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DOI: 10.56732/pensarenf.v27i1.277
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How to cite this article: Sousa IT, Bértolo MH. The role of grandparents in the transition to parenting: a
scoping review. Pensar Enf [Internet]. 2023 Nov; 27(1):131-139. Available from:
The role of grandparents in the transition to
parenting: a scoping review
The transition to parenthood involves a set of intra and interpersonal changes, which affect
not only the woman and her partner, but also the entire family system. Grandparents are
highlighted as prominent figures in the contemporary family, constituting the main source
of support for the family in this process. Therefore, it is extremely important to understand
how grandparents can influence or not the transition to positive parenting, acting as
facilitating agents or as hinderances in this process.
To map the available scientific evidence regarding the role of grandparents in the transition
to parenthood of their children, encompassing the period of pregnancy, childbirth and the
postpartum period up to 3 years.
This scoping review was developed according to the methodology of the Joanna Briggs
Institute (JBI), 2020, with research carried out in April and May 2022 and updated in July
2023. Qualitative, quantitative or mixed studies were included, as well as review articles,
published in English and produced between 2015 and 2023.
This scoping review includes articles that address the role of grandparents in the context
of the transition to parenting of their children, including the time of pregnancy, childbirth
and the postpartum period up to 3 years.
11 articles that met the inclusion criteria were included. Four categories emerged:
grandparents as a source of support; grandparents and their influence on family nutrition
and exclusive breastfeeding; the ambivalence of feelings and the role of health
Grandparents can stand out as prominent elements of the family during the transition to
parenting of their children, developing instrumental, emotional, informational and financial
support roles; may influence exclusive breastfeeding and family nutrition. When concepts
and beliefs about fundamental aspects relating to children differ, ambivalent feelings can
arise and that lead to intergenerational conflicts. There is a gap in health care regarding the
inclusion of meaningful people in the care of the couple and the child, in this case the
Grandparents; Role; Parenthood Transition; Pregnancy; Childbirth; Post-Partum
Inês Sousa
Maria Helena Bértolo
Master's student in Maternal and Obstetric Health
Nursing. Nursing School of Lisbon (ESEL), Lisbon,
Master. Nursing Research, Innovation and
Development Centre of Lisbon (CIDNUR), Lisbon;
Nursing School of Lisbon (ESEL), Maternal Health
Department, Lisbon, Portugal.
Corresponding author:
Inês Sousa
E-mail: isousa@campus.esel.pt
Received: 20.04.2023
Accepted: 11.09.2023
132 | Sousa, I.
Review Article
Parenting can be understood as one of the most demanding
and challenging aspects of a person's life. Becoming a
mother and father is an important milestone and can
simultaneously be a period of great joy, but also a stressful
life event.
Thus, parenting can be understood as a set of
emotional bonds, knowledge, attitudes, and behaviors of
mothers and fathers, which is influenced by several factors,
such as previous experiences (from their own childhood),
personal and sociocultural circumstances, expectations and
It is also influenced by the sense of personal
competence, marital relationship or the relationship
established with the other parent, the support network
(namely the family), available social services, as well as other
situations of inequality or vulnerability.
The concept of
parenting therefore refers to the set of activities and
attitudes and the way of interacting in relationships with
According to Meleis
, the transition to parenthood is a
multidimensional concept that presupposes changes in
roles, definitions and redefinitions of the self and the very
transition, which is considered a passage or movement
from one state, condition or place to another.
The transition to parenthood is a complex process of
various physiological, psycho-emotional, social, and
cultural changes and adjustments. It is a demanding
process, characterized by constant learning, skill and
relationship development, and deep identity
Parental experience depends on parenting
strategies and responses, and these include cognitive
components of learning and decision-making, relational
components such as family support, and operational
components such as task sharing, routine reorganization,
and role reconciliation.
Having support, whether
emotional or physical, can be seen as a crucial aid in this
process, decreasing the perception of stressful events, and
helping parents cope with them more effectively.
