is little evidence concerning whether these results are maintained over time, and there is limited follow5up information. 9ore research is needed to determine effective parenting programs and the factors affecting successful outcomes."' <hen a baby is born, important developmental changes occur in a family. 4he marital relationship of the parents is altered and the child becomes incorporated into the family. 4he relationship between marriage stability and parenthood has been largely studied. In ")%', ;e9asters"8 was among the first to report a decline in marital satisfaction after the birth of a child. #ubsequent longitudinal studies have also suggested a decline in marital satisfaction associated with parenthood."), .*, .", .., .+, ., 4he changes in marital satisfaction and period of ad@ustment caused by the birth of a child should be of great concern to health5care providers. Benerally, it is the ongoing prenatal and postpartum relationship between the patient and the physician, midwife, andIor pediatrician that will reveal marital conflict or family dysfunction precipitated by pregnancy or childbirth. #ocial support services or family counseling may be necessary in cases of unresolved conflict or crisis in the young family.
PARENTING AND THE PROVISION OF CHILD CARE

4he parent&child relationship is central to a child7s moral development, social behavior, and ultimate attainment of adult independence. 4he fact that the mother and father are the most important people in the growing child7s life prompts particular concern for the growing number of children in child care outside the family. 4he care of young children was once considered the responsibility of the family and e-tended family. In the ")th and early .*th centuries, grandparents played an instrumental role in religious training, education, and child care. $owever, the migration of families from rural to urban settings and economic changes characterized by an e-panding white collar workforce resulted in a shift to functional support systems outside the family and a

diminished role for grandparents. !ata obtained from the .*** 0# 1ensus do not indicate whether there is a trend in grandparent involvement in parenting because it was the first time the question was asked, although recent data suggest an increase. In .**/, 8 ( of households with children under "8 lived with at least one grandparent..%, ./ 9ost discussions about parenting and child care are intimately linked with the mother. 4raditionally, the mother was considered the childrearer and the father the breadwinner. 4he women7s movement, however, brought about a social change in the family roles of men and women, resulting in more shared childrearing. 4his change has not been without conflict, as women feel pressure both to stay at home to care for their children and to return to work. Amployed mothers feel guilt and doubt about their child5care competence, whereas women who stay at home report a loss of social or professional standing. <omen have become divided over employment status, choosing sides for what is viewed as best for the children. In response to this societal change, the demand for quality child care has become a ma@or issue in government policy, the women7s rights movement, and employee5benefit negotiations..' 4he increasing number of dual5provider households has generated a flurry of research and books written designed to evaluate the e-pected negative impact of supplementary day care on a child7s development. Gesearch indicates, however, that substitute care has little effect on a child7s emotional attachment, intellectual development, attention deficit disorder or social relationships. It appears that children who are enrolled in day care are similar developmentally to those reared by their parents at home.",, "/, .8 4here is no easy solutionD ma@or attitudinal change by those who determine government and employee policy is needed in order to support the children of working mothers. 4he involvement of fathers in parenting has changed dramatically in recent years. Part of this is due to an increase in the number of working mothers and changes in family demographics 2such as divorce3, necessitating a more active and shared role in parenting responsibilities by the father. 4he removal of obstacles to paternal participation in pregnancy and birth, and the impact of studies documenting the positive impact of the father7s role on child well5being has also contributed to increased involvement. Fathers are attending childbirth classes, providing support during labor and birth, and learning basic infant5care skills to prepare for their new role. 4his is not without its drawbacks, however. Father participation has become expected rather than optional, an attitude nearly e-clusive to the American middle class..) 4wo problems ariseD ". Fathers who choose not to participate are sometimes regarded with suspicion or malice by health5care providers. .. Participation may not be appropriate for all fathers. 9ore research is needed to determine the association between father participation and father&infant bonding, the marital relationship, and confidence in infant5care skills. $owever, important confounding variables such as perception, motivation, and e-pectations interfere with the interpretation of the information..., +*, +" 4oday7s fathers are much more involved in the care and nurturing of their children. 4his new role has contributed to the stress of the transition to parenthood, as the father is viewed as financier, stabilizer, companion, and caretaker. ;earning how to be an effective parent is a challenging task discovered mostly through trial and error. $ealth5care providers must acknowledge the pressure that is placed on today7s fathers to perform efficiently in various roles. Further, this recognition must be coupled with understanding, compassion, and support for their transition into parenthood.
PARENTING IN UNIQUE CIRCUMSTANCES: SINGLE-PARENT FAMILIES

