Delivery Mode, Maternal Characteristics, and Developmental Trajectories of Toddlers’ Emotional and Behavioral Problems

  • Jurgita Smilte JasiulioneEmail author
  • Roma Jusiene
Original Paper



Little empirical research examines relationships among delivery mode, other childbirth-related factors, maternal characteristics, and child psychosocial development.


The aim of this study is to explore the developmental trajectories of toddlers’ emotional and behavioral problems and the predictive role of psycho-social, childbirth, and maternal characteristics.


Participants were 258 mothers and their children who took part in a longitudinal study from birth till the age of 30 months. Self-report instruments were used for the assessment of mothers’ infant rearing attitudes, the quality of relationship with the partner, maternal emotional distress, and maternal self-efficacy. The Child Behavior Checklist (1½–5) was used for the assessment of children’s behavioral and emotional problems.


Latent class analysis for emotional and behavioral problems ended in 3-class solutions. In regard to emotional problems, 83% of children were classified as having a stable low, 11% an increasing, and 6% a decreasing level of emotional problems. In regard to behavioral problems, 86% of children showed a stable low, 5% an increasing, and 9% a stable high level of behavioral problems. Children’s gender in combination with maternal education and maternal infant rearing attitudes predict children’s membership in the increasing and decreasing emotional problem classes. Children’s gender and maternal age in combination with emergency caesarean section, the quality of the relationship with the partner, and maternal self-efficacy explain children’s membership in the classes of high and increasing behavioral problems.


A combination of such factors as emergency caesarean section, child’s gender, maternal age and level of education, maternal infant rearing attitudes, maternal self-efficacy, and inter-parental relationships predict developmental trajectories of emotional and behavioral problems in toddlers.


Emotional and behavioral problems Developmental trajectories Delivery mode Emergency caesarean section Maternal self-efficacy Infant rearing attitudes 



This research is a part of the prospective birth-cohort study initiated in 2009. We thank a whole group of scientists from Vilnius University and Lithuanian university of Health sciences who has worked on this study, as well as the mothers who participated in it.


This research is part of the project funded by the following Grants: T-09157/2009 from the Lithuanian State Science and Studies Foundation, MIP-147/2010 from the Research Council of Lithuania, and MIP-014/2012 from the Research Council of Lithuania.

Compliance with Ethical Standards

Conflict of interest

Jurgita Smilte Jasiulione declares that she has no conflict of interest. Roma Jusiene has received research Grants from Lithuanian State Science and Studies Foundation and the Research Council of Lithuania; however the funders have not intervened and/or influenced the research and the content of the manuscript.

Ethical Standards

All procedures performed were in accordance with the ethical standards of the national research committee and with 1964 Helsinki declaration and its later amendments. The study was approved by Regional Biomedical Research Ethics Committee (No. P1‐143/2007).

Informed Consent

It was obtained from all participating mothers.