Thus, the
nature of the transition to parenthood affects not only the
woman, but her partner, and the entire family system, and
in turn involves a set of intra- and interpersonal changes.
highlights grandparents as prominent figures in
the contemporary family, constituting the main source of
support and support for the family in this process,
promoting emotional, material and financial support.
Parents will be faced with a set of new and unexpected
situations for which experience, or lack thereof, does not
yet provide effective or convincing answers. At this point,
the support provided by grandparents, whether
instrumental or emotional, if provided properly, becomes a
protective factor in the adaptation of parents to the new
task that is required.
To understand these transitions, it is essential to know the
structure and functions of the family support network,
since they vary according to the socio-cultural context, time
and stage of life of the individual and the family as a group.
It is therefore extremely important to understand how
grandparents can influence or not the transition to
parenthood, acting as facilitators or barriers in this process.
Finally, and after consulting the JBI database, it was
confirmed that there is no scoping review on this topic,
which further accentuates its relevance. With that in mind,
the objective of this scoping review is to map the available
scientific evidence on the role of grandparents in the
transition to parenthood of their children, encompassing
the period of pregnancy, childbirth and the postpartum
period up to 3 years.
The research question of this scoping review is: what is the
role of grandparents in the transition to parenthood of their
In order to guide this scoping review, a protocol was
developed, published on the Open Science Framework
(OSF) platform, with the identification
DOI 10.17605/OSF.IO/KJC2Y.
Inclusion Criteria
Population Type: This scoping review will include articles
addressing grandparents who have experienced the
transition to parenthood of their children and other
community members who have witnessed the experience
of grandparents transitioning to parenthood of their
Concept: This scoping review will include articles that
address the role of grandparents who have experienced the
transition to parenthood of their children.
Background: This scoping review will include articles that
address the role of grandparents in the context of the
transition to child parenting, including the timing of
pregnancy, childbirth, and the postpartum period. The
postpartum period was considered up to 3 years after
delivery, since it is intended to cover the physical,
emotional, psychological, social and cultural developments
and adjustments that this transition comprises. This longer
period thus highlights the importance of considering the
transition to parenthood as a continuous, complex and
demanding process, promoting a more comprehensive and
holistic approach.
Types of information sources: This scoping review will
consider all studies of a qualitative, quantitative or mixed
nature, as well as review articles, published in Portuguese,
English or Spanish, that meet the inclusion criteria
described. Regarding the temporal issue, it is decided to
define as inclusion criteria the studies published in the last
8 years (2015 to 2023), with the purpose of gathering the
latest scientific evidence.
Research Strategy
The research strategy of this scoping review aims to identify
articles published in Portuguese, English or Spanish in the
last eight years that portray the role of grandparents in the
transition to parenthood of their children.
According to the strategy defined by JBI
, this was planned
in three distinct stages.
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DOI: 10.56732/pensarenf.v27i1.277
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As a first step, a search was carried out limited to the
CINAHL, MEDLINE databases, through the EBSCOhost
platform, and the Scopus database, to identify articles on
the subject. To this end, the keywords extracted from the
natural terms of the research question were used. Then, an
analysis of the words used in the titles and abstracts and the
identification of the indexed terms corresponding to each
database was carried out.
In this sense, a table was prepared referring to the
keywords, natural terms and respective indexed terms
(table 1), in order to organize the first stage.
Table 1 Systematization of the inclusion criteria, natural terms and respective terms indexed in the CINAHL, MEDLINE
and Scopus databases
Natural terms
CINAHL indexed terms
Indexed terms
Scopus terms
Parenthood transition
Parenting transition
Postnatal period
Parenthood transition
Parenting transition
In a second stage, a search was performed using all the
natural and indexed terms identified in table 1, in the
databases separately.
In the CINAHL database, a search of the natural terms as
well as the respective indexed terms was done, later
crossing with the Boolean operator OR. After aggregation
between the natural terms and the respective indexed
terms, a new search was carried out associating the results
obtained previously, with the Boolean operator AND. This
process is depicted in Appendix I and with the search
((grandparents OR (MM “Grandparents”) OR
“grandparents”)) AND ((role OR (MM “role+) OR
“role”)) AND ((parenthood transition OR parenting
transition OR “transition to parenthood” OR “parenting
transition”) OR (childbirth OR (MM “childbirth+”) OR
“childbirth”) OR (pregnancy OR (MM “Pregnancy+”) OR
“pregnancy”) OR (postpartum OR (MM “Postnatal
Period+”) OR “postpartum”)).