#ingle5parent families are becoming more commonplace. 4he birth rate for unmarried women aged "%&,, rose to ,'.% births per "***, the highest rate in more than si- decades.) 4he proportion of non5marital births to teenagers continues to fall, while the birth rate for women ages +%&+) continues to increase, rising %.( since "))*. 4he factors responsible for this increase cannot be precisely determined, although it is known that a growing number of unmarried women of childbearing age are postponing marriage, and an increasing number

of marriages are ending in divorce. It is estimated that one of every five families with children less than "8 years of age are headed by a single parent. 9others continue to be the children7s primary caretaker, with almost '%( of single5parent families maintained by the mother.+. 4hese families are characterized by a high rate of poverty and minority representation, low educational levels, and high mobility. 4he economic and social needs of this group are enormous. #ingle5parent families can be divided into three typesD 2"3 single parenting as a result of divorce or death? 2.3 unplanned single parenting? and 2+3 =elective> single parenting. !ivorce America7s divorce rate has declined from its peak in ")8" to its lowest level since ")'*. Peaking at %.+ divorces per ",*** people in ")8", it began a slow decline to +./ in .**/. 4he reason for the decline is attributed to an increase in the number of couples who live together and a falling rate of marriage. 4he number of couples who live together without marrying has increased tenfold since ")/*? the marriage rate has dropped by nearly +*( in past .% years? and Americans are waiting about % years longer to marry than they did in ")'*. It is estimated that nearly half of all American children will e-perience the breakup of their parents7 marriage before the age of "8 years, and nearly one5third of children will live in a single5parent home 2Fig. .3.+., ++ For divorcing families, there has been little change in custody arrangements over the past "% years, despite e-pert predictions to the contrary. 4he effect of divorce on parents and children will vary for different members of the family and generally involves an e-tended ad@ustment period. 9any of the parenting responsibilities previously shared as a couple will fall upon the custodial parent. 4he stresses and difficulties in coping that are e-perienced by families in which the parents are divorced can lead to disturbances in personal and social ad@ustment of the child. 4his fact is countered, however, by the knowledge that divorce may be a positive solution to destructive family functioning. 4he long5term effects of divorce are still controversial although evidence suggests that children of divorced parents eventually were functioning as well as non5divorce homes.+,, +% Affective social support systems must be identified and developed that will help the family ad@ust to the parental changes associated with divorce.

Figure 2. 2004

Percentage of children ages 017 living in various family arrangements,

#ourceD Federal Interagency Forum on 1hild and Family #tatistics. Americas Children: Key National Indicators of Well-Being, !!". Federal Interagency Forum on 1hild and Family #tatistics, <ashington, !1D 0# Bovernment Printing ffice.

