In the past several decades there have been dramatic changes in hospital practices and policies regarding the presence of family and friends in the labor and delivery rooms. The presence of support persons during childbirth has been considered a protective factor in the transition to motherhood, especially for young and first-time mothers who may be more susceptible to stress during this transition (e.g., Troutman & Cutrona, 1990). The present study explores factors related to the presence of support figures during childbirth within a sample of young urban mothers. Particular attention will be focused on those mothers who came to childbirth without support from family and friends.

Methods Two hundred forty one African-American women between the ages of 13 and 21 (mean age 17.6 years) were interviewed during the second trimester of pregnancy, during the postpartum period in the hospital, and at 4-months postpartum. All mothers were recruited through the prenatal clinics of a major urban teaching hospital. Most were unmarried and giving birth for the first time.

In the prenatal period, the mothers were administered a variety of scales to assess their psychosocial adjustment, including the Center for Epidemiological Studies Depression Scale (CES-D) (Radloff, 1977), the Parental Acceptance Rejection Questionnaire (PARQ) (Rohner, 1980), and a shortened version of the Conflict Tactics Scale (CTS) (Straus, 1979). The Labour Agentry Scale (Hodnett & Simmons-Tropea, 1989) was administered the day after birth.

Results 167 (69.3%) of the mothers were accompanied to the birth by their own mother or other mother figure. 139 (57.7%) of the mothers were accompanied to the birth by their infants' father. A large variety of other family members and friends were present at births as well. Only 10 mothers (4.1%) were not accompanied by a family member or friend.

Compared to other young mothers in the sample, the 10 mothers who were not accompanied by a family member or friend were significantly more likely to have had depressive symptoms during pregnancy, histories of rejection during childhood by caregivers, conflictual relationships with male partners, and relationships with men engaging in criminal behavior. The mothers without support described feeling frightened and helpless during labor. Notably, infants of the 10 unsupported mothers also were at exceptional risk during the first months of life. One infant died at home from unexplained causes; another infant was removed from the home by child protective services.

Discussion In our study, the overwhelming majority of young African-American mothers received support from family and/or friends during labor and delivery. However, the very small number of women who are unsupported during this time should be viewed as a group at very high risk for emotional and parenting problems. Hospital policies should be adjusted to provide support services during labor, perhaps in the form of doulas, to women who come by themselves to deliver. Moreover, women who come to deliver by themselves should be targeted for intensive social work intervention, including follow-up in the months following the birth.