The same steps were followed in the MEDLINE database,
with the respective terms identified in Table 1. This process
is presented in Appendix II.
Regarding the Scopus database, only the natural terms were
searched, since this database does not present indexed
terms, crossing the terms childbirth, pregnancy and post-partum,
with the Boolean operator OR, as well as with the terms
parenthood transition and parenting transition and the remaining
terms with the Boolean operator AND. This process is
depicted in Appendix III.
Finally, in the third stage of the research strategy, an
analysis of the bibliographic references of the selected
articles was carried out, looking for more evidence,
especially primary evidence.
This survey was conducted between April and May 2022
and updated in July 2023, extending its time limit to 2023.
Study Selection
The articles found were analyzed by two independent
reviewers, taking into account the relevance of the title and
the abstract. Duplicates and those that did not meet the
previously defined inclusion criteria were removed.
Subsequently, the selected articles were fully analyzed
through full-text reading, meeting all the inclusion criteria,
and none were excluded. This step was also carried out by
two independent reviewers, and the disagreements between
them were resolved through discussion.
An article was integrated by analyzing the bibliographic
references of the previously selected articles.
Data extraction
A data extraction tool was built by an independent reviewer
as per JBI
indications. This tool was tested in order to
ensure its clarity and accuracy of the extracted data. The
data of the selected articles were extracted using this tool.
Thus, the extracted data detail with clarity and specificity,
aspects about the phenomenon of interest, population,
objectives, study method and significant results for the
research question.
Data presentation
The data extracted from the selected articles are presented
in narrative form, as well as in a table (Appendix IV), which
organizes the studies according to the title, authors, year of
publication, country of origin, language, type of study,
objectives, sample and results relevant to the research
134 | Sousa, I.
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question. The discussion of results is elaborated in narrative
Search Results
The search in the three databases identified 63 articles. After
the duplicates were removed, 57 articles remained for
analysis of titles and abstracts according to the defined
inclusion criteria. At this stage, 47 articles were excluded
because they did not meet one or more inclusion criteria,
leaving 10 articles for full-text analysis. All 10 articles were
analyzed and none were excluded. The bibliographic
references of the 10 selected articles were also consulted and
another full-text article was integrated, in a total of 11
articles included in this scoping review. This process is
schematized in the Prisma diagram to which figure 1 refers.
Figure 1- PRISMA diagram: research results and selection of studies to be included in the scoping review. Adapted JBI.
Characteristics of sources of evidence
The articles selected in this scoping review were published
between 2015 and 2023, and 72% (n=8) were published in
the last six years. They are all articles published in
international journals, such as the Journal of Family Issues
(n=1), Nursing Inquiry (n=1), Global Public Health (n=1),
Maternal & Child Nutrition (n=1), International Journal of
Childbirth Education (n=1), Midwifery (n=2),
Breastfeeding Review (n=1), BMC Pregnancy and
Scopus: 7
Items removed before selection:
Duplicates (n=6)
Articles analyzed by title
Articles excluded by titles
Articles analyzed by abstracts
Articles excluded by abstracts
Full-text articles analyzed for eligibility
Articles excluded in full-text
Articles included in the scoping review
Articles identified by bibliographic references
Articles identified in the databases
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Childbirth (n=1), Human Nature (n=2). All articles are
written in English. Two articles are from China, another
two from the United States of America (USA), followed by
Austria, Ghana, Colombia, New Zealand, Australia, France
and Namibia, with one article each. Four literature reviews
and seven primary studies with a qualitative or mixed
approach were then included.
The population of articles is diverse, including couples who
have been parents, grandparents, health professionals, as
well as community leaders.
Seven studies used in-depth semi-structured interviews as a
methodology and most studies aim to evaluate and explore
the experiences of parents and grandparents in the
transition to parenthood.