0nplanned Parenting 4he number of unplanned pregnancies continues to escalate despite the availability of effective contraceptive methods. Geasons for this phenomenon have been proposed by various theories, including the intrapsychic conflict theory, which postulates unconscious desires to manifest fertility? and theories of complecontraceptive risk5taking behavior. Adolescent pregnancy is a matter of great public concern, as the rate which had been falling since "))", showed an increase in .**/. Parenthood at an early age, not only affects the educational and social prospects for the adolescent mother, but also infants born to teenage mothers are at risk for poor birth outcomes such as low birthweight and preterm birth.) Gesearch results have found that adolescent parents have high levels of stress, inadequate social support, poor knowledge of child development, and inappropriate childrearing attitudes.+/, +', +8 9ost teenage mothers live at home with a parent or parents, the ma@ority keeping their babies. 4he ability of an adolescent to parent in a manner that promotes optimal child development is difficult to evaluate and longitudinal studies are minimal.+/, +), ,*, ," <hile most teen pregnancies can be established as unplanned, unplanned parenting among other age groups is more difficult to differentiate. 4he recent rise in unmarried and nonmarital childbearing does not necessarily indicate that the pregnancies were unplanned, as delayed childbearing and a simultaneous rise in cohabitation make such statistics meaningless. Alective #ingle Parenting Alective single parenting has become more acceptable and popular in the past decade. <omen who choose to become a parent without the involvement of a partner typically come from two groupsD those who have become discouraged with or @aded toward men in general? and those whose advancing age necessitates their becoming pregnant while they are still biologically able. For some this represents an ethical dilemmaD personal attitudes regarding the upholding of a traditional family structure interfere with willingness to make modern reproductive options, such as artificial insemination, available to these women.,. 4here is some concern about the financial stability of elective single mothers and the lack of male role models for their children, believing that these factors may stunt the child7s social and cognitive development.,+ $owever, studies indicate that children raised by their mothers alone have no adverse effect on mothers7 parenting ability or the psychological ad@ustment of the child.,, 9any centers of reproductive medicine require a psychological profile to evaluate factors underlying the desire for elective single parenting.
WOMEN WITH PHYSICAL CHALLENGES There # " %ro)#$% $*-0er o! )o-e$ )#&h '# "0#,#&#e )ho "re #$&ere &e' #$ pre%$"$c1 "$' 0eco-#$% -o&her . Tech$o,o%#c", "'2"$ce #$ pec#",#3e' "'"p&#2e e+*#p-e$& "$' "$ #$cre" e #$ oc#", er2#ce o!!er %re"&er oppor&*$#&1 !or )o-e$ )#&h ph1 #c", ch",,e$%e &o co$ #'er pre%$"$c1( ,"0or( 0#r&h "$' ch#,'re"r#$%. Wo-e$ )#&h !*$c&#o$", ,#-#&"&#o$ "re -ore ,#4e,1 &o 0e o2er)e#%h&( -o4e( h"2e h1per&e$ #o$( "$' e/per#e$ce -e$&", he",&h pro0,e- )h#ch co-p,#c"&e pre%$"$c1.56 There # 2er1 ,#&&,e re e"rch "''re #$% &he pec#!#c repro'*c&#2e $ee' o! )o-e$ )#&h '# "0#,#&#e . E2#'e$ce *%%e & &h"& )o-e$ )#&h '# "0#,#&#e "re -ore ,#4e,1 &o 'e,#2er pre&er- "$' ,o) 0#r&h)e#%h& #$!"$& "$' h"2e -ore ho p#&", "'-# #o$ '*r#$% pre%$"$c1( ce "re"$ 'e,#2er#e ( "$' re"'-# #o$ )#&h#$ 7 -o$&h o! 'e,#2er1.58 Rece$& 9o*r$", "r&#c,e h"2e he,pe' &o #$cre" e ")"re$e o! he",&h c"re pro2#'er #$ &he pec#!#c # *e .5:( 57( 5; He",&h-c"re pro!e #o$", "$' &he p*0,#c -* & 0e e'*c"&e' &o re'*ce &he &ereo&1pe o! he,p,e $e "$' p" #2#&1 o!&e$ " oc#"&e' )#&h '# "0,e' )o-e$. E!!or& h"2e 0ee$ -"'e &o pro2#'e p*0,#c "cce ( "$' &ech$o,o%#c", "'2"$ce h"2e pro2#'e' &he oppor&*$#&1 !or -"$1 )o-e$ &o !*$c&#o$ #$'epe$'e$&,1 "& )or4 "$' "& ho-e. Wo-e$ )ho "re '# "0,e' -* & co$ #'er &he "-e !#$"$c#", "$' e-o&#o$", !"c&or o! p"re$&hoo' " $o$'# "0,e' )o-e$ &h"& )#,, #-p"c& &he#r ,#2e . I$ or'er !or p"re$&hoo' &o 0e " re",# &#c op&#o$ !or &he e )o-e$( "'9* &-e$& #$ ,#2#$% "rr"$%e-e$& -"1 0e $ece "r1( "$' " %re"&er r"$%e o! *ppor&#2e er2#ce # o!&e$ re+*#re'. Th* ( &he !#$"$c#", co & o! p"re$&hoo' -"1 0e %re"&er( &he prep"r"&or1 e!!or& -ore #$2o,2e'( "$' &he ph1 #c", re+*#re-e$& -ore ch",,e$%#$% "-o$% &he e )o-e$ &h"$ "-o$% )o-e$ )#&ho*& '# "0#,#&#e .

FUTURE TRENDS

9ore mothers than ever are in the workforce, and consequently more children are in alternative child5care settings. 4his is not likely to change, as two incomes are becoming increasingly necessary to meet household costs of living. 4he impact of increasing numbers of working mothers is far5reaching. Alternative child5care settings will increase in number, thus increasing the concern over their quality, size, and accessibility. Bovernment representatives and employers must recognize the need for ma@or changes in policy to assist working mothers and their children. 4here is a wide spectrum of choices available to women preparing for childbirthD birth attendant, birth setting, childbirth education classes, and various procedures and medications proffered during the birth itself. 4he trend for consumer involvement and control is likely to continue as women become more knowledgeable about their own health care. 4o meet the needs of childbearing women, prudent health5care providers and hospitals will keep abreast of consumer requests for birthing alternatives. #ingle5parent families are more commonplace today because of high divorce rates, unplanned parenting, and elective single parenting. Eontraditional parenting arrangements chosen by single professional women and homose-ual couples are occurring more frequently, challenging societal norms and changing definitions of parenthood and family.
REFERENCES http://www.glowm.com/section_view/hea ing/P!epa!ation"#$%o!"#$Pa!enthoo /item/&&$

Preparation for Parenthood Classes ee! 1 Planning for the "irth # "irthing $ptions 6asic anatomy and physiology #tages of labour <hen to come to the hospital I admissions 4herapeutic and non therapeutic options during the birthing process 1oping strategies I rela-ation strategies 1aesarian section and une-pected outcomes ee! 2 Postnatal Care of the %other $ospital stay and preparing for discharge 1ommunity support &our ne' "a(y 1haracteristics of the newborn Goutine practices and newborn care #trategies to cope with the new baby !emonstration and active participation in baby care ee! )

*nfant feeding and Physiotherapy Aducation and information about feeding newborns Physiotherapy tips for antenatal and postnatal care