  1. Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms & profiles. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  2. Al Khalaf, S., O’Neill, S., O’Keeffe, L., Henriksen, T., Kenny, L., Cryan, J., et al. (2015). The impact of obstetric mode of delivery on childhood behavior. Social Psychiatry and Psychiatric Epidemiology, 50(10), 1557–1567. Scholar
  3. Almqvist, C., Cnattingius, S., Lichtenstein, P., & Lundholm, C. (2012). The impact of birth mode of delivery on childhood asthma and allergic diseases: A sibling study. Clinical and Experimental Allergy, 42(9), 1369–1376. Scholar
  4. Andersen, L. B., Melvaer, L. B., Videbech, P., Lamont, R. F., & Joergensen, J. S. (2012). Risk factors for developing post-traumatic stress disorder following childbirth: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 91, 1261–1272. Scholar
  5. Arsenault, L., Tremblay, R. E., Boulerice, B., & Saucier, J. F. (2002). Obstetrical complications and violent delinquency: Testing two developmental pathways. Child Development, 73, 496–508. Scholar
  6. Beck, J., & Shaw, D. (2005). The influence of perinatal complications and environmental adversity on boys’ antisocial behavior. Journal of Child Psychology and Psychiatry, 46, 35–46. Scholar
  7. Britto, P. R., Lye, S. J., Proulx, K., Yousafzai, A. K., Matthews, S. G., Vaivada, T., et al. (2016). Nurturing care: Promoting early childhood development. Lancet, 389(10064), 91–102. Scholar
  8. Cassiano, R. G., Gaspardo, C. M., & Linhares, M. B. (2016). Prematurity, neonatal health status, and later child behavioral/emotional problems: A systematic review. Infant Mental Health Journal, 37(3), 274–288. Scholar
  9. Caughy, M. O., Peredo, T. N., Owen, M. T., & Mills, B. (2016). Gender differences in the relation between mothering behaviors and child behavior problems among Hispanic preschoolers. Developmental Psychology, 52(4), 592–598. Scholar
  10. Chien, L. N., Lin, H. C., Shao, Y. H., Chiou, S. T., & Chiou, H. Y. (2015). Risk of autism associated with general anesthesia during caesarean delivery: A population-based birth-cohort analysis. Journal of Autism and Developmental Disorders, 45(4), 932–942. Scholar
  11. Cho, C. E., & Norman, M. (2013). Caesarean section and development of the immune system in the offspring. American Journal of Obstetric and Gynecology, 208, 249–254. Scholar
  12. Coleman, P. K., & Karraker, K. H. (2000). Parenting self-efficacy among mothers of school-age children: Conceptualization, measurement, and correlates. Family Relations, 49, 13–24. Scholar
  13. Coleman, P. K., & Karraker, K. H. (2003). Maternal self-efficacy beliefs, competence in parenting, and toddlers’ behavior and developmental status. Infant Mental Health Journal, 24(2), 126–148. Scholar
  14. Fuchs, S., Klein, A. M., Otto, Y., & von Klitzing, K. (2013). Prevalence of emotional and behavioral symptoms and their impact on daily life activities in a community sample of 3 to 5-year-old children. Child Psychiatry and Human Development, 44, 493–503. Scholar
  15. Giallo, R., Cooklin, A., Wade, C., D’Esposito, F., & Nicholson, J. M. (2013). Maternal postnatal mental health and later emotional–behavioral development of children: The mediating role of parenting behavior. Child: Care, Health and Development, 40(3), 327–336. Scholar
  16. Goisis, A. (2015). How are children of older mothers doing? Evidence from the United Kingdom. Biodemography and Social Biology, 61, 231–251. Scholar
  17. Grych, J. H., Fincham, F. D., Jouriles, E. N., & McDonald, R. (2000). Interparental conflict and child adjustment: Testing the mediational role of appraisals in the cognitive-contextual frame-work. Child Development, 71, 1648–1661. Scholar
  18. Gutierrez-Galve, L., Stein, A., Heron, A., & Ramchandan, P. (2015). Paternal depression in the postnatal period and child development: Mediators and moderators. Pediatrics, 135(2), e339–e347. Scholar
  19. Hobbs, A. J., Mannion, C. A., McDonald, S. W., Brockway, M., & Tough, S. C. (2016). The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth, 16, 90. Scholar
  20. Jordan, S., Emery, S., Bradshaw, C., Watkins, A., & Friswell, W. (2005). The impact of intrapartum analgesia on infant feeding. BJOG: An International Journal of Obstetrics & Gynaecology, 12, 927–934. Scholar
  21. Jung, T., & Wickrama, K. A. S. (2008). An introduction to latent class growth analysis and growth mixture modeling. Social and Personality Psychology Compass, 2, 302–317. Scholar
  22. Jusienė, R., & Raižienė, S. (2006). Ikimokyklinio amžiaus vaikų elgesio bei emocinių sunkumų įvertinimas: motinų, tėčių ir auklėtojų vertinimų lyginamoji analizė. Psichologija, 33, 47–63.Google Scholar
  23. Jusienė, R., & Žalienė, J. (2012). Nėštumo ir gimdymo komplikacijų bei psichosocialinių veiksnių įtaka pogimdyminei depresijai. Lietuvos akušerija ir ginekologija, 15(1), 23–33.Google Scholar
  24. Kelmanson, I. A. (2013). Emotional and behavioral features of preschool children born by caesarean deliveries at maternal request. European Journal of Developmental Psychology, 10(6), 676–690. Scholar