Review Results
In order to organize the results that emerged from the
research, we grouped them into four categories:
grandparents as a source of support; grandparents and the
influence on family nutrition and exclusive breastfeeding;
the ambivalence of feelings; and the role of health
Grandparents as a source of support
Many grandparents play a vital role in the lives of pregnant
women or women/mothers and their grandchildren and
represent a source of support, whether instrumental,
emotional, informative or financial.
distance, culture, maternal and paternal relationship with
parents and in-laws, as well as the age of grandparents can
change the role that grandparents play and subsequently
change the influence they have on the parenting of
children. The interconnected nature of the different
generations can affect parenting styles, baby safety, as well
as parenting role performance.
Grandmothers were identified as the main support of
pregnant women, providing them with information,
guidance and emotional support.
Grandmothers are the
ones who have the role of preserving cultural traditions
related to this period, they are repositories of knowledge
about local medicine and decision-makers in health-seeking
behaviors, that is, they decide where childbirth takes place
and the need to resort to health services.
In a study
conducted in an African country, Namibia,
three domains
were identified in which grandmothers contribute, namely:
a) learning to be mothers, through representations of care
and examples, as well as information; b) support in
breastfeeding; and c) health and well-being in the postnatal
period. It is concluded that the informational, emotional
and instrumental support provided to mothers and their
newborns during the perinatal period can help establish the
mother-child bond, promote maternal energy balance and
improve the nutritional outcomes of babies.
The instrumental and emotional support provided by
grandparents, although dependent on the type of
relationship between parents and children, when not
intrusive, is a protective factor for the development of
maternal mental health problems in the first postpartum
Beneficial effects for the child are also reported, as
mothers without mental health problems are more
emotionally available and actively respond to the child's
Another article
also mentions that the role of
grandparents is as a support network, taking care of both
mother and baby, preparing meals, and doing other
household chores. The role of grandparents also involves
the intergenerational transmission of roles, in which
mothers learn either by observation, advice or imitation of
Grandparents and the influence on family nutrition
and exclusive breastfeeding
The culture of breastfeeding in a family plays a significant
role in supporting new mothers to breastfeed exclusively
and the practice of exclusive breastfeeding for six months
is not limited to the intentions or actions of the mother-
child dyad; it is a relational behavior influenced not only by
family networks around the mother, but also by cultural,
historical and social contexts.
Grandmothers have the ability to influence exclusive
breastfeeding. A grandmother's positive opinion about
breastfeeding has the potential to influence a mother up to
12% to initiate breastfeeding.
On the other hand, it can
also have a negative influence, having the ability to decrease
the likelihood of breastfeeding up to 70%.
Wagner et al,
suggest that mothers who were breastfed as infants were
more likely to initiate and continue breastfeeding than non-
breastfed mothers. The mother's mother and the mother's
previous breastfeeding experience have a strong influence
on breastfeeding practices.
Concha and Jovchelocitch,
suggest that grandmothers
play a central role in the nutrition of many families during
the prepartum, postpartum, breastfeeding or
complementary feeding periods, namely in the preparation
of meals.
The ambivalence of feelings
Ambivalent feelings arise when the involvement of
grandparents in one or more domains, whether affective,
cognitive or behavioral, does not correspond to the wishes
and expectations of parents.
This ambivalence also exists
when there are divergent views of parents and grandparents
in relation to concepts and convictions about pregnancy,
education, childcare, nutrition, or other fundamental
aspects in raising children. In the same study, these
ambivalent feelings also occurred when grandparents
questioned the roles and attitudes of parents and there were
critical judgments of grandparents about their parenting
abilities. Another aspect related to ambivalent feelings in
the involvement of grandparents is at the behavioral level,
when the grandparents do not respect the limits imposed
by the parents and, at the affective level, when it involves
disappointment with emotional aspects of the
136 | Sousa, I.
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relationships, namely feelings of competition between
parents and grandparents.
A study conducted in China
identifies that grandparents
are expected to support parents during the transition to
parenthood, even without parents asking for it. The study
mentions that, regarding postpartum and newborn care,
parents identify a significant gap between their beliefs and
those of their grandparents, noting that the approaches of
the older generation are outdated and unscientific. On the
other hand, the older generation believes they have the
experience of having children and the wisdom already
passed on for years. This discord creates family strife. The
study also identifies that parents appreciate the support
received by grandparents, for allowing time off from the
demands of care; however, they criticize them for
potentially causing harm to the baby, for their traditional
approaches. The same study also argues that clear and
direct communication leads to a better family relationship
and mutual understanding, rather than criticism. On the
other hand, there were conflicts whenever family members
expressed ineffective or non-existent communication and
insisted on doing it their way, which led to precarious family
relationships. If family members did not speak up and hide
their conflicts or communicate in a vague way, they were
more likely to trigger feelings of anger and silent aggression.
Families with well-established boundaries tend to have
more harmony in this transition period.
Most of the
interviewed grandparents recognized their role and
boundaries and refrained from expressing their views on
parental decisions. In some families there was competition
among their members for control and, when this
competition was strong, conflicts arose. This study
refers to generational limits, that is, the expectations of
perceived limits and rules of interaction of all family
members, involving the regulation of the behavior of
parents and grandparents. Clear boundaries require
grandparents to respect parental authority and avoid
offering too much advice regarding their parenting
decisions. Unwanted advice from grandparents is the most
ineffective form of communication and can be perceived as
a critique of parental care, affecting trust in one's own
parental skills.
Thus, the involvement of grandparents in
the parental role can threaten the autonomy of parents and
may not be well received by them.
The role of healthcare professionals
Parents and grandparents attribute a relevant role to health
professionals as mediators of family conflicts.
The former
claim that the latter are in a better position to mediate
family conflicts related to the clarification of roles, division
of tasks, communication and establishment of limits in the
puerperium and in the care of the newborn. The need for
knowledge and development of parental skills, the need for
information and education in the postpartum period and
psychological support for mothers are also identified.
There is a potential gap between health education
campaigns that target mothers as autonomous decision-
makers and the reality of a more collectivist community
structure in which mothers rarely make these decisions
without the support of other community members.
argues that it is important for health professionals
preparing for childbirth and promoting adaptation to
parenting to recognize the role of grandparents and work
to assess their knowledge of current care practices and child
safety, including their role in caring for the baby. A
thorough evaluation will allow health professionals to
provide appropriate educational and support interventions
and resources for both parents and grandparents. The birth
of a new baby is not only an isolated experience for the
future mother, but also a transition for the grandparents.
In this sense, the provision of support by health
professionals can improve self-efficacy, as well as the
growth of grandparents as individuals. As educators, they
should be mindful of what this transition can mean and
help families embrace the interconnectedness that the birth
of this new baby brings to all
In the last eight years, 11 articles were found that identify
the various roles of grandparents in the transition to
parenthood of their children, thus providing an answer to
the research question initially formulated. This scoping
review therefore allows us to understand that grandparents
can play a vital role in the lives of children and their
grandchildren and represent a source of support, whether
instrumental, emotional, informative or financial,
providing information and guidance.
This informational,
emotional and instrumental support during the perinatal
period can help establish the parent-child bond, promote
maternal energy balance, improve child's nutritional
and improve maternal mental health.
It is also identified the influence that grandmothers
represent in the nutrition of the whole family in the
perinatal period, namely in the preparation of meals,
well as their influence on exclusive breastfeeding. We know
that breast milk is the best food for the baby until food
introduction and that it is exclusively recommended until 6
months of age;
however, several factors contribute to
influence its practice. Thus, the practice of exclusive
breastfeeding during the first 6 months of the baby's life is
a relational behavior influenced by the mother's intentions,
family networks and cultural, historical and social
There is scientific evidence that corroborates
the ability of grandmothers to influence exclusive
Although there are differences in the
type of breastfeeding outcome and how the influence of
grandmothers was measured, the overall effect on
breastfeeding was positive when the attitudes or
experiences of older female generations in relation to
breastfeeding were favorable. A grandmother's positive
opinion of breastfeeding had the potential to influence a
mother up to 12% to initiate breastfeeding. On the other
hand, a negative opinion has the ability to reduce the
probability of breastfeeding up to 70%.