  25. Kingston, D., & Tough, S. (2014). Prenatal and postnatal maternal mental health and school-age child development: A systematic review. Maternal and Child Health Journal, 18(7), 1728–1741. Scholar
  26. Leerkes, E. M., Blankson, N. A., & O’Brien, M. (2009). Differential effects of maternal sensitivity to infant distress and nondistress on social-emotional functioning. Child Development, 80(3), 762–775. Scholar
  27. Leis, J. A., Heron, J., Stuart, E. A., & Mendelson, T. (2014). Associations between maternal mental health and child emotional and behavioral problems: Does prenatal mental health matter? Journal of Abnormal Child Psychology, 42, 161–171. Scholar
  28. Liang, W., & Chikritzhs, T. (2012). Obstetric conditions and risk of first ever mental health contact during infancy, childhood and adolescence. Midwifery, 28, 439–444. Scholar
  29. Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. Scholar
  30. Magnus, M. C., Haberg, S. E., Stigum, H., Nafstad, P., London, S. J., Vangen, S., et al. (2011). Delivery by caesarean section and early childhood respiratory symptoms and disorders. American Journal of Epidemiology, 174(11), 1275–1285. Scholar
  31. Martelius, L., Janér, C., Süvari, L., Helve, O., Lauerma, K., Pitkänen, O., et al. (2013). Delayed lung liquid absorption after caesarean section at term. Neonatology, 104, 133–136. Scholar
  32. Metsälä, J., Kilkkinen, A., Kaila, M., Tapanainen, H., Klaukka, T., Gissler, M., et al. (2008). Perinatal factors and the risk of asthma in childhood: A population-based register study in Finland. American Journal of Epidemiology, 168, 170–178. Scholar
  33. Muthén, B. O., & Muthén, L. K. (2000). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24, 1–10.CrossRefGoogle Scholar
  34. Muthén, L. K., & Muthén, B. O. (2006). Mplus users guide. Los Angeles, CA: Muthén and Muthén.Google Scholar
  35. Mylonas, I., & Friese, K. (2015). Indications for and risks of elective caesarean section. Deutsches Arzteblatt International, 112(29–30), 489–495. Scholar
  36. Myrskylä, M., Barclay, K., & Goisis, A. (2017). Advantages of later motherhood. Gynakologe, 50(10), 767–772. Scholar
  37. Rijlaarsdam, J., Stevens, G. W. J. M., van der Ende, J., Hofman, A., Jaddoe, V. W. V., Mackenbach, J. P., et al. (2013). Economic disadvantage and young children’s emotional and behavioral problems: Mechanisms of risk. Journal of Abnormal Child Psychology, 41, 125–137. Scholar
  38. Ross, L. E., & McLean, L. (2006). Anxiety disorders during pregnancy and the postpartum period: A systematic review. The Journal of clinical psychiatry, 67, 1285–1298.CrossRefGoogle Scholar
  39. Schmidt, L., Sobotka, T., Bentzen, J. G., & Andersen, N. A. (2012). Demographic and medical consequences of the postponement of parenthood. Human Reproduction Update, 18(1), 29–43. Scholar
  40. Sirvinskiene, G., Zemaitiene, N., Jusiene, R., & Markuniene, E. (2016). Predictors of emotional and behavioral problems in 1-year-old children: A longitudinal perspective. Infant Mental Health Journal, 37, 401–410. Scholar
  41. Sirvinskiene, G., Zemaitiene, N., Zaborskis, A., Markuniene, E., & Jusiene, R. (2012). Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment. BMC Pediatrics, 12, 44. Scholar
  42. Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., et al. (2014). Effects of perinatal mental disorders on the fetus and child. Lancet, 384, 1800–1819. Scholar
  43. Tearne, J. E., Robinson, M., Jakoby, P., Li, J., Newham, J., & McLean, N. (2015). Does late childbearing increase the risk for behavioral problems in children? A longitudinal cohort study. Paediatric and Perinatal Epidemiology, 29, 41–49. Scholar
  44. Van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Juffer, F. (1999). The parental efficacy questionnaire. Leiden University, Center for Child and Family Studies (Unpublished Manuscript).Google Scholar
  45. Weaver, C. M., Shaw, D. S., Dishion, T. J., & Wilson, M. N. (2008). Parenting self-efficacy and problem behavior in children at high risk for early conduct problems: The mediating role of maternal depression. Infant Behavior and Development, 31(4), 594–605. Scholar
  46. WHO. (2013). Comprehensive mental health action plan 2013–2020. Retrieved January 8, 2019 from
  47. Xu, H., Ding, Y., Xin, X., & Zhang, D. (2017). Caesarean section and risk of postpartum depression: A meta-analysis. Journal of Psychosomatic Research, 97, 118–126. Scholar
  48. Zeifman, D. B. (2003). Predicting adult responses to infant distress. Infant Mental Health Journal, 24, 597–612. Scholar
  49. Zemp, M., Milek, A., Davies, P. T., & Bodenmann, G. (2016). Improved child problem behavior enhances the parents’ relationship quality: A randomized trial. Journal of Family Psychology, 30(8), 896–906. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Psychology, Faculty of PhilosophyVilnius UniversityVilniusLithuania

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