In this sense, it is
pertinent to allow and encourage the presence and
participation of grandmothers in the health care provided
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DOI: 10.56732/pensarenf.v27i1.277
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to pregnant women and parents, if desired, especially in the
perinatal period.
The ambivalence of parents' feelings towards their
grandparents was another aspect highlighted in this scoping
review. If, on the one hand, parents appreciate and
recognize the importance of grandparents' support in the
transition to parenthood, on the other hand, when there are
divergent views regarding concepts and convictions related
to children, through questioning parental attitudes and
roles and through critical judgment about their abilities,
there is an ambivalence of feelings, which can lead to
intergenerational conflicts.
Clear and direct
communication leads to a better family relationship and
mutual understanding, to the detriment of criticism.
the other hand, the most ineffective form of
communication translates into the unwanted advice of
grandparents, which can be perceived as a criticism of
parental care, affecting confidence in their own parental
In this sense, health professionals can assume a role
as mediators of conflicts, through the clarification of points
of view, based on the latest scientific evidence. According
to a qualitative exploratory study,
all participants
expressed the wish that health professionals could help
them, believing that they are in a better position to mediate
family conflicts.
Several articles also mention a gap in health care regarding
the inclusion of significant people in the care of women,
namely grandparents, who represent a crucial source of
support in the transition to parenthood.
It is important
that health professionals, namely those who prepare for
childbirth and who promote adaptation to parenthood,
recognize the role of grandparents, making a complete
assessment, which will allow them to provide appropriate
care for both parents and grandparents, adopting a more
inclusive approach.
The various articles analyzed identified many roles that
grandparents can have in the transition to parenthood of
their children in the most different places in the world,
meeting the objective of this scoping review, as well as
answering the research question formulated. In addition to
identifying the roles of grandparents in the transition to
parenthood of their children, we also identified the possible
feelings and conflicts that may arise between them and their
children in this period, suggesting that it is through clear
and assertive communication that they can be resolved. It
also identified gaps in relation to health care and the
integration of grandparents into it, suggesting that health
professionals include grandparents in their approach to
As nurses are one of the main providers of health care to
women and couples in the transition to parenthood, it is
important to incorporate the results of this scoping review,
in order to envisage a continuous improvement in the care
provided by them, in different contexts. Thus, the nurse
should involve significant people in the care process, also
integrating them as care clients and establishing
partnerships with them.
By understanding the different roles that grandparents can
play in the transition to parenthood, we will better
understand the importance of integrating them into the
health care of women/couples and children in this process.
However, this aspect implies an individual and personalized
evaluation, as each person is unique. We live in an
increasingly multicultural society with specific health care
needs. We emphasize as a strong point of this scoping
review, the multiculturalism of the various studies included,
allowing to broaden the vision of care and alerting to the
different perspectives and specificities of each individual as
a social, cultural and spiritual being. On the other hand, we
emphasize as limitations this same multiculturality of the
studies, which does not allow a generalization of the results;
as well as most of the selected studies focus only on
women/pregnant women and grandmothers in the
transition to parenthood. Although a vital role is
increasingly being attributed also to male figures in relation
to parenting, still today, in many cultures this is experienced
especially by the female gender. It is therefore important to
consider that sometimes couples may prefer to include
fathers, namely mothers, in their health process during the
transition to parenthood.
More research on this topic is considered necessary,
particularly in Portugal, in order to raise awareness among
health professionals, namely nurses, about the importance
of family integration in health care. Thus, future primary
studies are suggested in order to discover the Portuguese
reality of the role of grandparents in contemporary society.
Authors’ contributions
IS: Conception and design of the study; Collection of data;
Analysis and interpretation of data and Writing of the
HB: Data collection; Data analysis and interpretation;
Critical revision of the manuscript.
Conflicts of interest and Funding
No conflicts of interest were declared by the authors.
Sources of support / Financing
The study was not funded.
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